CASE PRESENATATION

HISTORY COLLECTION

 IDENTIFICATION DATA

Name: Baby Amishka

Age: 8 years
Sex: Female
Religion Hindu
Weight: 21kg
Height: 138 cm
Father’s Name: Mr. Danveersingh
Mother’s Name: Mrs. Bhankumari
Date of birth: 01. 01. 16
Date of admission: 24.03.23
Language: Hindi
Registration No: 138775
Unit/Ward: Post Operative surgical ward
Bed No.: 07
Hospital: GMH rewa
Diagnosis: Sub Acute Intestinal Obstruction
Address: nirala nagar, Rewa

 Chief Complaints: Baby Amiksha says thatAbdomen pain with distension since 3 days
no passing in flatus & motion for 3 days with low grade fever since 7 days
 Present medical history: As per the history of parents, BabyAmiksha is admitted to
Kamala Nehru Hospital with the complaints ofabdomen pain & tenderness, no passing
motion after operation with moderate fever present.
 Present surgical history:Baby Amiksha is surgical correction of laparotomy with right
side illiocecalresection .
 Past medical history: Baby Amiksha had no past medical history but same time she
affected with common cold.
 Past surgical history: BabyAmiksha had no any past surgical history.
NATAL HISTORY

Pre-Natal History

Mother of Baby Amikshawas healthy during pregnancy. She had antenatal check up. She
has taken two doses of injection tetanus toxoid.She has taken folic acid & iron
supplementary for 3 months. The mother had no history of fever, rashes, diabetes mellitus,
and hypertension during her pregnancy

Intra-Natal History
Baby Amiksha first child of her parent born on 01.01.06. by normal vaginal delivery
atdistrict hospital. Baby cried few seconds after birth.Apgar score at 1 minute 8/10 and
after 5 minutes Apgar score was 9/10. There was no complication during birth.

Post-Natal History
Breast feeding was initiated after one hour of her delivery. The birth weight was 2.6 kg. the
child not affected with any post natal infection and complaints.

 FAMILY HISTORY

Baby Amiksha Family consist of four members, father mother and two children, There is no
history of familial diseases like diabetes mellitus, hypertension.

FAMILY TREE

43y
45y

14y 10y

Key word= Male

= Female
 = Patient child

Socio economic history: Baby Amiksha belongs to a middle class family. They have pakka
house with good ventilation. They have three rooms including latrine bathroom. Father is a
private school teacher. He is the only earning member in the family. The family income is
about 10,000/ month.
Disposal of garbage: The disposal of garbage is in open place

Water supply: Baby Amiksha family get water supply from the hand pump for the drinking
and for the household work.

Developmental history:

Physiological development

Features In Book In Child

Weight 32- 35 kg 21 kg

Height 138.5 cm 138cm

Pulse Rate 90 -100beats/ min 124beats/min

respiration rate 22 breaths/min 28breaths/min

Featues In Book In child
 Gross  Rides bicycle without training  Master Amiksha rides two
Motordevelopment  Runs, jumps climbs bicycle
 Constantly in motion  Able to run & jumps
 Child feels tired ,not
 Coordination improving constantly moving
 Coordination doing and
saying is improving
 Fine Motor
development  Knows right from left hand  Knows right from left hand
 Draws a person with 12-16 parts  Able to draw 12- 16 part
 Print words, learns cursive writing  She is able to write, print
word learns
 Has improved eye hand  Eye hand coordination is
coordination present
 Self care
 Improved his eating
 Feeding skill  Improves table manner  Speaks less while eating
 Less talking while eating  She has wash the hands
 Grooming & before eating
dressing skills  Needs to be reminded to wash  She has to wear own
hands clothes & dressing
 Needs some help with dressing  Whatever mother selects
 Wears whatever is selected by to wear she wears
parents  Wherever he removes
 Leaves clothes where they are clothes leaves there
removed  Master Amiksha brushes
 Can brush & comb hair by himself

