Case Pres - Pedia Final

8/11/2019 Case Pres - Pedia Final

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OnOnBLOODBLOOD DyscrasiaDyscrasia

Submitted to:Submitted to:Ms. Dawn Janice A. Tiempo, N, BsnMs. Dawn Janice A. Tiempo, N, Bsn

Submitted by:Submitted b y:!r ist ine Mar ie ". Bu#uiran!rist ine Marie ". Bu#uiran$%an Jason M. DeLos Santos$%an Jason M. DeLos Santos

Submitted on:Submitted on:Marc& ', ())*Marc& ', ())*

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ApplicationletterCol lege o f Nurs ingS i l l iman Univers i ty

Dumaguete C i tyNegros Or ienta l

Mar c h 5 , 2 0 0

Ms! Da"n #anice A ! $ iempo, %N, &SNCl in ica l 'ns t ruc torCo l lege o f Nurs ingS i l l iman Univers i ty

Dear Ma(am)

*oo+ Day -e, . r i s t i ne Mar i e * ! &u/ u i r an an+ ' van # as on M ! De os Sant os , l eve l ' ' ' s t u+ ent s o f

SUC N ar e hop ing fo r your ap p r oval fo r a c as e s t u+ y a1 out our c l i ent , # ohn C ar l o Mah inayAus t ino " ho i s 2 + ays o l+ , a r es i+ ent o f &ar ang ay .a luy 3ahan &a i s , N eg r os O r i ent a l " hohas a+mit te+ at NO4 las t 6e1ruary 2 , 200 an+ "as + iagnose+ "i th & loo+ Dyscras ia !

-e " ou l+ l i 7 e t o t a7 e t h i s op p or t un i t y t o p r es ent t h i s c as e 1 ec aus e " e 1 e l i eve t hats har ing our e8 p er i enc es t o our c l as s m at es an+ a l s o t o o t her s " ho " ant t o 7 no" an+ l ea r na1 out t h i s c as e ! $ h i s a i+ s us i n our l ea r n ing an+ fu r t her enhanc es no t on l y our 7 no" le+ gean+ s7 i l l s 1ut at t i tu+e as "el l !

$han7 you for your 7 in+ cons i+erat ion!

%espect fu l ly yours ,

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.r i st i ne Mar i e * ! &u/ui ran 'van #ason M! De os Santos

Tabeo-ontents o % e r p a g e +Le t t e r (Ta b e o - c o n t e n t s /0 i s i on 1 m i s s i on o - S i im a n 2 n i% e r s i t y 3O b 4e c t i % e s o - t & e a s e 5re s e n t a t i on 6 7'$n t ro d u c t i on 8D e m o g r a p & i c D a ta * 79" e n og r a m + )5& y s i c a a s se s s m e n t + + 7 + 9" r owt & an d d e %e op me n t ( ) 7( (O % e r % i e w o - me d i c a d i a g n os i s ( / 7 ( 3A n a t om y an d p & y s i o o g y ( 6 7/ 6

5a t & o p y & s io o g y / ' 7/ 8M e d i c a t i o n s / * 7/ 9u n c t i o n a & e a t & p a t t e rn 3 ) 73 'N u r s i n g a re p a n 3 8 76 )S u m m a r y o - n u r s i n g d i a g n o s i s 6 +S y N T ; < S $ S 6 (Ac = n o w e d g e m e n t 6 /B ib i o g r a p & y 6 3A n n ot a t e d r e ad in g s 6 6 7' )

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CO:*: O6 NU%S'N*Silliman University

Dumaguete City

;'S'ON< M'SS'ON S$A$:M:N$

0$S$ON:

As a eading &ristian institution o- earning in Asia, Siiman 2ni%ersity is committed to tota &uman de%eopment -or societa

and en%ironmenta we7being.

M$SS$ON:

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5ro%ides opportunities -or a members o- t&e academic community to see= t&e trut&, 4ustice, and o%e.

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pro-ound sense o- in%o%ement, and a genuine compassion -or e%ery person.


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4lacement ) NM + ) ( , Le %e $ $ $$ ime a l l o tment ) + & ou r$op i c ) B o o d D y s c r a s i a$opic Descr ipt ion) T & i s + & o u r c a s e p re s e n t a t i o n d e a s w i t & t & e c a re o - p a t i e n t s w i t & b o od

a bn or ma i t i es u nd er 5e di at r i c ?a rd . T &i s s tu dy i nc u de s t &e g ro wt & a ndd e % e o p m en t o - t & e p a t i e nt , a n a t om y a n d p & y s i o og y o - t & e s y s t e m s i n % o % e,p a t & o p & y s i o o g y , t & e p r o @ e o - t & e p a t i e n t , - u n c t i o n a & e a t & p a t t e r n , p & y s i c a a s s e s s m e n t , n u r s i n g c a r e p a n s , a b o r a t o r y a n d d i a g n o s t i c t e s t a n d m e d i c a t i o n s .

Centra l O1 =e c t ives ) A t t & e e n d o - o u r + & o ur c a se p re s en ta t io n , t &e e ar ne r s s &a a c #u ir e= n o w e d g e o n c o n c e p t s r e a t e d t o p a t i e n t s w i t & b o o d d y s c r a s i a , d e % e o p s = i sa n d m a ni - es t d es i ra b e a t ti tu d es i n p ro % id in g c a re t o p a ti e nt s , - a mi y a n ds i g n i @ c a n t o t & e rs .

Spec i> c O1 =ec t ives ) ?e , t & e p r e se n t e r s o - t & i s c ase s t u d y & a%e t & e -o ow in g ob 4e c t i %e s :+ . < > p a in t &e g ro w t& a nd d e% e o p me n t o - t& e c& i d( . D is cu ss t &e a na to my a nd p &y si o og y o - t &e o rg an s i n% o %e d i n c ar in g

p a t i e n t s w i t & b o o d d y s c r a s i a/ . < n& an ce o ur = no w ed ge o n t & e d i e re nt c on ce pt s r e at ed t o t & e c a re o -

p a t i e n t s w i t & b o o d d y s c r a s i a3 . Ac #u ire m ore re ad in gs a nd s ou rc es - or a dd ed i n- orm at io n a nd a s a n

e n & an c e me n t -o r ou r se %e s an d o t & e r s6 . o rm u at e c om p re & e ns i % e nu r s in g c ar e p a n s ba s e d o n t &e i de n t i@ e d n ur s i ng

p r ob e m in r e a t i on t o c & i d an d -ami y' . ri t i ca y a n a y e t &e n ee d - o r t a = in g m e di ca t i on s w i t& r eg ard s t o t &e

c & i d C s c o n d i t i o n8 . M a n i - e s t p o s i t i % e a t t i t u d e s w & e n c a r i n g - o r a c & i d e> p e r i e n c i n g

i n e s s 1 d i s o rd e r s d u r i n g & o s p i t a i a t i on

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A t t & e e n d o - t & e c ase p r e se n t a t i on , ou r - e ow e a r n e r s s& a :+ . D e @ n e t & e i m p o r t a n t t e rm s u s e d i n t & e p r e s e n t a t i on u s i n g t & e i r o w n w o r d s( . o rm u a te n u r si n g d i a g n o si s w i t & t & e g i % e n c u es a n d e % i d e nc e s - o r a c & i d

e >p e r i e n c in g i n e ss 1d i so r d e r s d u r i n g & osp i t a i a t i on/ . $ d e n t i - y a t e rn a t i % e t & e r a p i e s t & a t c a n b e u s e d t o p r o m o t e t & e c o m - o r t o - t & e

c & i d d u r i n g & o s p i t a i a t i o n

3 . 0 er b a i e d u n d e r s t a nd i n g o - t & e p a r e n t s a n d t & e c & i d

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$NTOD2T$ON

T & e 4 o yo u s - e e i n g o - & a % i n g a b a b y i s a n i r re p a ce a b e m o m e n t o - o u r i % e s . T & e t i m e w e @ r s ts e e , - e e a n d c u d d e t & e m m a = e s o u r & e a r t g r o w - o n d e r. S o m e t i m e s , w e a r e t o o o % e r w & e m e d o - i t

t & a t w e t e n d t o - o r g e t o u r b a s i c r e s p o n s i b i i t i e s - o r o u r b a b y. ? e c a n n o t d e n y s o m e - a c t s o - i - e t & a t

t & e r e a r e a o t o - c o n t r i b u t i n g - a c t o r s w & i c & & i n d e r s t o o u r c a r e . D e s p i t e

t & e se t & in g s , w e s t i d o a n y t & i ng t & a t w e c a n, i n o r d e r - o r t & e e n t i re

- a m i y t o m a i n t a i n a n o p t i m u m e % e o - w e n e s s . T & r o u g & i - e C s c & a e n g e s ,

w e i n s t i & o p e a n d c a r e n o m a t t e r w & a t i t t a = e s . A w o n d e r - u s a c r i @ c e i s a n

u n e > p a i n a b e d e e d i n w & i c & i t i s t & e r e a s o n t & a t a c u s t e r o - p e o p e c a n b e

c a e d a - a m i y . 2 n c o n d i t i o n a o % e b i n d s u s t o o n e p a t & a n d e n s u r e s u s o - a

b i s s - u i - e .

