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    Acute Gastro

    enteritis

    ( )ageA Group 4 GIT Concept CasePresentation

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    I. INTRODUCTIONAcute Gastroenteritis (AGE) astroenteritis is a catchall termor infection or irritation of the,igestive tract particularly the.tomach and intestine It is frequentlyeferred to as the stomach or intestinal,lu although the influenza virus is not

    .ssociated with this illness Major,ymptoms include nausea and vomiting, .iarrhea and abdominal cramps Theseymptoms are sometimes also accompanied.y fever and overall weaknessastroenteritis typically lasts about.hree days Adults usually recover, ,ithout problem but children the,lderly and anyone with an underlyingisease are more vulnerable to.omplications such as dehydrationastroenteritis arises from ingestion of

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    ood that has spoiled may also cause.llness Certain medications and excessivelcohol can irritate the digestive tract to.he point of inducing gastroenteritis,egardless of the cause the symptoms of,astroenteritis include diarrhea nausea and, .omiting and abdominal pain and cramping,ufferers may also experience bloating low, . ,ever and overall tiredness Typically the,ymptoms last only two to three days but.ome viruses may last up to a week A usualout of gastroenteritis shouldn't require a. ,isit to the doctor However medicalreatment is essential if symptoms worsen or. ,f there are complications Infants young, ,hildren the elderly and persons with

    nderlying disease require special attention.n this regard The greatest danger.resented by gastroenteritis is dehydrationhe loss of fluids through diarrhea andomiting can upset the body's electrolyte, -alance leading to potentially lifehreatening problems such as heart beat( ).bnormalities arrhythmia The risk ofehydration increases as symptoms are

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    ehydration should be suspected if a, ,ry mouth increased or excessive thirst or.canty urination is experienced If symptoms,o not resolve within a week an infectionr disorder more serious than.astroenteritis may be involved Symptoms of( reat concern include a high fever 102[ . ] ),38 9 C or above blood or mucus in the, ,iarrhea blood in the vomit and severe.bdominal pain or swelling These symptoms.equire prompt medical attention-astroenteritis is a self limiting illness. ,hich will resolve by itself However for,omfort and convenience a person may use- -ver the counter medications such as Pepto

    .ismol to relieve the symptoms Theseedications work by altering the ability ofhe intestine to move or secrete, ,pontaneously absorbing toxins and water.r altering intestinal micro flora Some- -ver the counter medicines use more than one.lement to treat symptoms

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    II. Patients Profile

    . . , / ,Q is a female 11 12 months old, .esiding at Pacac Guimba Nueva Ecija Her. . ,other is J Q works part time in a shop and. . , .er father is R Q factory worker She has, . ., .ne sibling older than her K Q 3 years old. . , ,Q was born on March 6 2009 and born at, ,acac Guimba Nueva Ecija Filipino in.ationalityheir whole family is Born Again in. . . eligion She weighs 8 7 kg She s admitted, - ,n August 12 2010 Thursday at room 103 Cedia ward with chief complaint of highever for 2 days with emesis and has a.iagnosis of Acute Gastroenteritis And shewas , ,ischarged on August 19 2010 Thursday at: . .30 pm Their attending physician were Dr. . . . .agunilla M D and Dr Zablan M D

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    III. Health History & ChiefComplain

    Chief Complaint he was admitted for having high.ever for 2 days with vomitingPresent Illness . .Q was only admitted to theospital due to gastrointestinal problemow and was alsouspected of urinary tract infection by. . ,r Lagunilla Aside from the diagnosiso otherisease or complication was seen or.iagnosed

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    Past Health History Mrs. Q says eto first time nya ma-

    admit after nya ipanganak. S.Q. getsseasonalcough and colds at times but never seriousbecause it usually last only for a few days.

    They

    always consult their doctor once sick. She iscomplete in her vaccinations except thosewhichwould be taken on her 1 year of age.