 Psychosocial
development  Sense of industry  Sense of industry
 Enjoy doing socially useful works  Enjoys doing work for any
for others others family member
 Craves attention  By keeping quite seeks
 Become egocentric attention
 Insist on being first in everything  Same time egocentric
 Returns to temper tantrum-may  Considers everything as
use verbal, physical attack his own
 When she get things when
asked he returns to temper
tantrum
  Child develops new interest &
 Psychosexual social abilities
development  Interacting with others
 Less egocentric develops social interest
 Associate with the same sex peer
 Child is still in egocentric
 Tend to ignore members of the  Plays with the same sex.
opposite sex. group
 Master Amiksha mingles
less with the opposite sex
group.-

 Intellectual Preoperational thought

development
 Can describe an objects in picture  Able to recognize the
knows their use picture & it’s use
 Can see differences more than  Can differentiates between
similarities the similarities
 Can, time ,date ,name of the month  Able to say the day date
 Learns to read  Able to learn to
 Follows rule to avoid punishment readpunishment so follows
the rule.
 Moral development Conventional morality
 Child learns to conform the group  Child tries to confront the
 Child conform to rule to please group
others  Tries to please the other.

 Spiritual Mythical  Child folds his hand & says

pranam,
 Bows his head before god
 Language  Responds to praise & recognition
development  Has vocabulary of 2500 words  Feel happy when praise is
 Uses all forms of sentence given
structure  Has more vocabulary
 Develops a sense of humour -
 Play enjoys telling stories  He enjoys listening stories.
 Likes to play rough & tumble play
 Loves active play Master Amiksha enjoys
 Prefers group play playing with the peer group.

Dietary history:Master Amikshatakes threetimes meals and in between snacks. She does
not have allergic to any types of foods. He likes sweet things more to eat.
 Immunization schedule

Age Vaccine Dose Route Amount Remark

At Birth  BCG Single Intradermal 0.05ml Received

 OPV Zero dose Oral 2 drops Received

6 weeks  DPT-1 1st Intramuscular 0.5 ml

 OPV-1 1st Oral 2 drops Received
 Hepatitis- B 1st Intramuscular 0.5ml

10 weeks  DPT-2 2nd Intramuscular 0.5ml

 OPV -2 2nd Oral 2 drops Received
 Hepatitis B- 2 2nd Intramuscular 0.5 ml

14th weeks  DPT-3 3rd Intramuscular O.5ml

 OPV-3 3rd Oral 2 drops Received
 Hepatitis B-3 3rd Intramuscular 0.5ml
9 Months  Measles Single Subcutaneous 0.5 ml
dose Received
 MMR 1st dose Subcutaneous 0.5 ml

16-24 DPT Booster Intramuscular 0.5 ml Received

months
OPV Booster Oral 2 drops

5-6 years DT Single Intramuscular 0.5 ml Received

Physical History

Parameters In book In child

 Weight 32 - 35 kg 21 kg

 Height: 138.5 cm 138cm

 HEAD TO EXAMINATION

 General appearance  Body Built : Moderate body built

 Look/Appearance: Weak
 Mental status : Conscious
 Movement /Activities: Dull
 Posture: normal
 Skin colour: fair
 Movement/Activities: lethargy

 Vital Signs  Temperature: 100.50F

 Pulse: 100 beats/min
 Respiration: 22 breath/minute
 Blood Pressure: 100/60 mmHg

 Integumentary system  Colour: white

 Texture: Soft
 Skin turgor: Dehydrated
 Skin lesion: Not present

 Nails  Shape: Flat

 Capillary refilling: < 2 seconds

 Head  Shape: normal

 Hair colour: Black
 Scalp: No injury, scalp is clean
 Fontanelles: Closed.
 Posterior: fontanel is closed.