$ n o u r r o t a t i o n , w e a r e - a c e d w i t & a c & a e ng e i n w & i c & , w e a r e o u g & t

t o t a = e c a r e o - a p a t i e n t t & a t n e e d s m u c & o - o u r c a r e . A + ( d a y o d b a b y

n a m ed , J o & n a r o M . A g us t i no , w & o i % e s a t ! a o y 7a & an , B a is , N e g ro s

O r i e n t a , a n d & a s b e e n d i a g n o s e d t o & a % e b o o d d y s c r a s i a . ? e w o u d i = e t o

s & a r e o u r e > p e r i e n c e a n d = n o w e d g e r e g a r d i n g B a b y J o & n C s c o n d i t i o n . $ n t & i s c a s e b o o = , w e & o p e

t & a t y o u w i u n d e r s t a n d a n d g a i n = n o w e d g e t o w a r d s t a = i n g c a r e o - a n e w b o r n w i t & b o o d d y s c r a s i a .

? e a r e s o g r a te - u t o b e g i %e n t & e c & a n ce o - s & a r i ng a c o mp e> & e a t & c o n d i ti o n , i n w & i c& w e

e a r n e d a o t - r o m i t a n d & o p e y o u w i e a r n a s o a s m u c & a s w e & a % e p e r c e i % e d i t . To d a y , w e & o p e

t & a t y o u w i - o c u s y o u r a t t e n t i o n t o t & e c a s e p r e s e n t e d a n d o p e n y o u r m i n d s - o r a n o t & e r c & a p t e r o -

8


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e a r n i n g . A m i e s t o n e o - e > p e r t i s e t o a d i a g n o s i s a n d a c o m p a s s i o n a t e & e a r t t o e > t e n d # u a i t y c a r e ,

w & e n e % e r w e r e - a c e d w i t & a s t r e s s - u s i t u a t i o n .

Name) J o & n a r o M a & in a y A g u s t i n o Ag e) + ( d ays o d Civ i l S tatus ) Ne wb or nSe8 ) M a e %el ig ion) a t & o i c Nat ional i ty ) i i p i n oA++ress ) B a r a n g a y ! a u y 7 a & a n , B a i s N e g . O r Case no ! )& i r th +ate) A p r i ( ) , ( ) ) 8 $ ime an+ Date o f A+miss ion) e b r u ar y ( , ( ) ) * + ( :3 ) p mMother ) 0 i c t o r i a A g u s t i n o Occupat ion) ; o u s e w i - e6ather ) an d y A g u s t i n o Occupat ion : a r me rDoctor in charge) D r . A - e c & e

Chief Compla ints : No t e d su d d e n on se t o - p r o -u se b e e d in g i n t & e u mb i i c a c o r d

istory o f 4resent ' l lness )Tw o d a ys p r i o r t o a d m i ss i o n , i t C s m o t & e r n o t e d s u d d e n on se t o - p ro - u s e b e e d in g i n t & e

u mb i i c a c o r d .

*enera l 'mpress ion o f the c l ient ) e c e i% e d i n s u p i n e p o s i t i o n , r e s t e s s a n d p a e w i t & D 6 . / N a 6 ) ) c c r i g & t m e t a c a r p a % e i n

r e g u a t e d + 3 m 1& r.

5ast Medica ;istory:

Client is 12 days old and he belongs to the infancy period. As verbalized by mother, client is in good health in the past days.Client has not hospitalized since home delivery and is not allergic to food, drugs and plants. Client is not also prone to accidentsince family is always at his side and takes good care of him always. Wounds easily heal and does not bleed profusely. Asverbalized by mother, client has not yet immunized since delivery.

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Demographic Data


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+NON i c u m G H ;ar e # u in s i g n G H Mon g o i an S p o t s G H Te an g ie c t a t i c n e % i G I s t o r = b i t e s HB . ; e a d :

on t an e : G H A n t e r i o r G H 5os t e r i o r G H B u g in g -on t an e s b e c au se o - c r y i n g G H Mo d in g G H ou n d G H ap u t su c c e d an e u m G H e p & a & e m a t o m a . < y e s:

o o r : B a c = G H A b se n c e o - t e a r s G H S ymme t r i c a G H o r n e a r e K e > i n r e s p o n s e t o t o u c &

G H 5 u p i a r y r e K e > i n r e s p o n s e t o i g & t G H B i n = r e K e > i n r e s p o n s e t o i g & t o r t o u c & G H u d i m en t a r y @ > a t i o n o n o b 4 e c t s G H A b i i t y t o - o o w t o m i d i n e

G H S u b 4u n c t i on a G S c e r a H & e mor r & ag e s G H < p i c an t & a - o d s G O r i e n t a i n -an t s HD . < a r s : 5 o s i t i o n: G H To p o - p i n n a o n & o r i o n t a i n e w i t & o u t e r c a n t & u s o - e y e G H S &a pe : w e 7 -o rm ed G H S ym me tr ic a G H S t a rt e r e K e > e i ci t ed b y a o u d, s u d de n n o i se G H 5 in na K e> ib e G H ar ti a ge p re se nt

G H $ r r e g u a r s& ap e o r s i e G H S = in t ag s< . N o se :

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G H L o c a t i o n a t m i d i n e G H 5a t e n t G H B r e a t & e s e as i y w i t & mou t & c ose d G H a t t e n e d G H L i t t e n asa b r i d g e G H B r u i se d G H D i s c & ar g e s G sp e c i - y H. M o u t & a n d T & r o a t

G H 0 i g o ro u s g a g r e K e > G H A b s e n t o r m i n i m a s a i % a t i o n G H $ n t ac t , & i g & 7a r c & e d p a a t e G H 2 % u a i n m i d i n e G H r e n u u m o - t on g u e G H r e n u m o - u p p e r i p G H Ton g u e n o t p r o t r u d in g G H S u c = i n g r e K e > s t r o n g a n d c o o r d i n a te d G H oo t in g r eK e > G H S w a ow i ng e K e > G H < > t r u s i o n r e K e > G H Na t a t e e t & G H < i p s t e in p e ar s

G H e - t i p G H e - t p a a t e G H 5 r o -u se sa i %a t i o n o r d r oo i n g

G H an d id as i s G t & r u s& H G H A b n or ma c r y G c & ar ac t e r i e H

" . N e c = : G H S & or t , t & i c = , u su a y su r r ou n d e d b y s= in - o d s G H Mo%e s - r e e y - r om s id e t o s i d e G H Ton i c 7n e c = r e K e > G H To r t i c o i s G H ?e b b in g G H Masse s G H D i s t e n d e d %e in s; . & e s t : S & ap e : G H A mos t c i r c u a r G an t e p os t e r i o r an d a t e r a d i ame t e r s e # u a H

G H S ymme t r i c a mo%e me n t s w i t & r e sp i r a t i on G H S i g & t s t e r n a r e t r ac t i on s e % id e n t d u r i n g i n sp i r a t i on G H F i p& o id p ro c es s e % id en t

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15/58

G H B r e as t e n a r g e me n t G H e s pi ra t io n s a b do m in a

G H A b n or ma c & e s t mo%e me n t s w i t & r e sp i r a t i on s G d e sc r i b e H G H A b n or ma s& ap e G d e sc r i b e H G H S u p e r n u me r ar y o - n i p p e s G H S e c r e t i on o - Iw i t c & m i = G H A symme t r i c c & e s t e >p an s ion$ . L un gs :

B r e a t & sou n d s : A b se n c e o - b r e a t & sou n d s su c & as r a e s , w& e e in g an d c r ac = e s . a t e : N o r m a D e p t & : Nor ma G H A b n or ma b r e a t & sou n d s G d e sc r i b e H

J . A b d o m e n : S & ap e : G H ou n d e d G y i n d r i c H an d p r omin e n t G H O t & e r s : D e sc r i b e G H o r d s t u mp d r y , n o t - ou sme i n g G H 2mb i i c a & e r n i a G H B i a t e r a - e m o r a p u s e s G H ? & a r t o n C s 4 e y G H D i as t as i s r e c t i

! . " e n it a ia : G H L a b i a a n d c i t o r i s e d e m a t o u s Lab ia C s ap p e ar a r g e G H 2 r e t & r a me at u s b e & in d c i t o r i s G H Mu c o d d i s c & ar g e s b e t we e n ab i a G H 2 r i n a t i o n w i t & i n ( 3 & o u r s G H 5 su e d ome n s t r u a t i on G H ; y m e n a t a gMa e " e n i t a i a : G H 2 r e t & r a o p e n i n g a t t i p o - g a n s p e n i s G H A b n or ma u r e t & r a op e n in g G d e sc r i b e H G H Te s t e s p a p ab e i n e ac & sc r o t u m

G H S c r o t u m u su a y a r g e , e d e mat ou s , p e n d u ou s , G H c o%e r e d w i t & r u g ae G H 5 i g me n t e d G H S me g ma

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17/58


18/58

* o t h e r v e r b a l i + e d t h a t t h e b a b y h a d n o t t a k e n a b a t h s i n c e d e l i v e r y o r f o r # , d a y s a l r e a d y . C l i e n t i s

w e l l - g r oo m e d . C l i e n t i s n o t a l l e r g ic t o f o o d s & d r u g s a n d p l a n t s . er b a l i + e d b y m o t h e r & w o u n d e a s i l y h e a l sa n d d o e s n o t b l e ed p r of u s el y f o r t h e f i r s t # % d a y s. C l i en t h a d n o t u n d er g on e a n y s u rg e ry i n v ol v i ng t h e

i n t e g u m e n t .