    Family Health History No one in the family had any respiratory

    illness or allergies. On her fathers side,almost everyone have hypertension. Onemember of their family died on a heart attack.

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    IV. Gordons PatternHealth Perception . , s Mrs Q stated lagi naman kami.agpapacheck up ni stephani Napuntatalaga kami. .ay Dr Lagunilla Malikot lang talaga yan pero. . .naalagaan yan sa bahay S Q has a mannerism of.ticking anything on her mouth Whatever she.ouches she directs it toward her mouth, lthough she doesn t practice hand washing everynow

    .nd then There are some medications she takesasily but there are also those medications.hich is hard for her because of the taste

    Nutritional-Metabolic . . . . .Q weighs 8 7 kg She eats soft foods

    - . .he drinks 6 7 bottles of milk in a day Mrs provides her daughter milk and food in .ccordance to age and doctor s advice She.rinks formula milk She stop being.reastfed when she was 10 moths She has.o allergy

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    Elimination he defecates once or twice a day in her. -sual days She changes diaper 3 5 times in a.ay when full or had defecated She was adviseo use Lactacid for her perennial wash and.almoseptin ointment on her diaper rashActivity-Exercise . . .Q is a very playful and active girlhe has lots of energy but cries when she .oesn t like something She smiles and

    . , ,aughs a lot Her coordination gait balance.s not yet stable due to age Her dailyiving activities were provided by her.arents There is no musculoskeletal.mpairment She usually plays after she.akes up in the morning

    Sleep-Rest . .he sleeps at 8 P M in the evening. . . .nd usually gets up 7A M 8 A M in.hemorning After playing or eating she.akes a nap She has straight.ndisturbed sleep atnight

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    Cognitive Perceptual . . .Q has no sensory deficits She responseell to verbal stimulus by looking at you or. aving facial expressions Bibo nga yan bata na,an makulit pero mabilis mo naman makuha, .ttention as her mother stated

    Self-Perception

    . .Q is not afraid of new people.round her She is friendly and is easy.o accommodate

    Sexual-Reproduction , . .rior to age S Q is not yet oriented with anyexual matters

    Coping Stress

    ,n her age she usually cries when.omething is wrong about her Simple,mile or cry is a sign of her comfort.istress or feelings She isamiliarized to her family members andong for them when she doesn t want theituation like giving ofmedications or

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    Role-Relationship he doesn t know the concept of.eath yet due to age Forms words like .ede and dada She knows her familyembers and can easily familiarize the.eople around her

    Value-Belief .he family is Born Again Theyegularly attend church together with. ll the members of the family They don t .sually believe in hilot Once one is,ick in the family they go immediately- .o the hospital or for check up

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    V. Head-to-Toe Assessment

    rea Assessed Technique ormalFindings ctualFindings Evaluationkin color Inspection ,ight brownanned skin( ery ccording)o race

    rown skin Normal

    ,ips nail,eds solesnd palmsInspection ighterolored,alms ,oles lips

    nd nailbeds

    ighterolored,alms ,oles lipsnd nailbeds

    Normal

    Moisture nspection/ Palpation kin ormallydrykin ormallydry

    NormalTemperature Palpation arm totouch . ,6 4 warmo touch Normal

    : ,General Assessment Playful and active neat

    :Initial Vital Sign = . = =T 36 4 CRR 27PR 118

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    Texture Palpation ,moothoft andlexiblealms andoles( )hicker

    ,moothoft andlexiblealms andoles( )hicker

    Normal

    Turgor Palpation kin snapsackimmediatelykin snapsackimmediatel-1 2

    seconds

    Normal

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    kinAppendagesNails Inspection Transparensmoothnd convexut andclean