 Shape is symmetrical, no facial puffiness

 Face  Expression: Dull

 Symmetry: Symmetrical in size and shape.

 Eyes  Eye lids: not oedematous
 Eye Lashes: No infection is present
 Conjunctiva: no infection
 Sclera: Sclera’s of both eyes are white. .
 Cornea: No sclerocornea is present
 Pupil: Reacts to light
 Vision/Visual acuity: Clear and good
 Ocular muscles: No squint eye is present
 Eye movement: Eye movements are present.
 Nose  Nasal bridge: Deviation of Nasal bridge is present
 Nasal septum: normal midline septum is present
 Nasal mucosa: Pink
 Nasal polyp, discharge: No polyp or discharge is
present
 Para-nasal sinuses: present
 Ear
 Position /alignment: Symmetrical in size
 Shape, hearing acuity: Normal in shape. Baby is able to
hear.
 Pinnae are normal in shape and contour.
 Mouth and throat
 Lips: Pale in colour
 Tongue: dried
 Teeth: all teeth present
 Mucous membranes: Pink
 Pharynx: No infection
 Tonsils: No congestion or enlargement.
 Neck
 Holding: Able to hold the neck
 Range of motion: Possible
 Lymph nodes: Not palpated
 Thyroid: Not enlarged
 Trachea: Normal
 Distended neck vein: Distended
 Chest  Movements: Symmetrical Movements
 Symmetry of expansion: Symmetrical expansion of chest
 Shape: Normal in shape, measures42cm.
 Heart rate: 94 beat/minutes
 Respiratory rate is 22 beats/min
 Respiratory murmur: No crepitating sound is heard
 Cardiac murmur: Not heard
 Heart sound S1 and S2 heard
 Abdomen  Inspection: abdomen is distended present
 Palpation: Spleen is not palpated
 Percussion: No abnormal fluid collection
 Auscultation: Bowel sound is not present in the left
lower quadrant, remain quadrant present normal
bowel sound
  Upper extremities  Symmetry: Symmetrical in shape and size.
 Range of motion: possible
 Oedema: Not present
 Pain : No pain
 Joints: It is flexible, range of motion is possible
 Lower extremities
 Symmetry: Symmetrical in shape and size
 Range of motion: Possible
 Oedema :Pedal oedema present
 Pain: No Pain
 Back and spine Hips: No deformity is found

 Genitalia  Congenital abnormality: No spina bifida or

meningomyelocele

 Rectum and anus  Urethra opening is in normal place.

 No hypospadias and epispadias
 Fecal incontinence and repeated feeling of motion is
present

 No congenital abnormalities are found

FOCALSYSTEMIC ASSESSMENT

 Inspection: Abdomen is distended Present, , scar is present

 Auscultation: Bowel sound is not present in the left lower quadrant, remain quadrant
present normal bowel sound.
 Percussion: Abnormal sound of collection of fluid is heard
 Palpation: No liver & spleen is palpable
LAB INVESTIGATION