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A ! S7 in

/ h e c o l o r i s p a l e a n d t h e s a m e w i t h t h e s u r r ou n d i n g s k i n . / h e r e i s n o p e r s p i r a ti o n n o t e d a t t h e f o r e h e a d &n e c k a n d a ! i l l a r y a r e a s . 0 k i n i s c o l d t o t o u c h a n d t e m p e r a t u r e e 1 u a l b i l a t e r a l l y . 2 t i s s m o o t h a n d l o v e l y t ot o u ch . 0 k i n t u rg o r i s g o o d& i t l i f ts e a s il y a n d s n a ps b a c k i m m e di a t el y t o i t s n o r m a l p o s i ti o n . / h e re a r e n o

b i r t h m a r k s o r f r e c k l e s p r e s e n t . / h e r e i s n o i n f l a m m a t i o n s i n c e t h e r e i s a b s e n c e o f r a s h e s a n d l e s i o n s . / h e r e i sn o e d e m a n o t e d o n t h e i n t e g u m e n t .

&!N a i l s a i l s a r e s h o r t a n d c l e a n . a i l s a r e u n i f o r m i n t h i c k n e s s . a i l b e d s a r e p i n k i s h i n c o l o r w i t h t r a n s l u c e n t

w h i t e t i p s . 2 t i s w e l l r o u n d e d w i t h a c o n v e ! c u r v e a b o u t # ( % . L a n u l a i s c o l o r e d w h i t e . C a p i l l a r y r e f i l l i s ,

s e c o n d s . / h e r e a r e n o l e s i o n s a n d i n f l a m m a t i o n n o t e d .

C ! a i r5 a i r i s c o l o r e d b l a c k a n d s o f t w i t h t h i n s t r a n d s . 5 a i r i s e v e n l y d i s t r i b u t e d a n d i s a p p r o p r i a t e f o r t h e f a c e .

/ h e r e i s a b s e n c e o f n i t s & d a n d r u f f s a n d s c a l i n e s s . 5 a i r i s a l s o s m o o t h a n d p l i a n t .

ABDOM


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'! ealth istory

* o t h e r v e r b a l i + e d t h a t s h e b r e a s t f e d s t h e b a b y 6 v e r y t i m e h e c r i e s w i t h # - , o u n c e s o f m i l k . C l i e n t s u c k s

w e l l . C l i e n t h a s n e v e r e ! p e r i e n c e d a n y o p e r a t i o n s u rg e r y i n v o l v i n g t h e a b d o m e n . 0 h e w a s d i a g n o s e d f o r b l o o d d y s c r a s i a s w i t h p r o f u se b l e e d i n g a t t h e c o r d s t u m p . e ll o w w a t e r y s t o o l s a r e p a s s e d a t l e a s t o n c e o r

t w i c e a d a y . C o r d s t u m p w a s n o t c l e a n e d s i n c e d e l i v e r y p r i o r t o a d m i s s i o n .

''! 4hysical :8amination

A! 'nspection

A b d o m e n h a s 4 1 u a d r a n t s " r i g h t u p p e r 1 u a d r a n t & l e f t u p p e r 1 u a d r a n t & l e f t l o w e r 1 u a d r a n t a n d r i g h t l o w e r1 u a d r a n t . 2 t a l s o c o m p r i s e s o f 8 r e g i o n s " r i g h t a n d l e f t h y p o c h o n d r i a c r e gi o n & u m b i l i c a l r e g i o n & r i g h t a n d l e f t

l u m b a r r e g i o n & h y p o g a s tr i c r e g i o n a n d r i g h t a n d l e f t i l i a c r e g i o n . A b d o m e n h a s f l a w l e s s s k i n a n d h a s t h e s a m ec o l o r w i t h t h e s u r r ou n d i n g s k i n . 2 t i s s m o o t h a n d s y m m e t r i c a l . C o n t o u r o f t h e a b d o m e n i s s l i g h t l y r o u n d ed a n d

d i s t e n d e d . / h e r e i s n o s p l e e n o r l i v e r e n l a r g e m e n t n o t e d . 9 e r i s t a l s i s a n d p u l s a t i o n s a r e n o t v i s i b l e . : m b i l i c u si s s l i g h t l y p r o t r u d i n g s l i g h t l y m o i s t w i t h l e s i o n . 2 t w a s c l e a n e d a n d d r e s s e d u p o n a d m i s s i o n . / h e r e a r e n o

s c a r s & s t r i a e & r a s h e s a n d r a s h e s n o t e d d u r i n g e ! a m i n a t i o n .

&! Auscultation

; o w e l s o u n d s a r e a u d i b l e i n 4 1 u a d r a n t s . / h e r e a r e # $ - # ) b o w e l s o u n d s h e a r d f o r o n e m i n u t e i n < L = .C! ight pa lpat ion

A b d o m e n i s r e l a ! e d a n d h a s n o e n l a r g e d o r g a n s . o m a s s e s a n d t e n d e r n e s s n o t e d i n t h e a b d o m e n d u r i n gp a l p a t i o n o f t h e a b d o m e n .

D! Deep pa lpat i onL i v e r p a l p a t i o n n o t d o n e d u e t o p a i n i n t h e a b d o m e n a s v e r b a l i + e d b y m o t h e r a n d t h e c l i e n t i s a l s o c r y i n gw h e n e v e r 2 t o u c h h i s a b d o m e n a n d i n t e g u m e n t . > u r i n g p a l p a t i o n & b l a d d e r i s n o t d i s t e n d e d a n d p a s s e d y e l l o w

s o f t s t o o l s t o g e t h e r w i t h y e l l o w c o l o r e d u r i n e .

: !4 er c us s ion/ y m p a n y s o u n d s a r e h e a r d i n t h e 4 1 u a d r a n t s b u t d u l l s o m e w h a t i n t h e l i v e r a r e a .

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' ! ea l t h is tory

* o t h e r v e r b a l i + e d & c l i e n t c o u l d c o n s u m e 3 - 4 d i a p e r s l i n e n s a d a y o r w h e n e v e r t h e b a b y ?s d i a p e r l i n e n i s

w e t . C l i e n t c a n p a s s s t o o l s o r d e f e c a t e s o n c e a d a y w i t h s o f t a n d y e l l o w s t o o l w i t h t h e e s t i m a t e d a m o u n t o f, % % g r a m s w i t h o u t d i f f i c u l t y . C l i e n t i s a l s o a b l e t o u r i n a t e w i t h y e l l o w c o l o r e d u r i n e w i t h t h e e s t i m a t e d

a m o u n t o f , 4 % m l w i t h o u t d i f f i c u l t y . C l i e n t h a d n o t u n d e r g o n e o p e r a t i o n s u r g e r y i n v o l v i n g g e n i t o u r i n a r ys y s t e m . C l i e n t d i d n ?t e ! p e r i e n c e a n y u r i n a r y t r a c t i n f e c t i o n a s v e r b a l i + e d b y m o t h e r.

' '! 4 hy si ca l : 8a mi na ti on

A ! 4en is2 t i s s m a l l a n d h a s n o s i g n s o f s w e l l i n g & s k i n l e s i o n s & i n f l a m m a t i o n & o r o t h e r i r r e g u l a r i t i e s . / h e u r e t h r a l

m e a t u s i s l o c a t e d a t t h e c e n t e r a n d t i p o f t h e g l a n s .

&!Sc r o t um2 t i s l a r g e i n r e l a t i o n t o t h e r e s t o f t h e g e n i t a l i a a n d h a n g s f r e e l y f r o m t h e p e r i n e u m b e h i n d t h e p e n i s a n d

t h e l e f t s c r o t u m h a n g s l o w e r t h a n t h e r i g h t . / h e s k i n i s l o o s e a n d s l i g h t l y w r i n k e d . 9 r e s e n c e o f p h y m o s i s a n d

n o t c i r c u m c i s e d .

C !* r o inC o l o r o f t h e s k i n i s t h e s a m e a s t h e s u r r o u n d i n g a r e a . A b s e n c e o f s k i n l e s i o n s & s c a r s a n d n o d e s a r e n o t

p a l p a b l e .

D! %ec ta l$ l u t e a l f o l d s a r e s y m m e t r i c a l a n d % r m . A b s e n c e o f r a s h e s , l e s i o n s a n d s c a r s . A n u s i s

p r e s e n t b e t w e e n t h e g lu t e a l f o l d s .

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a & io log i c Deve lop ment

" r owt & - as t e s t a t 6 7' d ou b e b i r t & we ig & t

O n e ye ar i t i s t r i p e d .

Ta p e r s o i n ( n d y e a r G w i g a i n 6 7 ' b s . H

/ r d y e a r 3 7 6 b s . ;e ig & t + ) 7+ ( I b y + s t y r . / ) i n c & e s t a

( n d y e a r u p t o 6 I

( y r s . / - t .

" r o w t & o c c u r s i n s p u r t s .

;e ad b e c ome s p r op or t i on a t e y sma e r u n t i - u ad u t & e ig & t i s r e ac & e d .

B e c o m e s e a n e r

" en es d ic ta te & ei g& t, b ui t b ut i nt er ac ts w it & e n% ir on me nt G N ut ri t i on , i% in g

e n % i r on me n t - r e e d om - r om d i se ase s H

1 4syc ho so ci al D eve lopmen t

Tr u s t % s . M i s t r u s t G b i r t & t o + y ea r H

Tr u s t i s t & e - o re m os t i m p o r t a n t a t t r i b u t e t o b e d e % e o p e d -o r a & e a t & y p e r s on a i t y.

Tr u s t e> i s t s o n y i n re a t i o n t o s o m e t & i n g o r so m e o n e .

e s u ts t o - a i t & a n d o p t i m i s m .