    Transparensmoothnd convexncut anddirty

    oorgrooming

    ail beds Inspection Pinkish Pinkish Normalail Base Inspection irm Firm NormalapillaryRefill Inspectio/palpationhiteolor ofail bednder ressurehouldeturn toink -ithin 2 3.econds

    hiteolor ofail bednder ressurehouldeturn toink -ithin 2 3.econds

    Normal

    airDistributionInspection venlydistributed

    venlydistributedNormal

    Color Inspection Black Black NormalTexture Inspectio/palpation

    Smooth mooth andCurly Normal

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    Eyes Inspection arallelo eachotherarallelo eachther butlightlysunken

    ay be aign ofdehydrationisualAcuity nspection( )enlight ERRLAupils quallyoundeact toight andaccommodation

    ERRLAupils quallyoundeact toight andaccommodation

    Normal

    Eyebrows InspectionSymmetrica,in size ,xtensionair exturendmovement

    Symmetrica,in size ,xtensionair exturendmovement

    Normal

    Eyelashes InspectionDistributeevenlynd curvedoutwardDistributeevenlynd curvedoutward

    Normal

    Eyelids Inspection ame colors theskiname colors theskin

    Normallinksinvoluntarly andbilaterallup to 20

    imes perminute

    linksinvoluntarly andbilaterallup to 16imes perminute

    Normal

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    o notover theupil and ,he scleraidsormallylosesymmetrically

    o notover theupil and ,he scleraidsormallylosesymmetrically

    Normal

    Conjunctiva Inspection ransparentith lightink colorransparentith lightink colorNormal

    Sclera Inspection olor iswhite olor iswhite NormalCornea Inspection Transparent, shiny Transparent, shiny NormalPupils Inspection ,lack onstrictriskly,lack onstrictbriskly

    NormalIris Inspection learlyvisible learlyvisible NormalEarsars canalopening Inspection ree of ,esions ischargefinflammation anal wallspink

    ree of ,esions ischargefinflammation anal wallspink

    Normal

    earingactivity Inspection lient ormallyears whenwhisperedlient ormallyears whenwhispered

    Normal

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    Nose,hape sizend skincolor

    Inspection mooth ymmetricith sameolors ashe face

    mooth ymmetricith sameolors ashe face

    Normal

    asal septum Inspection lose toidlinehicker nteriorlyhanposteriorly

    lose toidlinehicker nteriorlyhanposteriorly

    Normal

    Nares Inspection ,val ymmetricnd withoutdischarge,val ymmetricnd withoutischarge

    Normal

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    outh andharynx Lips Inspection ,ink moistsymmetric ,ink moistsymmetric NormaluccalMucosa Inspection listeringink softmoistlisteringink softmoistNormal

    Gums Inspection lightly ,ink coloroist andightly fitgainstach tooth

    lightly ,ink coloroist andightly fitgainstach tooth

    Normal

    Tongue Inspection ,oistlightlyough onorsal urfaceedium dullred

    ,oistlightlyough onorsal urfaceedium dullred

    Normal

    Teeth Inspection ,irmly setshiny ,irmly sethiny Noooth decayNormal

    ard andoft palate Inspection ard -alate dome,hapedoft -alateight pink

    ard -alate dome,hapedoft -alateight pink

    Normal

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    Neckymmetry of ,eck muscleslignment of

    trachea

    Inspection eck is lightlyhyperextend,d withoutasses ofassymertry

    eck is lightlyhyperextend,d withoutasses ofassymertry

    Normal

    horax andLungs Auscultation lear reathsoundslear reathsounds

    Normal

    Abdomen Inspection kin sameolor withhe rest ofhe bodykin sameolor withhe rest ofhe body