DATE NAME OF PATIENT VALUE NORMAL VALUE REMARKS

INVESTIGATION
23/03/15 Total leukocytes 11500/cu /mm 4000-11000/cu increased
count /mm
WBC
(differential count)
Basophil 00% 0-1% Decreased
Eosinophils 4.5% 1-6% Normal
Lymphocytes 20% 20-45% Normal
Monocytes 0.5% 2-10% nnormal
Neutrophils 75% 40-75% Normal
Urea 15mg/dl 10-50mg/dl Normal
Potassium 4.7mmol/l 3.5-5.5mmol/l Normal
Hb 10 gm/% [13-18]gm% Mild
Anemia
Platelet count 1.60 lakh/cu 1.5-4.5lakh/cu Normal
Glucose blood 126 mg/dl 70-140mg/dl Normal
Sodium 138 mmol/l 130-150 mmol/l Normal
Antibodies to HIV Non-reactive Negative Normal
Creatinine 1.83mg/dl 0.6-1.4mg/dl Increased
E.S.R 40mm/hr 0-10mm/f Increased
CTBT
Low intensity 2.0 - 3.0
High intensity 2.5 - 3.5
Bleeding time 2.15 sec 2-5sec Normal
Clotting time 5.40 sec 4-5 sec Increased
Alkaline phosphate 71U/L 15-47U/L Increased
 Name of the Pharmacolo Dos Route Frequ Mode of action Contraindicatio Side effects Nurses
medication gical name e ency ns responsibility
1. .Inj.Dynapar Diclofenac 50 I/M SOS Inhibits Allergic to CNS: Assess B.P, pulse
AQ sodium mg prostaglandins NSAIDs, Dizziness,dro if systolic B/P
synthesis to significant renal wsiness , drops 20 mmHg
cause impairment,pre confusion , hold product
antipyretic and gnancy,lactation. headache notify
anti – anxiety , prescriber.
inflammatory tremors. Administer with
effects; the CV: cardiac food or milk for
exact arrest , GI symptoms.
mechanism is hypotension
unknown. INTEG: rash ,
dermatitis ,
itching
2. Inj. Pantop 40 I/V OD Suppresses Hypersensitivity CNS: Assess bowel
Pantoprazole mg gastric secretion Dizziness,dro sound q8 hr,
by inhibiting wsiness,conf abdomen for
hydrogen / usion, pain,swelling,
potassium headache anorexia Teach
ATPase enzyme anxiety, not take more
system in tremors. than prescribed
gastric parietal GI: diarrhoea amount.
cell; , abdominal Teach to report
characterized as pain , severe diarrhoea
gastric acid flatulence product may
pump inhibitor, INTEG: rash have to be
since it blocks discontinued
final step of acid discontinue.
production .
 SUB ACUTE INTESTINAL OBSTRUCTION

INTRODUCTION:
The major events of digestion and absorption occur in long tubes called the small
intestine, because most digestion and absorption of nutritient occur in the small intestine.
Its structure is specially adapted for these functions. It length along provides a larger
surface area for digestion and absorption and that area is further increased by circular
folds, villi, and microvilli

DEFINITION:-

“Intestinal obstruction is the partial or complete blockage of the intestines at one or more
locations. Obstructions prevent liquids and solids from passing through the digestive tract.
There are a variety of causes”.

- Dorothy R Marlow

ANATOMY OF THE SMALL INTESTINE:

The small intestine is continuous with the stomach at the pyloric sphincter and
leads into the large intestine at the ileocecal valve. It is a little over 5 meters long and lies in
the abdominal cavity surrounded by the large intestine. The small intestine devided into
three regions continuous with each other.
1. duodenum
2. jejunum
3. ileum

1. DUODENUM
It is the shortest region, is retroperitoneal. It starts at the pyloric sphincter of the
stomach and extends about 25 cm (10 inch) until it merges with the jejunum. It curves
around the head of pancreas. Secretion from the gall bladder and pancreas are released
into the duodenum through a common structure, the hepatopancreatic ampulla and the
hepato pancreatic sphincter guards opening.

2. JEJUNUM
It is the middle regions of the small intestine and is about 2 metres longs.
3. ILEUM
It is final and longest region of the small intestine about 3 meters long and ends at
the ileocaecal valve, which controls the flow of material from the ileum to the caecum.

STRUCTURE:
The wall of the small intestine are composed of the four layers of tissue.

1. Peritoneum
It consists of the loose fibrous tissue and covered by a serous membrane. A double
layer as peritoneum called the mesentery attaches the jejunum and ileum to the posterior
abdominal wall. The large blood vessels and nerves lies on the posterior abdominal wall
and the branches to the small intestine pass between the two layers of the mesentery.