5 r i m a r y N a r c i s s i s m i s a t i t s & e i g & t .

T & e n e> t s o c i a m o d a i t y i n %o %e s a m o d e o - re a c & in g ou t t o o t & e r s t & ro u g & g r a s p i n g .

D u r in g t & e se c on d s t ag e t & e mor e ac t i %e an d ag g r e ss i %e mod a i t y o - b i t i n g oc c u r s .

c C og n i t i ve Deve lop ment

S e n s o r i m o t o r G b i r t & 7 ( y e a r s H " o%e r n e d b y se n sa t i on s i n w& i c & s imp e e a r n in g t a=e s p ac e .

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& i d re n p ro g re s s - ro m r eK e > a c ti % it y t &o u g& s im p e , r ep et i ti % e b e &a % io r s t o

im i t a t i %e b e & a% io r .

5 ro b em s o %i ng i s t ri a a nd e rro r. T &e y d is p ay a & ig & e% e o - c ur io si ty ,

e >p e r ime n t a t i on an d e n 4oyme n t . T & re e r u c i a < %e n t s t a =e p a c e d u r i n g t & i s s t a g e :

S e p a r a t i o n 7 T & e y b e g i n t o d e % e o p a s e n s e o - s e - a s t & e y a r e a b e t o d i e r e n t ia t e

t & e mse %e s - r om t & e e n % i r on me n t . O b 4 e c t p e r m a n e n c e 7 T & e y b e c o m e a w a r e t & a t o b 4 e c t s & a % e p e r m a n e n c e m e a n i n g

t & e ob 4e c t s e > i s t e %e n i - i t i s n o on g e r % i s i b e .

S y m b o s o r M e n t a e p r e s en t a t i o n T & e u s e o - s y m b o s a o w s t & e i n - a n t t o t & i n = o -

an ob 4e c t o r s i t u a t i on w i t & ou t ac t u a y e >p e r i e n c in g i t . S t a g e s o - S e n s o r i m o t o r 5 & a s e

2 s e o - r e K e > e s a t b i r t & t & e i n - a n t C s i n d i % i d u a i t y a n d t e m p e r a m e n t a r e e > p re s s e d

t & r o u g & t & e p & y s i o o g i c r e K e > e s o - s u c = i n g , r o o t i n g , g r a s p i n g , a n d c r y i n g .

5 r im a r y i r c u a r ea c t i on m a r = s t & e b e g in n i ng o - t & e r e p a ce m e nt o - r e K e > i % e

b e &a % io r w i t& % o u n ta r y a c ts . A ct i %i t ie s s u c& a s s u c= i ng o r g ra s pi n g b ec o med e ib e ra t e a c t s t & a t e i ci t c e r ta i n r e sp o n se s . T & e b e g i n n in g o - a c c o mm o d a ti o n i se % id e n t .

S e co n da r y i rc u a r e a ct i on i n t & is s t ag e t &e p ri m ar y c i rc u a r r ea c ti o ns a re

r e pe a t ed a n d p r o o ng e d - o r t & e r e s p o ns e t & a t r e s u t s . " r a s pi n g a n d & o di n g n o wb e c o m e s & a = i n g , b a n g i n g , a n d p u i n g .

o o rd i n at i o n o - S e c on d a ry S c & em a s a n d t & ei r A p p i c a ti o n t o n e w s i t ua t i o ns t & i s

s t a g e i s a r g e y t r a n s i t i o n a . T & e y b e g i n t o d i s c o % e r t & a t & i d i n g a n o b 4 e c t d o e s n o tme an t & a t i t i s g on e b u t t & a t r e mo% in g an ob s t ac e w i r e %e a t & e ob 4e c t

+ Mora l Developme nt

T & e i n -a n t p e r i o d i s a p re 7 re i g i o u s s t a g e .

$ t i s i m p o r t a n t t o p r a i s e a n i n - a n t - o r d o i n g w & a t & e o r s & e & a s b e e n a s = e d t o d o .

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T & e d e % e op m e n t o - t r u s t i s im p or t a n t i n m o r a d e % e o p m e n t b e c a u se i n - a n t s w & o

d e % e o p a s o u n d s e n s e o - t r u s t c a n b e t t e r d e % e o p a s p i r i t u a o r i e n t a t i o n i n - u t u r ey e a r s o r b e b o u n d b y a m o r a c o n s c i e n c e .

e Soc ia l Deve lop m ent

A t t a c & m en t t o t & e p a r e n t i s i n c r e a s i n g y e % i d e n t d u r i n g t & e s e c o n d & a - o - t & e @ r s t

ye ar .

5 a y i s a m a 4 o r s o c i a i i n g a g e n t t & a t p r o % i d e s s t i m u a t i o n n e e de d t o e a r n - r o m a n d

in t e r ac t w i t & t & e e n % i r on me n t .

ea c t i% e a t t ac & m en t d i s or d er i s a p s y c& o o gi c a n d d e % e o p me n t a p r ob e m t & a t

s t e m s - r o m m a a d a p t i % e o r a b s e n t a t t a c & m e n t b e t w e e n t & e i n - a n t a n d t & e p a r e n t a n dm a y p e r s i s t i n t o c & i d & o o d e % e n a d u t & o o d .

S e p a r a t i o n a n > i e t y t & e i n - a n t b e g i n s t o & a % e s o m e a w a r e n e s s o - s e - a n d m o t & e r a s

s e p a r a t e b e i n g s . T & e r e - o r e s e p a r a t i o n a n > i e t y d e % e o p s a n d i s m a n i - e s t e d t & r o u g&p r e d i c t ab e se # u e n c e o - b e & a% io r s .

S t r a n g e r ea r b e c o m e p r o m i n e n t a n d a r e r e a t e d t o i n - a n t s C a b i i t y t o d i s c r i m i n a t e

b e t w e e n - a m i i a r a n d n o n 7 - a m i i a r p e o p e .

Ty p e o - p a y i s s o i t a r y

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;emoytic disease o- t&e Newborn

T & e m o s t c o m m on ca u s e o - & e m o y t i c a n e m i a i n n e w b o rn s i sa i m m u n e d i s e a se G ; D N H . ; D N c a n o c c u r o n y i - a n t ig e n s o n- e t a e r y t & roc y t e s d i e r - ro m a n t i g e n s on m a t e rn a e r y t & ro c y t e s . M a t e r n a 7 - e t a i n c o m p a t i b i i ty e > i s t s i - m o t & e r a n d

- e t u s d i e r i n A B O b o o d t y p e o r i - t & e - e t u s i s & 7 p o s i t i % e a n dt & e m o t & e r i s & 7 n e g a t i % e . S o m e m i n o r b o o d a n t i g e n s a s o m a yb e i n % o % e d .

A BO i nc om pa ti bi i ty o cc ur s i n a bo ut ( ) 7( 6P o - a p r eg n a nc i e s, b u t o n y + i n + ) c a s e s o - A B O r e s u t s i n ; D N . &i n c om p a ti b i it y o c c ur s i n - e w er t & a n + ) o - p r eg n a nc i e s a n dr a re y c a u s e s ; D N i n t & e @ r s t i n c o m p at i b e - e t us . < % e n a - t e r@ % e o r m o r e p r eg n a nc i e s, o n y 6 o - w o m e n & a % e b a b ie s w i t && em o yt ic d is ea se . 2 su a y e ry t& ro cy te s - ro m t &e @ r s ti nc om pa ti b e - et us c au se t &e m ot &e rC s i mm un e s ys te m t op ro du ce a nt ib od ie s t &a t a e c t t &e - et us es o - s ub se #u en ti n c om p a ti b e p r e g na n c ie s . O n y o n e i n t & re e c a s es o - ; D N i s

c au se d b y & i n c omp at ib i i t y an d mos t c ase s a r e c au se d b y A B O i n c omp at ib i i t y .

L$N$AL mani -estat ions

N e o n a t e s w i t & m i d ; D N m a y a p p e a r & e a t & y o r s i g & t y p a e , w i t &s i g & t e n a r g e me n t o - t & e i %e r o r sp e e n . 5 r on ou n c e d p a o r ,s p e n o m e g a y a n d & e p a t o m e g a y i n d i c a t e s e % e r e a n e m i a w & i c &p r e d i sp ose s t & e n e on at e t o c a r d i o%asc u a r - a i u r e an d s& oc = . L i - e 7t & r e a t e n in g & i n c omp at ib i i t y i s r a r e t od ay , a r g e y b e c au se o - t & er ou t i n e u se o - & immu n og ob u i n

B ec au se t &e m at ern a a nt ib od ie s re ma in i n t &e n eo na te Csc i r c u a to r y s y s t e m a - t e r b i r t & , e r y t & ro c y t e d e s t r u c t i o n c a n c o n t i n u e .

