ETO NA TALAGA - Tapos Na Ang Lahat !!!

Republic of the PhilippinesUNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City

College of Nursing

A CASE ANALYSIS

on

ACUTE TONSILLOPHARYNGITIS

In Partial Fulfillmentof the Requirements of the Course

Presented to:Mr. Julius Laureta, RN, MAN

Clinical Instructor

Presented by:KEENEN ENGEL B. PASCUA

BSN IV-AMARYLLIS

CASE STUDY GRADING SHEET FOR NCM

PARAMETERS PERCENTAGE%

ACTUALGRADE

Introduction & Objectives 5Personal DataNursing History of Past and Present Illness

5

Assessment 15Diagnostic Procedures

a. Idealb. Actual

5

Anatomy & Physiology 5Pathophysiology Algorithm Explanation

15

Managementa. Medicalb. Surgicalc. NCP with Evaluationd. Preventive Management

5

205

Drug Study 5Discharge Planning 5Updates 5ORGANIZATION 2.5BIBLIOGRAPHY 2.5

TOTAL 100

REMARKS:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Mr. Julius Laureta, RN MAN

Clinical Instructor

Page | 2Keenen Engel B. Pascua

INTRODUCTION

Tonsillopharyngitis is the swelling of the pharynx and the tonsils.

Pharyngitis is the swelling and inflammation of the pharynx. The pharynx is

the back of the throat, including the back of the tongue. The tonsils

participate in systemic immune surveillance. In addition, local tonsillar

defenses include a lining of antigen-processing squamous epithelium that

involves B- and T-cell responses. Tonsillopharyngitis is acute infection of the

pharynx, palatine tonsils, or both. Symptoms may include sore throat,

dysphagia, cervical lymphadenopathy, and fever. Diagnosis is clinical,

supplemented by culture or rapid antigen test. Treatment depends on

symptoms and, in the case of group A β-hemolytic streptococcus, involves

antibiotics. Tonsillopharyngitis is usually viral, most often caused by the

common cold viruses but occasionally by Epstein-Barr virus, herpes simplex

virus, cytomegalovirus, or HIV. In about 30% of patients, the cause is

bacterial. Group A β-hemolytic streptococcus (GABHS) is most common. Rare

causes include pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.

GABHS occurs most commonly between ages 5 and 15 and is uncommon

before age 3. Its usual signs and symptoms are pain with swallowing which is

the hallmark and is often referred to the ears. Very young children who are

not able to complain of sore throat often refuse to eat. High fever, malaise,

headache, and GI upset are common, as are halitosis and a muffled voice.

The tonsils are swollen and red and often have purulent exudates. Tender

cervical lymphadenopathy may be present. Fever, adenopathy, palatal

petechiae, and exudates are somewhat more common with GABHS than with

viral tonsillopharyngitis, but there is much overlap. GABHS usually resolves

within 7 days. Untreated GABHS may lead to local suppurative complications

( peritonsillar abscess or cellulitis) and sometimes to rheumatic fever or

glomerulonephritis.

Patient X is a 4 y/o girl from Calingayan, Sinait, Ilocos Sur who was

admitted for the first time in Corpuz Clinic and Hospital with a chief complain

of fever and sore throat.

As the student-nurse assigned to care for Pt. X for 2 duty days, I have

observed his condition and identified some of his health needs. Although my

contribution to the patient’s recovery may be insignificant, witnessing my

patient’s condition improving is a very fulfilling experience. But more than


the feeling of fulfillment, I felt that I was an instrument of God in trying to

bring back wholeness in X’s life no matter how insignificant it may be.

OBJECTIVES

After completing this case study, the student-nurse will be able to obtain

appropriate knowledge, skills and attitude in caring for a patient with bone

injury particularly to a patient with space occupying lesion. This is

manifested by the student’s ability:

1. To present accurately the patient’s profile.

2. To obtain a comprehensive past, present and family history of patient’s

illness.

3. To assess the health status of the patient using the cephalocaudal method

and organize cues for Nursing Care Plan.