2. Muscular layer
With some exceptions, this consists of two layers of smooth (Involuntary) muscle.
The muscle fibres of the outer layer are arranged longitudinally between these two muscle
layers are blood vessels, lymph vessels and a plexus of sympathetic or parasympathetic
nerves called the myenteric. Contraction of smooth muscle is called peristalsis and it helps
in mix the food with digestive juices. Onwards movement controlled at various point by
sphincters consisting of circular muscle fibre which allow time for digestion.

3. SUBMUCOSA
This layer consists of loose connective tissue with some elastic fiber. Within this
layer or plexuses’ of blood vessels, nerves, lymph vessels and varying amount of lymphoid
tissues. The blood vessels consist of arterioles, venules and capillary. The nerve plexus is
the sub mucosal or Meissen’s plexus, consisting of sympathetic and parasympathetic nerve,
which supply the mucosal lining.
4. MUCOSA
It consist of three layers
a). Mucus membrane:
It is formed by columnar epithelial cell
b). lamina propria:
It consisting of loose connective tissue
c). muscularis mucosa:
It is thin outer layer of smooth muscle.
The surface are of the small intestine mucosa is greatly increased by permanent circular
folds, villi and microvilli.

The mucosa forms a series of finger like villi projection that are 0.5 – 1 mm long. The
larger number of villi (20 -40 per square mm) vastly increase the surface area of
epithelium for digestion and absorption and gives the intestinal mucosa a velvety
appearance. Each villus has a core of lamina propria (Areolar connective tissue). Their wall
consist of columnar epithelial cell or enterocytes, with tiny microvilli (1 m long)

The columnar epithelium that contains absorptive cells, goblets cells entero
endocrine cells.
Goblet cells that secrete mucus are interspread between the enterocytes. These epithelial
cells enclose a network of blood or lymph capillary. Lymph capillaries called lacteals
because absorbed fat gives the lymph milky appearance. There are an estimated 200
million microvilli per square mm of small intestine.

The mucosa contains the intestinal glands (crypts of lieberkuhn) and secretes
intestinal juice. Paneth cells, found in the deepest parts of the intestinal glands, secrete
lysozyme, a bactericidal enzyme and are capable of phagocytosis. These are three type of
entero endocrine cells, also in deepest part of the intestinal glands, secrete hormones:
secretin (by S cells), cholecystokinin (by CCK cells), and glucose dependent insulinotrophic
peptide (by K cells)

Numerous lymph nodes are found in the mucosa at irregular intervals throughout the
length of the small intestine. The smaller ones are known as solitary lymphatic follicles,
and about 20–30 larger nodes situated towards the distal end of ileum are called
aggregated lymphatic follicles (peyer’s patches). These lymphatic cells packed with
defensive cells.

BLOOD SUPPLY:
The superior mesenteric artery supply the blood to whole intestine, and venous
drainage is by the superior mesenteric vein which joints other veins to form the portal vein.

NERVE SUPPLY:

Innervation of the small intestine is both sympathetic and parasympathetic nerve.

INTESTINAL JUICE:
It is a clear yellow color fluid secreted in amounts of 1 – 2 liters a day. It contains –
Water
Mucus
Mineral salts
Enzyme: enterokinase (entropeptidases).
The PH of intestinal juice is usually between 7.6– 8.0.

FUNCTIONS OF THE SMALL INTESTINE

1. MECHANICAL DIGESTION

Two types of movements of the small intestine segmentations and a type of

peristalsis called migrating motility complexes (MMC). Segmentation is localized mixing
contractions that occur in portions of intestine distended by a large volume of chime.
Segmentation mix chime with digestive juices and brings the food particles into contacts
with the mucosa for absorption. Segmentations occur most rapidly in the duodenum, about
12 times per minutes and progressively slow to about 8 times per minute in the ileum. The
 type of peristalsis that occurs in the small intestine, termed as migrating motility complex
(MMC) begins in the lower portion of the stomach and push chime forward small intestine.