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T & i s ca u s e s & y p e r b i i r u b i n e m i a a n d i c t e r u s n e o n a t o r u m G n e o n a t a 4 a u n d i c e H s & o r t y a - t e r b i r t & .? i t& o u t r e p a c em e n t t r a ns - u s io n s , i n w & i c& t & e c & i d r e ce i % es & n eg a t i %e e r y t& ro c y t es , t & eb i i r u b i n i s d e p o s i t e d i n t & e b r a i n , a c o n d i t i o n t e r m e d = e r n i c t e r u s . ! e r n i c t e r u s p r o d u c e s c e r e b r a d a m a g e a n d u s u a y c a u s e s d e a t & G i c t e r u s g r a % i s n e o n a t o r u m H . $ n - a n t s w & o d o n o t d i e m a y & a % eme n t a r e t a r d a t i on , c e r e b r a p a sy o r & i g & - r e # u e n c y d e a -n e ss .

i s H . O n e o - t & e s u c c e s s s t o r i e s o - i m m u n o o g y & a s b e e n t & e r e s u t s o b t a i n e d w i t & & i m m u n e g o b u i n G & o " A M H , a p r e p a r a t i o n o - a n t i b o d y a g a i n s t & a n t i g e n D . $ - a n & 7 n e g a t i % e

w o m a n i s g i % e n & i m m u n e g o b u i n w i t & i n 8 ( & o u r s o - e > p o s u r e t o & 7 p o s i t i % e e r y t & r o c y t e s , s & ew i n o t p r o d u c e a n t i b o d y a g a i n s t t & e D a n t i g e n a n d t & e n e > t & 7 p o s i t i % e b a b y s & e c o n c e i % e s w i b e p r o t e c t e d .

$ - a n ti g en i c i n co m pa t ib i i t y o - t & e m o t& er C s e r yt & ro c yt e s i s n o t d i sc o %e re d i n t i me t oa d m i ni s t er p r op & y a c t i c i m m u n e g o b u in G & o" A M H a n d a c & i d i s b o rn w i t & ; D N , t r ea t m en tc o n s i s t s o - e > c & a n g e t r a n s - u s i o ns i n w & i c & t & e n e o n a t e C s b o o d i s r e p a c e d w i t & n e w & 7 p o s t i % eb o o d t & a t i s n o t c o n t a m i n a t e d w i t & a n t i 7 & a n t i b o d i e s . 5 & o t o t & e r a p y a s o i s u s e d t o r e d u c e t & et o > i c e e c t s o - u n c o n 4 u g a t e d b i i r u b i n.

ANATOMEAND5;ES$OLO"E

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Organs o- t&e &ematoogic Systems

;eMostasis

Norma &emostasis is a process t&at repairs %ascuar brea=s to reduce bood oss -rom bood %esses w&ie maintaining t&eKow o- bood t&roug& t&e %ascuar system. ;emostasis occurs in / stages.

+. 0asoconstriction o- bood %esses(. ormation o- pateet pug/. oaguation or -ormation o- a @brin cot.

Once t&e @brin cot &as ser%ed its purpose, -urt&er cot -ormation is baanced by anticoaguation and by @brinoysis GcotdissoutionH.

T&e -ormation o- a @brin cot can resut -rom acti%ation o- one o- / pat&ways: intrinsic or e>trinsic. T&e e>trinsic pat&way isinitiated w&en tissue in4ury occurs outside t&e %esses suc& as burn. T&e intrinsic pat&way in%o%es t&e bood itse- or damage tot&e bood %esses. Bood in norma %esses t&at is stagnant -or a ong period o- time can -orm cots.

$n some cases, -ormation o- a @brin cot is unnecessary because &emostasis occurs at an eary stage. Temporary cots are

sometimes insuQcient.

BLOOD

Bood, %ita Kuid -ound in &umans and ot&er animas t&at pro%ides important nouris&ment to a body organs and tissues andcarries away waste materias. Sometimes re-erred to as It&e ri%er o- i-e, bood is pumped -rom t&e &eart t&roug& a networ= o-bood %esses coecti%ey =nown as t&e circuatory system. T&e ceuar component o- bood consists o- t&ree primary ce types::rythrocytes B%&C, eu7ocytes B-&C, an+ throm1ocytes Bplatelets. T&ese ceuar components o- bood normay ma=eup 3)736 o- t&e bood %oume. Because most bood ces &a%e a s&ort i-e span, t&e need -or t&e body to repenis& its suppy o-ces is continuous and t&is process is termed ematopoiesis!

( '


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An adut &uman &as about 6 to ' iters G+ to ( gaH o-bood, w&ic& is roug&y 8 to +) o- tota body weig&t. $n-antsand c&idren &a%e comparaby ower %oumes o- bood, roug&yproportionate to t&eir smaer sie. T&e %oume o- bood in anindi%idua Kuctuates. During de&ydration, -or e>ampe w&ierunning a marat&on, bood %oume decreases. Bood %oumeincreases in circumstances suc& as pregnancy, w&en t&e

mot&erCs bood needs to carry e>tra o>ygen and nutrients to t&ebaby. ircuating t&roug& t&e %ascuar system and ser%ing as ain= between body organs, bood carries o>ygen absorbed -romt&e ungs and nutrients absorbed -rom t&e gastrointestina tractto t&e body ces -or ceuar metaboism. Bood aso carries&ormones, antibodies, and ot&er substances to t&eir sites o-action or use. $n addition, bood carries waste productsproduced by ceuar metaboism to t&e ungs, s=in, i%er, and=idneys, w&ere t&ey a re trans-ormed and eiminated -rom t&ebody.

Bood is Kuid, t&ere-ore, t&e danger aways e>ists t&at trauma can ead to oss o- bood-rom t&e %ascuar system. To pre%ent t&is, an intricate cotting mec&anism is acti%ated w&en necessary to sea any ea= in t&ebood %esses. cessi%e cotting is e#uay dangerous, because it can obstruct bood Kow to %ita tissues. To pre%ent &is, t&e body&as a @brinoytic mec&ansism t&at e%entuay disso%e cots Gt&rombiH -ormed wit&in bood %esses. T&e baance between t&ese twosystems, cot -ormation and cot dissoution or @brinoysis is caed emostasis!

2NT$ONS O T;< BLOOD

Bood per-orms many important -unctions wit&in t&e body incuding: Suppy o- o>ygento tissues Gbound to &emogobinw&ic& is carried in red cesH Suppy o- nutrients suc& as gucose, amino acidsand -atty acidsGdisso%ed in t&e bood or bound to

pasma proteinsH emo%a o- waste suc& as carbon dio>ide, ureaand actic acid

$mmunoogica -unctions, incuding circuation o- w&ite ces, and detection o- -oreign materiaby antibodies

oaguation, w&ic& is one part o- t&e bodyRs se-7repair mec&anism

( 8
http://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Amino_acidshttp://en.wikipedia.org/wiki/Fatty_acidshttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Antibodieshttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Hemoglobinhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Amino_acidshttp://en.wikipedia.org/wiki/Fatty_acidshttp://en.wikipedia.org/wiki/Carbon_dioxidehttp://en.wikipedia.org/wiki/Ureahttp://en.wikipedia.org/wiki/Lactic_acidhttp://en.wikipedia.org/wiki/Antibodieshttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Oxygen


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Messenger -unctions, incuding t&e transport o- &ormonesand t&e signaing o- tissuedamage eguation o- body p;Gt&e norma p; o- bood is in t&e range o- 8./6 7 8.36H eguation o- core body temperature ;ydrauic-unctions

BON< MAO?T & e b o n e m a rro w i s t & e s i t e o - & e m a t o p o ie s i s o r b o o d c e

- o rm a ti o n. A s =e et a b o ne s a re i n %o %e d i n c & i d re n, b u t a sc & i d re n a g e , m a r r o w a c t i % i t y d e c r e a s e s . M a r ro w a c t i % i t y i s u s u a y im i t e d t o t & e p e % i s , r i b s , %e r t e b r ae , an d s t e r n u m in ad u t s .

Mar r ow i s on e o - t & e a r g e s t o r g an s o - t & e b od y ma= in g u p 3 76 o - t ot a b od y w ei g& t. $ t c on si st s o - i s an d o - c e u a rc o m p o n e n t s G r e d m a r ro w H s e p a r a t e d b y - a t G y e o w m a r r o w H . A s t & ea d u t a g e s , t & e p r o p o r t i o n o - a c t i % e m a r r o w i s g r a d u a y r e p a c e db y - a t , & o w e% e r i n & e a t & y p e r s o n, t & e - a t c a n a g a i n r e p a ce d b yac t i %e mar r ow w& e n mor e b ood c e p r od u c t i on i s r e # u i r e d .

T & e ma rro w i s & i g & y % as c u a r. ?i t & i n i t a re p r i m i t i % e c e sc a ed s t e m c e l ls ! T &e s te m c e s & a% e t &e a bi i ty t o s e -7r e p i ca t e , t & e r e b y e n s u r i n g a c o n t i n u o u s s u p p y o - s t e m c e s c a nb e g i n a p ro c e s s o - + i e re nt ia ti on i n t o e i t & e r myelo i+ o r

l ym ph o i+ s te m c e ll s! T & e s e s t e m c e s c o m m i t t e d t o p ro d u c e sp e c i @ c t yp e s o - b oo d c e s .Ly m p & o i d s t e m c e s p r o d u c e e i t & e r T o r B y m p & o c y t e s . M y e o i d s t e m c e s d i e r e n t i a te i n t o t & r e eb r o a d c e t y p e s : e r y t & ro c y t e s , e u = o c y t e s a n d p a t e e t s . T & u s , w i t & t & e e > c e p t i o n o - y m p & o c y t e s ,a b o o d c e s a r e d e r i % ed - r om m y e o i d s t e m c e s . A d e - ec t i n a m y e o i d s t e m c e c a n c a u s ep r ob e ms w i t & e r y t& r oc y t e, e u =o c y te , a n d p a te e t p r od u c ti o n . M a n y c o m p e > m e c &a n i sm s a r ei n % o % e d i n & e m a t o p o i e s i s , o - t e n a t t & e m o e c u a r e % e .