    Normal

    owel sounds Auscultation

    licks orurglingoundsccur rregularnd range.rom 5 35er minute

    licks orurglingoundsccur rregularnd range.rom 5 35er minute

    Normal

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    Neurology Inspection ully ,onsciousespond touestions,uickly erceptivef events

    ully ,onsciousespond touestions,uickly erceptivef events

    Normal

    evel ofconsciousnessnstable

    ,ait alancendcoordinationehaviorndappearanceInspection akes eyeontactith ,xaminer

    hyperactiv,xpresses,eelingsith esponseo thesituation

    akes eyeontactith ,xaminerhyperactiv,xpresses,eelingsith esponse

    o thesituation

    Normal

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    VI. Anatomy & Physiology

    igestion is the process by which foods broken down into smaller pieces so thathe body can use them to build and nourish.ells and to provide energy Digestion,nvolves the mixing of food its movement(hrough the digestive tract also known as),he alimentary canal and the chemicalreakdown of larger molecules into smaller.olecules Every piece of food we eat has toe broken down into smaller nutrients that,he body can absorb which is why it takes.ours to fully digest food he digestive system is made up of the.igestive tract This consists of a longube of organs that runs from the mouth to,he anus and includes the esophagus, ,tomach small intestine and large, ,ntestine together with the liver gall, ,ladder and pancreas which producemportant secretions for digestion that.rain into the small intestine Theigestive tract in an adult is about 30 feet.ong

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    outh and Salivary GlandsDigestion - begins in the, .mouth where chemical and mechanical digestion occurs

    ,Saliva or spit produced by the salivary glands( ),located under the tongue and near the lower jaw is

    .released into the mouth Saliva begins to break down,the food moistening it and making it easier to. ( )swallow A digestive enzyme called amylase in thesaliva begins to break down

    ( ).the carbohydrates starches and sugars One of the.most important functions of the mouth is chewing

    Chewing allows food to be mashed into a soft mass that.is easier to swallow and digest later -sophagus ,Once food is swallowed it enters the

    ,esophagus a muscular tube that is about 10 inches.long The esophagus is located between the throat and

    .the stomach Muscular wavelike contractions known as

    peristalsis push the food down through the esophagusto. (the stomach A muscular ring called the

    )cardiac sphincter at the end of the esophagus allows, , ,food to enter the stomach and then it squeezes shut

    to prevent food and fluid from going back up the.esophagus

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    -tomach -a J shaped organ that lies between theesophagus and the small intestine in the upper

    . :abdomen The stomach has 3 main functions to store; ,the swallowed food and liquid to mix up the food

    , ;liquid and digestive juices produced by the stomachand to slowly empty its contents into the small.intestine

    mall Intestine - Most digestion and absorption of

    .food occurs in the small intestine The small

    ,intestine is a narrow twisting tube that occupiesmost of the lower abdomen between the stomach and the.beginning of the large intestine It extends about 20

    .feet in length The: (small intestine consists of 3 parts the duodenum the

    - ), ( ),C shaped part the jejunum the coiled midsection

    ( ).and the ileum the last section The small intestine. ,has 2 important functions First the digestiveprocess is completed here by enzymes and other

    , ,substances made by intestinal cells the pancreas and.the liver Glands in the intestine walls secrete

    .enzymes that breakdown starches and sugars

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    he pancreas secretes enzymes into thesmall ,ntestine that help breakdown carbohydrate, . ,ats and proteins The liver produces bile.hich is stored in the gallbladder Bile(elps to make fat molecules which otherwise) ,re not soluble in water soluble so they. ,an be absorbed by the body Second thesmallntestine absorbs the nutrients from the.igestive process The inner wall of themall intestine is covered by millions of.iny fingerlike projections called villihe villi are covered with even tinier

    .rojections called microvilli Theombination of villi and microvillincrease the surface area of the small,ntestine greatly allowing absorption of.utrients to occur Undigested material.ravels next to the large intestine

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    -arge intestine orms an upside down U.ver the coiled small intestine It begins at-he lower right hand side of the body and ends- .n the lower left hand side The large- .ntestine is about 5 6 feet long It has 3: , , .arts the cecum the colon and the rectum Theecum is a pouch at the beginning of the large.ntestine This area allows food to pass from.he small intestine to the large intestine Theolon is where fluids and salts are absorbed.nd extends from the cecum to the rectum The,ast part of the large intestine is the rectum( )hich is where feces waste material is stored.efore leaving the body through the anus Theain job of the large intestine is to remove( )ater and salts electrolytes from thendigested material and to form solid waste.hat can be excreted Bacteria in the largentestine help to break down the undigested.aterials The remaining contents of the large,ntestine are moved toward the rectum whereeces are stored until they leave the body.hrough the anus as a bowel movement