MMC slowly migrates down the small intestine,

reaching the end of ileum in 90–120 minutes then another MMC

begins in the stomach. Altogether, chyme remains in the small intestine for 3 – 5 hours.

CAUSES

In book In child

Mechanical obstructions physically block

the small intestine. This can be due to:

 Adhesions:  I observe through the x-ray that patient

had no adhesion
 Volvulus: twisting of the intestines
 She feels that twisting of the intestine.
 Intussusceptions:
 No intussusceptions only for reduction of
 Malformations of the intestine ileoceacal.

 Gallstone (rare)  Absent

 difficulty in Swallowing  Master amiksha say that she have

difficulties swallowing & sore throat.
 Hernias:  No herniation of the abdominal muscle

 Crohn’s disease

 Impacted stool

 Volvulus and intussusceptions;-  Sonography show the volvulas.

 Diverticulitis&Stricture:
 Signs and symptoms

In book In child
 Severe abdominal pain Pain present around the umbilical region.

 Cramps that come in wave Patient have no complaints of abdominal cramps

 Bloating

 Nausea and vomiting Patient have complaint of vomiting 3-4 times

 Diarrhoea The Child is having diarrhoea

 Constipation, or inability to have a Baby Amiksha says that I have a constipation with
bowel movement abnormal bowel sound

 Distension or swelling of the During physical assessment I found that the child is
abdomen having distension and tenderness is present.

 Loud noises from the abdomen

 Foul breath

DIAGNOSTIC EVALUATION

IN BOOK IN CHILD
 History of illness  History of illness is taken

 Physical examination  Physical examination done

 GI endoscopy  Endoscopy shows thevolvulas&

narrowing the iliac part.

 Barium swallow  Barium Swallow shows that gasses

present in intestine.
 Ultrasonography
 USG show the divertuculas
 MRI images
 MRI not did.
 X-Ray
 X-rays show gasses movement in the
abdomen.
TREATMENT

IN BOOK IN CHILD
Medical treatment
– Crystalloid infusion followed by blood  Inj. Cefotaxime1 gm Q8h
replacement  Inj. Amikacin 170mg 12 h
– Vitamin K  Inj. Metrogyl 45 mg 8 h
– Infusion of fresh frozen plasma  Inj. Dynapar IQ sos
– H-2 receptors antagonist Such as  Inj. Pantop. 40 mg
pantaprazole
 Surgical treatment
Leparotomy Lerarotomy done by ileocecal resection
Operation procedure Leparotomy with ileocecal
Site of operation Right side ileocecal

PATHOPHYSIOLOGY

Due to aganglionic cells in the affected colon

Absence of peristaltic movement

Dilatation of bowel and abdominal distension

Sequestration of fluid and gas proximal to obstruction

Fluid shift out of bowel into peritoneum perforation

Irritation of peritoneum (peritonitis)

Vascular shift into peritoneal cavity

Clinical feature ie: Hypovolemia, dehydration and shock

NURSING NEED
 Need for personal hygiene
 Need for medication
 Need for supportive position
 Need for health education