( *
http://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Body_temperaturehttp://en.wikipedia.org/wiki/Hydraulicshttp://en.wikipedia.org/wiki/Hormoneshttp://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/PHhttp://en.wikipedia.org/wiki/Body_temperaturehttp://en.wikipedia.org/wiki/Hydraulics


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BLOOD ibe t&atit can pass easiy t&roug& capiaries t&at may be as sma as (.* um in diameter.ygen -rom t&e ungs to e%ery ce in t&e body. ed boodces are composed predominanty o- a protein and iron compound, caedemoglo1int&at captures o>ygen moecues as t&e bood mo%es t&roug& t&e ungs,gi%ing bood its red coor. As bood passes t&roug& body tissues, &emogobin t&enreeases t&e o>ygen to ces t&roug&out t&e body. ed bood ces are so pac=ed wit&&emogobin t&at t&ey ac= many components, incuding a nuceus, -ound in ot&erces. ;emogobin aso ta=es up and reeases nitric o>ide, w&ic& pays an importantroe in reguating bood pressure.

T&e membrane, or outer ayer, o- t&e red bood ce is Ke>ibe, i=e a soap

bubbe, and is abe to bend in many directions wit&out brea=ing. T&is is importantbecause t&e red bood ces must be abe to pass t&roug& t&e tiniest bood %esses, t&ecapiaries, to dei%er o>ygen w&ere%er it is needed. T&e capiaries are so narrow t&at

t&e red bood ces, normay s&aped i=e adis= wit& a conca%e top and bottom, must

bend and twist to maneu%er singe @e t&roug& t&em.T&e i-e span o- t&e Bs is bout +)67+() days. As eryt&rocytes age, t&ey become

increasingy -ragie and e%entuay rupture.

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T&e diameter o- a typica &uman eryt&rocyte dis= is '* m, muc& smaer t&an most ot&er &uman ces. A typicaeryt&rocyte contains about (8) miion &emogobin moecues, wit& eac& carrying -our &eme groups.Adut &umans &a%e roug&y (/ +)+/red bood ces at any gi%en time Gwomen &a%e about 3 to 6 miion eryt&rocytes permicroiterGcubic miimeterH o- bood and men about 6 to ' miion peope i%ing at &ig& atitudes wit& ow o>ygen tension wi &a%emoreH. ed bood ces are t&us muc& more common t&an t&e ot&er bood partices: T&ere are about 3,)))++,))) w&ite boodcesand about +6),)))3)),))) pateetsin eac& microiter o- &uman bood.T&e red bood ces o- an a%erage adut &uman mae store coecti%ey about (.6 grams o- iron, representing about '6 o- t&e tota

iron contained in t&e body.U8VU*VGSee ;uman iron metaboism.H

L$< EList but t&eyare a produced and deri%ed -rom a mutipotentce in t&e bone marrow=nown as a&ematopoietic stem ce. Leu=ocytes are -ound t&roug&out t&e body, incuding t&eboodand ymp&atic system.

T&e number o- eu=ocytes in t&e bood is o-ten an indicator o- disease. T&ere

are normay between 3.6 ++ T1cumm w&ite bood ces in a iter o- bood,ma=ing up appro>imatey + o- bood in a &eat&y adut. $n conditions suc& aseu=emia, t&e number o- eu=ocytes is &ig&er t&an norma and in eu=openia, t&isnumber is muc& ower. T&e p&ysica properties o- eu=ocytes, suc& as %oume,conducti%ity, and granuarity, may c&ange due to acti%ation, t&e presence o-immature ces, or t&e presence o- maignant eu=ocytes in eu=emia.

Types o - Leu=ocytes

T&ere are se%era dierent types o- w&ite bood ces. One primary tec&ni#ue to cassi-y t&em is to oo= -or t&e presence o-granues, w&ic& aows t&e dierentiation o- ces into t&e categories granuocytesand agranuocytes:

*ranulocytes Bpolymorphonuclear leucocytes) eu=ocytes c&aracteried by t&e presence o- dierenty staininggranuesin t&eir cytopasm o- t&e ce. T&ese granues are membrane7boundenymes w&ic& primariy act in t&e digestion o-endocytosed partices. T&ere are t&ree types o- granuocytes: neutrop&is, basop&is, and eosinop&is, w&ic& are namedaccording to t&eir staining properties.

Agranulocytes Bmononuclear leucocytes) eu=ocytes c&aracteried by t&e apparent absence o- granues in t&eircytopasm. At&oug& t&e name impies a ac= o- granues t&ese ces do contain non7speci@c aurop&iic granues, w&ic& areysosomes. T&e ces incude ymp&ocytes, monocytes, and macrop&ages.

/ +
http://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Multipotenthttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Hematopoietic_stem_cellhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Literhttp://en.wikipedia.org/wiki/Leukemiahttp://en.wikipedia.org/wiki/Leukopeniahttp://en.wikipedia.org/wiki/Granule_(cell_biology)http://en.wikipedia.org/wiki/Granulocytehttp://en.wikipedia.org/wiki/Agranulocytehttp://en.wikipedia.org/wiki/Granule_(cell_biology)http://en.wikipedia.org/wiki/Lipid_membranehttp://en.wikipedia.org/wiki/Endocytosishttp://en.wikipedia.org/wiki/Neutrophilhttp://en.wikipedia.org/wiki/Basophilhttp://en.wikipedia.org/wiki/Eosinophilhttp://en.wikipedia.org/wiki/Granule_(cell_biology)http://en.wikipedia.org/wiki/Cytoplasmhttp://en.wikipedia.org/wiki/Azurophilic_granuleshttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Immune_systemhttp://en.wikipedia.org/wiki/Infectious_diseasehttp://en.wikipedia.org/wiki/Multipotenthttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Hematopoietic_stem_cellhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/Literhttp://en.wikipedia.org/wiki/Leukemiahttp://en.wikipedia.org/wiki/Leukopeniahttp://en.wikipedia.org/wiki/Granule_(cell_biology)http://en.wikipedia.org/wiki/Granulocytehttp://en.wikipedia.org/wiki/Agranulocytehttp://en.wikipedia.org/wiki/Granule_(cell_biology)http://en.wikipedia.org/wiki/Lipid_membranehttp://en.wikipedia.org/wiki/Endocytosishttp://en.wikipedia.org/wiki/Neutrophilhttp://en.wikipedia.org/wiki/Basophilhttp://en.wikipedia.org/wiki/Eosinophilhttp://en.wikipedia.org/wiki/Granule_(cell_biology)http://en.wikipedia.org/wiki/Cytoplasmhttp://en.wikipedia.org/wiki/Azurophilic_granuleshttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophage


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O0


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Lymp & oc y te

( ) 7 3 6 8 7*

B c e s : % a r i o u sp at & og e n s

T c e s :o D 3 W

G & e p e r H :i n t r ac e u ar b ac t e r i a .

o D * Wc yt o t o> i c Tc e s :% i r u s 7i n -e c t e dan d t u m o rc e s .

o Z [ T c e s : N at ur a = i e r

c e s : % i r u s 7i n - e c t e d a n dt u m o r c e s .

d e e p ys t a in i n g ,e c c e n t r i c

o n y N !7c e s U 3 V

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= id n e ys& ap e d

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Mac r op & age

N 1 A d a y s

Neutrophi l

Neutrop&is dea wit& de-ense against bacteria or -ungain-ection and ot&er %ery sma inKammatory processes and areusuay @rst responders to microbia in-ection t&eir acti%ity and deat& in arge numbers -orms pus. T&ey are aso =nown aspoymorp&onucear eu=ocytes and microp&ages. T&e term microp&age arises due to t&e cesR acti%e in%o%ement in p&agocytosis.

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http://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/B_cellhttp://en.wikipedia.org/wiki/Pathogenshttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/CD4http://en.wikipedia.org/wiki/Helper_T_cellhttp://en.wikipedia.org/wiki/CD8http://en.wikipedia.org/wiki/Cytotoxic_T_cellhttp://en.wikipedia.org/wiki/Virus_(biology)http://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Gamma/delta_T_cellshttp://en.wikipedia.org/wiki/Natural_killer_cellhttp://en.wikipedia.org/wiki/Natural_killer_cellhttp://en.wikipedia.org/wiki/Virus_(biology)http://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/White_blood_cell#_note-T4http://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Bacterialhttp://en.wikipedia.org/wiki/Fungalhttp://en.wikipedia.org/wiki/Image:Macrophage.pnghttp://en.wikipedia.org/wiki/Image:Macrophage.jpghttp://en.wikipedia.org/wiki/Image:Monocyte.pnghttp://en.wikipedia.org/wiki/Image:PBMonozyt.jpghttp://en.wikipedia.org/wiki/Image:Lymphocyte.pnghttp://en.wikipedia.org/wiki/Image:Lymphocyte2.jpghttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/B_cellhttp://en.wikipedia.org/wiki/Pathogenshttp://en.wikipedia.org/wiki/T_cellhttp://en.wikipedia.org/wiki/CD4http://en.wikipedia.org/wiki/Helper_T_cellhttp://en.wikipedia.org/wiki/CD8http://en.wikipedia.org/wiki/Cytotoxic_T_cellhttp://en.wikipedia.org/wiki/Virus_(biology)http://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Gamma/delta_T_cellshttp://en.wikipedia.org/wiki/Natural_killer_cellhttp://en.wikipedia.org/wiki/Natural_killer_cellhttp://en.wikipedia.org/wiki/Virus_(biology)http://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/White_blood_cell#_note-T4http://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Bacterialhttp://en.wikipedia.org/wiki/Fungal


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T&ey &a%e a muti7obed nuceus w&ic& may appear i=e mutipe nucei, &ence t&e name poymorp&onucear eu=ocyte. T&ecytopasm may oo= transparent because o- @ne granues t&at are -ainty pin= in coor. Neutrop&is are %ery acti%e inp&agocytosing bacteria and are present in arge amount in t&e pus o- wounds. 2n-ortunatey, t&ese ces are not abe to renewt&eir ysosomes used in digesting microbes and die a-ter &a%ing p&agocytosed a -ew pat&ogens 7 e>paining w&y t&ey are -oundprimariy in t&e pus, not in tissue.