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    VIII.Course in the Ward , , , :n day 1 January 30 2010 at 8 40. .m S Q is for check up with herttending physician due to high fever.or 2 days associated with vomiting She.as seen and examined by Dra Campos andas advised to be admitted for further.est and treatment due to suspected UTIhe was diagnosed with Acute

    .astroenteritis An IVF D5 INM 500 ml x/ .0cc hr is hooked and CBC was done Sheas brought to pedia ward at around: .1 00 am and received by nurse on chargeonitoring of input and output wasrdered by the doctor with increase.luid intake Medications werearacetamol drops 1ml every 4 hours for.ever 1 dose was given on admission andollowing doses for.very 4 hours was given

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    , , ,n the second day August 13 2010#VF was changed to 2 D5 INM 500 ml x/ : . .0cc hr at 9 50 am She was seen by Dr:agunilla at 10 15 am and given an order.f urinalysis and fecalysis She was( )rescribed with Omeprazole Omepron 5mg,V once a day 1st :ose is given at 8 00. ,m the next morning Also Zinc Sulfate( - ) ( . )Zinc drops 0 6 ml once daily was.rdered Her fever decreases graduallyntil there administration ofaracetamol every 4 hours for fever was.iscontinued She is being given( )eftriaxone Xtenda 750 mg IV once a

    .ay side drip every 12 noon She was.layful all throughout the day The.aboratory results was followed up

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    , ,n the third day Auguust 14 2010 she was. . rying when received She has fever of 37 9 C anddministration of Paracetamol drops 1 ml every 4. .ours was resumed She has been irritable all day: . , . .0 40 am Dr Lagunilla examined S Q and was refered.o Dr Zablan due to decreased results of. .rinalysis All laboratory results were seen by Dr. ,agunilla During the afternoon her fever subsides. . # /o 37 2 C IVF 3 D5INM 500 ml x 10 cc hr was: . .ooked at 1 00 pm All medications were given

    , ,n the fourth day August 15 2010 she has no, . .ever negative vomiting and playful Dra Campos had: . .er round at 4 50 pm and checked S Q she onderedontinueall medications and treatment and wait for. . #r Zablan s assessment IVF 4 D5 INM500 ml x 10/ : .c hr was hooked at 11 30 am s

    , , , ,n the fifth day August 16 2010 Wednesday. : .r Zablan had his round at 11 30 am Findings were,ith positive diaper rash decrease laboratory, .esults and afebrile no vomiting He ordered repeat( ),A from AM clear catch urine culture and,ensitivity use of Lactacid pink for perennial,ash and apply Calmoseptin ointment to diaper rash. # /x a day IVF 5 INM 500 ml x 10cc hr was hooked at: .2 15 nn

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    , , , .n the sixth day August 17 2010 Tuesday Draampos ordered continue all medications and follow. . # /rder of Dr Zablan IVF 6 INM 500 ml x 10cc hr washooked: . . . ,t 11 00 am S Q is received active playful but. .ries at times All medications were given on time.r Zablan saw laboratory results and advise cliento increase fluid.ntake and replace loses with PLRS Follow up urine.ulture and sensitivity Repeat urinalysis and- . #otify him when WBC is 1 3 IVF 7 INM 500 ml x/ : .0cc hr was hookedat 1 00am

    , , , ,n the seventh day August 18 2010 Wednesdayra Campos ordered continue all medications and. . . :reatments Proceed to Dr Zablan s orders All 8 00. . . ,m medications were given S Q is taking a bath.layful and laughing when received IVF was.egulated IVF was ordered to shift to D5 IMB L x/ . # /0 cc hr IVF 8 IMB L x 20 cc hr was hooked at: . . : ,1 30 am Dr Zablan had his round at 11 45 he. . .hecked S Q and the laboratory test He said all.est were now stabilized and normal He orderedollow up of urine culture and sensitivity anddvised periodic complete emptying of urinary.ladder , , ,n the eighth day August 19 2010 Thursday. . . ,ll findings were on normal range S Q is afebrile, ,o vomiting diminished diaper rash and was active