LIST OF NURSING DIAGNOSIS

 Increased body temperature (hyperthermia) related to peritonitis as evidenced by

rise in temperature above normal
 Fluid volume deficit less than body requirement related to less intake of fluid as
evidenced by vomiting.
 Imbalanced nutrition less than body requirementrelated to anorexia as evidenced
by lose of weight.
 Activity intolerance related to fatigue as evidenced by not able to walk.
 Risk for skin integrity related to compromised immunologic status, poor nutrition
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS
Subjective Increased body Baby Amiksha Assess the  Assessed the  Helps to Reading of
temperature body temperature thermometer within
data condition of condition of obtain base
(Hyperthermia) will be normal limits reveals
Mother related to maintained child. child. line data. that Master amiksha
infection as within normal is maintaining
ofAmiksha Remove extra  Checked vital
evidenced by limits normal body
complaints that rise in body cloths signs  Provides temperature.
temperature
her daughter Provide cold - Temp: 100.5° F. base line
above normal Temperature is 98.4
is having fever limits. sponging to the - Pulse-100/min data for F
Objective data: child. - Resp.-22/min plan of care.
body is warm to Administer  Extra blanket  Promotes
antipyretics
touch. removed cooling
Temperature - Opened the effect
checked doors &  Tepid
Temp. 100.5°F windows Sponging
Pulse-100/min - Tepid sponging reduces
Resp.22/min done fever
 Administered
antipyretic as  Aids in
prescribed. lowering
the body
 Syp.Crocin 5 ml temperatur
Po given e
Assessment Nursing diagnosis Goal Intervention Implementation Rationale Evaluation
Subjective  Activity Child will  Assess nutritional  Assess nutritional  he decline in Baby amiksha is
intolerance demonstrate needs associated body mass, able to participate
data needs associated
related to fatigue, increased with activity with in physical
Mother of general debility, tolerance to intolerance. with activity physical activity.
muscle as activity by weakness,
Amiksha intolerance.
evidenced by discharge. inhibits
verbalizes Physical .  Provide  Provided mobility
that her weakness emotional emotional support  Fear of
support and and falling may
daughter encouragement encouragement to decrease
gets soon to the client to the child to willingness
gradually gradually increase to increase
tired increase activity. activity. activity
 This can be
Objective  Monitor vitals  Monitored vitals caused by
before and after before and after temporary
data any activity, any activity, noting insufficiency
noting any any abnormal of blood
On
abnormal changes. supply
observation changes.
- Temp.-100.5°F  Encouraging
child is
- Pulse -100/min the child to
physically  Encourage child - Resp. _22b/min walk will
to walk - Bp.100/60mmHg increase the
weak
mobility by
 Encourage child to helping child
walk by holding to overcome
the hand limitation
Nursing Nursing Goal Planning Implementation Rationale evaluation
assessment Diagnosis
Subjective Imbalanced The child will  Assess the  Assessed nutritional  Insufficient  The child
data nutrition less receive nutrition status status of child intake can lead is
Mother of than body nutrients of the child - Hb% 10 gm/dl to impaired receiving
Amiksha requirements needed for  Teach the - Weight- 21 kg growth and adequate
verbalizes that related to normal family dehydration. nutrition
 Teach the family
child is not anorexia as growth. techniques to  Special as
techniques to promote
interested in evidenced by promote caloric techniques can evidence
caloric& nutrient
eating &she lose of weight and nutrient facilitate food by
has lost his age intake intake. physical
 Provide food appearanc
 Provided food in small
Objective data frequently in e
amount frequently like  Increase the
Baby Amiksha small amount
dalia skimmed milk, appetite
is refusing to
kanjee, etc.
eat. she is thin  Provide - Used soft and blended
Weight-21 kg according his
foods.
Hb%-10 gm/dl likeness and
- Food served according
dislike
to his likeness  Increase the
- Served in attractive interest of

way eating.
HEALTH EDUCATION

 Nutrition  Educated mother to provide low fat diet

 Advised parents Avoid give spicy & fast food for the child
 .Encouraged mother to give foods which is easily digestible like
kanjee,Dalia, green leafy vegetable.

 Medication  Advised caregiver to give medication as per doctor’s order

 Observe for any side effect of the medication
 If any adverse reaction of medication immediately report the
physician.

 Prevention of
 Explained parents to prevent the child from infection
infection
 Explained about the importance of personal hygiene,
 Advised parents to bring thechild for follow up check up as per
 Follow up
the doctors advised.

Summary
Baby Amiksha was brought with the complaints of abdomen distention with vomiting
bileness since 3 days & no passing flatus and motion since 4 days . Child’s general condition
is weak. Fever has reduced there is no bloody stool after the medication. The treatment is
continuing.
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