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o Natura =ier ces: Natura =ier ces are abe to =i ces o- t&e body w&ic& are dispaying a signa to =i t&em, as t&ey

&a%e been in-ected by a %irusor &a%e become cancerous.

Monocyte

Monocytes s&are t&e ]%acuum ceaner] Gp&agocytosisH -unction o- neutrop&is, but are muc& onger i%ed as t&ey &a%e anadditiona roe: t&ey present pieces o- pat&ogensto T ces so t&at t&e pat&ogens may be recognied again and =ied, or so t&at an

antibody response may be mounted. Monocytes e%entuay ea%e t&e boodstream to become tissue macrop&ages w&ic& remo%edead ce debris as we as attac=ing microorganisms. Neit&er o- t&ese can be deat wit& eecti%ey by t&e neutrop&is. 2ni=eneutrop&is, monocytes are abe to repace t&eir ysosoma contents and are t&oug&t to &a%e a muc& onger acti%e i-e. T&ey &a%et&e =idney s&aped nuceus and typicay agranuated. T&ey aso possess abundant cytopasm.

Macrophage

Monocytes are abe to dierentiate into t&e dedicated p&agocytosing macrop&agece a-ter migrating -rom t&e boodstreaminto tissues.

unctions o- Leu=ocytes

eu7ocytesprotect t&e body -rom in%asion by bacteria and ot&er -oreign entities. T&e ma4or-unction o- neutrophils is p&agocytosis. Neutrop&is arri%e at a gi%en site wit&in + &our a-ter t&eonset o- an inKammatory reaction and initiate p&agocytosis, but t&ey are s&ort7i%ed. An inKu> o-monocytes -oows. T&ese ces continue t&eir p&agocytic acti%ities -or ong periods asmacrop&ages. T&is process constitutes a second ine o- de-ense -or t&e body against inKammationand in-ection. Macrophages aso digest senescent bood ces, suc& as eryt&rocytes, primariywit&in t&e speen.

T&e primary -unction o- lymphocytes is to produce substances t&at aid in attac=ing -oreignmateria. One group o- ymp&ocytes GT ymp&ocytesH =is -oreign ces directy or reeases a %arietyo- ymp&o=ines, substances t&at en&ances t&e acti%ity o- p&agocytic ces. T ymp&ocytes areresponsibe -or deayed aergic reactions, re4ection o- -oreign tissue and destruction o- tumor ces.

T&e process is =nown cellular immunity. T&e ot&er group o- ymp&ocytes GB ymp&ocytesH is capabe o- dierentiating into

/ 6
http://en.wikipedia.org/wiki/Natural_killer_cellhttp://en.wikipedia.org/wiki/Virus_(biology)http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Pathogenhttp://en.wikipedia.org/wiki/Macrophagehttp://en.wikipedia.org/wiki/Natural_killer_cellhttp://en.wikipedia.org/wiki/Virus_(biology)http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Phagocytosishttp://en.wikipedia.org/wiki/Pathogenhttp://en.wikipedia.org/wiki/Macrophage


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pasma ces. 5asma ces produce antibodies caed immunogobuin G$gH, w&ic& are protein moecues t&at destroy -oreignmateria by se%era mec&anisms. T&is process is =nown as &umora immunity.

:osinophils an+ 1asophils -unction in &ypersensiti%ity reactions. :osinophils are important in t&e p&agocytosis o-parasites. &asophilsproduce and store &istamine as we as ot&er substances in%o%ed in &ypersensiti%ity reactions. T&e reeaseo- t&ese substances pro%o=es aergic reactions.

5ateets GT&rombocytesH4latelets or throm1ocytesare not tec&nicay ces rat&er t&ey are

granuar -ragments o- giant ces in t&e bone maroow caedmega=aryocytes. 5ateet production in t&e bone marrow is reguated inpart by t&e &ormone t&rombopoeitin w&ic& stimuates t&e production anddierentiation o- mega=aryocytes -rom t&e myeoid stem ce.

5ateets pay an essentia roe in t&e contro o- beeding. T&eycircuate -reey in t&e bood in an inacti%e state w&ere t&ey nurture t&eendot&eium o- t&e bood %esses maintaining t&e integrity o- t&e %esse.?&en %ascuar in4ury occurs, pateets coect at t&e site and are acti%ated.T&ey ad&ere to t&e site o- in4ury and to eac& ot&er, -orming a pateet pug t&at temporariy stops beeding.

Substances reeased -rom pateet granues acti%ate coaguation -actors in t&e bood pasma and initiatet&e -ormation o- a stabe cot composed o- @brin, a @amentous protein. 5ateets &a%e a norma i-e span o-

87+) days.

/ '


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39/58

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Ma m i c a c i dc o mp et i ti % e y i n &i b it s t & e a c ti % at i on o - p a s m in o ge n t o p as m in , r es u t in g i n i n &i bi t io n o - @ b r i n o y s i s a t & i g & e r c o n c e n t r a t i o n s , t & i s a g e n t n o n c o m p e t i t i % e y i n & i b i t s p a s m i n . T & i s a g e n t& as a on ge r & a -7 i -e , i s a pp ro> im at e y t en t im es m ore p ot en t, a nd i s es s t o> ic t &a na m i n o c a p r o ic a c i d , w & i c & p o s s e s s e s s i m i a r m e c & a n i s m s o - a c t i o n .S i+ e : e c ts ) ; e a da c & e G s e % e re a n d s u d de n H o s s o - c o o rd i n at i o n G s u d d e nH p a i ns i n c & es t ,g r oi n , o r e g s, e s p ec i a y t & e c a % es s & o rt n es s o - b r ea t & G s u dd e n H s u rr e d s p e ec & G s u dd e n H

% i s i on c & an g e s G su d d e n H we a=n e ss o r n u mb n e ss i n a r m o r e gDosage) + ( 6 mg T $DC ont r a in+ i c a t i ons ) 5 at i e nt s w i t & a & i s to r y o r r i s = o - t & ro m b o si s . a u t i o n s & o u d b e u s ed i np a t i e n t s w i t & r en a i n s u Q c i e n c y s i n c e t & e d r u g i s e i m i n a t ed b y g o m e r u a r @ t r a t i o n .Nurs ing Cons i+erat ions ) M o n i t o r a d % e r s e e e c t s .

M o n i t o r c o m p e t e b o o d c o u n t .

Mon i t o r % i t a s i g n s e sp e c ia y b ood p r e ssu r e .

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" < N < $ N A M < : 5& y t on ad ion eB A ND NA M< : A # u ame p & yt on 1 ;e ma ! LA S S $ $A T $O N: 0 i t . ! $ND $A T $O N: t o p r e %e n t & e mor r & ag i c d i se ase o - n e wb or n

Mis and treatment o- &emorr&agic disease in t&e newborn. $t is necessary component -ort&e production o- certain coaguation -actorsS $D < < < TS 1 A D 0 < S < < A T $O NS : 5a in an d e d e ma may oc c u r a t i n 4 e c t i on s i t e . 5oss ib e a e r g i cr e a c t i o n s u c & a s r a s & e s m a y o c c u rD O S A " < : ) .6 7+ .) mg $M on e t ime imme d ia t e y a - t e r b i r t &O NTA $ND $A T $O NS : on t r a in d i c a t e d i n p a t i e n t s & yp e r se n s i t i %e t o d r u gN2S$N" ONS$DDp a in p u r p ose o - d r u g

Te p a t i e n t t o a %o i d & a a rd ou s a c t i % i t i e s i - d i i n e s s o c c u r s

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a c c u m u a t i o n

& e c = b r an d n ame ab e s - o r ad min i s t r a t i on r ou t e r e s t r i c t i on s

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# . H e a ! t h P e r c e p t i o n #H e a ! t h M a n a g e m e n t

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43/58

C ue s / E v i de n ce s N u rs i ng

D i a g n o s i s

O b j e c t i v e s I n t e r v e n t i o n s R a t i o n a l e E v a l u a t i o n

3 /

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a t h o m e .

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; a b y s l e e p s o n t h e w o o d e n

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s u p i n e p o s i t i o n w i t h > $ . 3 a C l $ % %c c a t r i g ht m e t ac a r pa l v e i n # 4

m l h r

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u b j e c t i v e

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a k o n g b a t a .

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k i n i s d r y P / .

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f e v e r c h a n g e si n t h e l e v e l o f

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m e m b r a n e s . 4 o n i t o r

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i t s a b i l i t y t o

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d i l u t e u r i n e a n df i = a t i o n o f s p e c i f i c

g r a v i t y .

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c i r c u l a t i ng b l o o d

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t a c h y c a r d i a . y m p t o m s

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n e c e s s i t a t er e p l a c e m e n t .

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g r a v i t y o fu r i n e .

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b l o o d t y p er e s u l t i s g i v e n .

e a c h p a r e n t s

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e s p e c i a l l yb r e a s t f e e d i n g .