    . .nd playful All morning medications were given IVF# / : . .imb l X 20 cc hr was hooked at 10 45 am Dra

    b l

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    IX. Laboratory ResultUrinalysis

    .nt .nt .nt .ntColor Yellow Normal Yellow ormal Yellow Normal ight YellowormalTrancparency ITurbid ncreaserineconcentration

    Iturbid ncreaserineconcentrationClear Normal Clear ormal

    Reaction .5 Decrease .0 Normal .0 Normal .0 NormalpecificGravity .025 Normal .010 Normal .025 Normal .010 Normal

    Albumin trace normal trace Normal +1 UTI (-) NormalSugar (#) ncreaseSugar (-) Normal (-) Normal (-) NormalWBC -10 Infection -5 20 Infection -8 10 infection -3 Normal

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    Fecalysis

    Color Green igns ofdiarrheaConsistency Soft ign ofdiarrheaParasites o OVA rparasitesseen

    Normal

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    HematologyHEmoglobin 123 -20 150 NormalHematocrit .38 . .37 0 45 NormalRBC .98 . .6 5 2 NormalWBC .9 1 - /10 x 10 L ncreaseinfectionNeutrophils .77 . - .55 0 65 ,ncrease Acute

    acterialinfectionLymphocytes .23 . - .25 0 35 ,ecrease mayause severemalnutritionPlatelets 297 - /40 340x10 L NormalMCV .7 3 -6 100 NormalMCH .6 7 -6 31 NormalMCHC .1 9 -1 37 Normal

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    Laboratory Test:

    Results ormal Value InterpretationBUN 11 .17 NormalCreatinine .3 . - .52 1 04 ecreased ndirectly roportionalo glomelulariltrate rate

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    X.Drug Study

    GENERIC BRAND CLASSIFICATION INDICATION ACTION NURSING

    RESPONSIBILITY

    -inc ulfate( .rops 0 63ml)OD-Zinc itamins andMineral O preventndividualrace lementdeficiencie

    in atient eceivingong termotal arenteralnutrition

    Participae in ynthesisndstabilizaion ofroteinnd ucleiccids insubcellulr and embrane

    ransportsystem

    > xplain needor zincadministratioto patient.nd family> eport signsfhypersensitiv.ty promptly

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    meprazole5mgV OD omepron roton pumpInhibitor astrointestinalisturbances andirritationsnhibitsctivity of(cid proton) umps andinds toydrogen Kdenosinetriphosphat at ecretoryurface ofastric arietalells tolock ormationf gastric.cid

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    XII. Prognosis

    edications pon discharge client was-dvised to continue intake of Zinc( - ) .ulfate E zinc drops 0 6 ml once a.ay

    conomics dvised client to buy foods. ,ithin the budget The client prior todmission present a health insurance, ( + ) .ard HMO They had discount on. . Q s hospitalization and also to the .octor s fee

    reatment . .Q was still advised for,ncrease fluid intake periodic,omplete emptying of urinary bladder,se of lactacid for perinnial wash and.eep hands clean She still have aollow up check up after 1 week after.ischarge

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    ealth Teaching roper hygiene of bothhild and parent are very important as.efense from infection Proper andtrict supervision of child until, ,alance gait and coordination is.ained Advise to restrict child fromandling items or objects especially.f unfamiliar and not edible Emphasizemportance of hand washing and nail.are

    ut Patient lient was discharge on, .anuary 6 2010 Last advises and.ollow up checkups were reminded Other.reatments were elaborated iet lient was ordered with diet for,ge with increase fluid intake