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3 6


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u b j e c t i v e

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v e r b a l i z e d , L i h o k a n

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a k o n g b a t a .

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s u l o d .

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n o e r y t h e m aa n d

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s i t e c a r e .

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s i t e f o r i n t a c t n e s s

o f s k i n , e r y t h e m aa n d t e n d e r n e s s .

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u b j e c t i v e

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a k o n g b a t a s a m u tn a g a m a t a .

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o = y g e n . O b j e c t i v e

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n a r e s , r e g u l a t e d@ ( l i t e r A m i n

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t a b l e v i t a ls i g n s

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a s e v i d e n c e d1 i t h m o i s t

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o = y g e n s u p p o r t .

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& ! u i d v o ! u m e d e f i c i t r e ! a t e d t o b ! e e d i n g a t t h e c o r d s t u m p&

" i s ' f o r i n f e c t i o n r e ! a t e d t o p r e s e n c e o f ( % ! i n e ) r i g h t m e t a c a r p a ! v e i n&

" i s ' f o r a ! t e r e d s ' i n i n t e g r i t y r e ! a t e d t o p r e s e n c e o f o * y g e n v i a n a s a ! c a n n u ! a&

+ n o w ! e d g e d e f i c i t r e ! a t e d t o p a r e n t , s u n d e r s t a n d i n g a b o u t b ! o o d d y s c r a s i a .

& a t i g u e r e ! a t e d t o c o m p e n s a t o r y m e c h a n i s m f o r o * y g e n i n t h e b o d y .

( n e f f e c t i v e f a m i ! y c o p i n g r e ! a t e d t o f i n a n c i a ! p r o b ! e m s .

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SENT; p e r i e n c e i s s o c & a e n g i n g - o r u s s t u d e n t n u r s e s a n d n u r s e s i n t & e - u t u re . ?e n u r s e s m u s tb e p r e p a re d a n d b e K e > ib e i n d e a i n g w i t & p e d ia t r ic p a t ie n t s o r a n y o ne w & o m w e e n c ou n te rs o m e d a y. ? e s & o u d n e % e r s u rr e n d e r t o a n y o b s t a c e s 1 p ro b e m s w e C % e b e e n t & r o u g & i n o u r i % e sa n d s & o u d n e % e r s t o p a s = i n g - o r g u i d a n c e t o o u r e % e r o % i n g " O D .

5 ed i a t ri c ot a t io n i s - u n a n d c & a e ng i n g. ? e d i d n C t - e e a n y e > &a u s ti o n d u r in g o u r d u t y.A t &o u g & w e w e re b o m ba r d ed b y & u m o n g ou s p i e o - p a p er w o r= b u t w e w e re a b e t o c o p e a n d

s u r % i % e - r o m i t . N e % e r t & e e s s , t & a n = s t o o u r i n i c a $ n s t r u c t o r - o r b e i n g p a t i e n t a n d o % i n g .

O u r c a s e i s t & e m o s t i n t e re s t i n g o - a , s i n c e i t d e a s w i t & b o o d . $ t i s t & e m o s t c & a e n g i n ga n d i t & e p s o u r m i n d w o r = t o = n o w a n d e a r n w & a t c a u s e s t & e s e d i s e a s e s t o c & i d r e n a n d a d u t s .! n o w i n g t & e s p e c i @ c a t e r a t i o n s i n t & e b o d y , w e s & a r p e n e d o u r a s s e s s m e n t s = i s a n d & a d a = e e nm i n d . D o i n g t & e a p p r o p r i a t e n u r s i n g i n t e r % en t i o n s p r o % e d u s t & a t w e a r e c a p a b e o - & a n d i n g t & i s= i nd o - c a se a n d t & a t w e a re o p t t o g i %e t & e b e st c a re . D ea in g w i t & b o o d i s % er y c r uc i ae sp ec ia y w it & t &e p re se nc e o - b o od a bn orm a it ie s. ?e s &o u d p re %e nt o ur se % es - ro mc o n t a m i n a t i o n. T & a t i s t & e r e a s o n b e & i n d e > er c i s i n g o u r n u r s i n g s = i s . ? e a r e s o g r a t e - u t & a t w ea r e g i % e n t & i s t y p e o - c a s e a n d o u r p a t i e n t t o g e t & e r w i t & & i s p a r e n t s c o o p e r a t e d t o o u r c a r e . ? ea r e & a p p y t & a t t & e y p e r m it t e d u s t o p r es e n t t & e ir s o n s c a s e - o r t & e b e n e@ t o - e a rn i n g u p o nassu r an c e o - c on @ d e n t i a i t y . $ t & as b e e n a 4 ou r n e y t & r ou g & i - e .

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?e , ! r i s t i n e an d $ %an , t & i r d ye ar n u r s i n g s t u d e n t s o - S i iman 2n i%e r s i t y a r e & on or e d t o & a%e g i %e n

su c & op p or t u n i t y i n s t u d y in g an d p r e se n t i n g t & i s c ase . T& i s c ase s t u d y & e p e d u s b r oad e n ou r

= n o w e d g e , e n &a n c i n g o u r s = i s a n d i m p ro % e d o u r a t t i t u de s . T & i s s t u d y a s o m o d e d u s t o b e a

b e t t e r s t u d e n t s an d n u r se s i n t & e -u t u r e . $ t a so & e p e d u s r e a i e & ow g r a t e -u we a r e t o b e i n

t & i s w o r d a n d & o w w e s & o u d b e t & a n = - u t o " o d a n d - a m i y w & o & a % e s a c r i @ c e d e % e r y t & i n g - o r u s .

T & ro u g & t & i s e>p e r i e n c e , w e w o u d a s o i =e t o t & a n = t & e - o ow in g p e op e b e c a u se w i t & o u t

t & e m t & i s wou d n o t b e mad e p oss ib e . i r s t , we wou d i =e t o t & an = " od -o r g i % i n g u s t & i s sp e c i a

i - e t & a t we we r e ab e t o r e ac & t & i s s t ag e an d -o r t & e g u id an c e t & r ou g & ou r 4 ou r n e y i n i - e S e c on d ,

- o r o u r - a m i i e s - o r b e i n g % e r y s u p p o r t i % e a n d u n d e r s t a nd i n g T & i r d , o u r b e o % e d . $ M s . D a w n

J a n i c e A. T i e m p o - o r t e a c & in g u s t & e g o od w a y s a n d m o d e d u s a s a b e t t e r p e r so n o u r t & , - o r t & e

N O 5 ; 5 e d i a t r ic s t a s - o r a o w i n g u s t o b e e > p o s e d i n t & i s r o t a t i o n i - t & , w o u d b e o u r c a s s m a t e s

w& ose a ways t & e r e -o r u s t & r ou g & t & i c = an d t & in A n d as t y , wou d b e ou r p a t i e n t J o& n ar o

M a & i n a y A g u s t i n o a n d & e r - a m i y w & o g a % e - u y t & e i r p a r t i c i p a t i o n a n d c o o p e r a t i on . T & a n = y o u .

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B a c = , J o y c e P ; a w = s , J a n e ; . G ( ) ) 6 H . M e d i c a 7 s u r g i c a n u r s i ng : c i n i c a m a n a g e m e n t - o r

p os i t i %e ou t c ome s . 8 t & e d . S t L o u i s , M i s s o u r i , 2 S A : < s e % i e r $ n c .

D e g i n , J u d i t & ; . G ( ) ) 6 H . D a % i s C s D r u g " u id e o r Nu r se s 9 t & e d . 5& i ad e p & ia : ? .B . S au n d e r s ,

o m p a n y

D oe n g e s , Ma r i yn n < . G ( ) ) 3 H . N u r se C s 5oc =e t " u id e . 9 t & e d . op y r i g & t b y .A D a% i s omp an y

< n c ar t a < n c yc op e d ia 5 r e miu m S u i t e . G ( ) ) 8 H

" or r i e , T .M .e t .a . ou n d a t i on s o - m at e r n a n e wb or n n u r s i n g . 5& i ad e p & i a : ? .B . S au n d e r s ,

o m p a n y

;oc =e n b e r r y , M . J . G ( ) ) 6 H . Won g !s & sse n t i a l s o f 'e d ia t r i c (u r s i n g . G 8 t & e d H . < %e s i e r : Mosb y

M a r i e b , < . ( ) )) . & s s e n t i a l s o f ) u m a n A n a t o m y * ' h y s i o l o g y G ' t & < d . H 5 e a r s o n < d u c a t i o n A s i a

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M c a n c e , ! . P ; u e t & e r , S . G + 9 9 3 H . 'at h op h ys i o l og y . ( n d e d . 2 .S .A . : Mosb y 7 Ee ar B oo= , $ n c .

Mosb y C s p oc =e t d i c t i on ar y o - me d i c i n e , n u r s i n g an d a i e d & e a t & G 3 t & d . H . G ( ) ) ( H .

O d s , S a y e t .a . G + 9 9 * H Mat e r n a 7 n e wb or n n u r s i n g . G 6 t & e d H . A d d i so n 7?e s e y : Ne w Eor = .

5 i i t e r i , A d e e . G + 9 9 9 H . Mat e r n a an d Ne wb or n & e a t & c a r e . ( n d e d . L i p p in c o t t : 5& i ad e p & ia

?on g , D on n a L . G + 9 9 9 H . Wh ale y a n d Won g !s n u r s i n g c a r e o f i n fan t s an d c h i l d r e n . ' t & e d .

M i s s o u r i , 2 S A : M o s b y , $ n c .

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