4. To know the different diagnostic examinations (ideal and actual) related to

the patient’s case and understand the purpose and limitation of each

examination.

5. To study the results/outcome of the diagnostic procedures that the patient

has undergone and explain how these are related to the case of the patient.

6. To discuss the anatomy and physiology of the organ involved in the case.

7. To illustrate through a schematic diagram the pathophysiology of the

patient’s case and explain the mechanism that is involved.

8. To present the medical and surgical management done to the patient.

9. To formulate a practical and realistic plan of care for the patient through:

a. systematic organization of the subjective and the objective cues

related to the case.

b. identifying and prioritizing nursing diagnoses using the PES format

(Problem-Etiology-Signs/Symptoms) and according to NANDA.

c. analysis of the pathophysiology of the identified diagnosis based on

the presentation of the patient

d. formulating appropriate nursing objectives following the SMART

criteria.

e. planning for independent, dependent and collaborative interventions

and explaining the rationale for every intervention done.

f. evaluating the degree of achievement for all the objectives set at the

beginning of the intervention.

10.To make a list of the different drugs taken and is presently taking by the

patient with their corresponding dosages, mechanisms of action,

side/adverse effects and nursing responsibilities.


11.To formulate a Discharge Plan covering the following areas: METHOD

(Medications, Exercises, Treatments, Health Teachings, Out-Patient

Department and Diet)


PATIENT PROFILE

NameShenna Anne Dinong

Yadao

Age 4 years old

Sex Female

AddressCalingayan, Sinait,

Ilocos Sur

Birthday March 24, 2007

Religion Roman Cathilic

Father Jeffrey Yadao

Mother Mylene Yadao

Date of admission June 20, 2011

DiagnosisAcute

Tonsillopharyngitis


PAST HISTORY

According to the patient’s mother, the patient was born via NSD. She

received her BCG at birth as well as Hep B and completed the dose at

July 10, 2007. She also completed the DPT and OPV vaccines. And also

she had MMR vaccine on December 14, 2007. She has no know

allergies as claimed by the mother. Her appetite in their house was low

but she can drink up to 3 bottles of coca-cola 8oz.

PRESENT ILLNESS

Prior to the admission, June 19, 2011, she got a fever of 38.5. The

mother gave her paracetamol syrup. She stayed at home for the time

being but because of her fever not decreasing, June 20, 2011, she

rushed her to Corpuz Clinic and Hospital for medical chek-up. The chief

complain was fever and later they found out that it was an acute

tonsillopharyngitis. Then she was admitted to the said hospital.


ASSESSMENT(PEARSON)


June 21, 2011 June 22, 2011

Psych

osocia

l

◌ Patient X, 4 y/o female, child, Roman Catholic lives in Calingayan, Sinait, Ilocos Sur

◌ She is conscious, coherent and well-oriented.

◌ Responds appropriately to stimuli s/a pain and during interaction.

◌ According to Erik Erickson’s Psychosocial Development is at the “Initiative vs. Guilt”. Around age three and continuing to age six, children assert themselves more frequently. They begin to plan activities, make up games, and initiate activities with others. If given this opportunity, children develop a sense of initiative, and feel secure in their ability to lead others and make decisions. Conversely, if this tendency is squelched, either through criticism or control, children develop a sense of guilt. They may feel like a nuisance to others and will therefore remain followers, lacking in self-initiative.

◌ Patient X, 4 y/o female, child, Roman Catholic lives in Calingayan, Sinait, Ilocos Sur

◌ She is conscious, coherent and well-oriented.

◌ Responds appropriately to stimuli s/a pain and during interaction.

◌ According to Erik Erickson’s Psychosocial Development is at the “Initiative vs. Guilt”. Around age three and continuing to age six, children assert themselves more frequently. They begin to plan activities, make up games, and initiate activities with others. If given this opportunity, children develop a sense of initiative, and feel secure in their ability to lead others and make decisions. Conversely, if this tendency is squelched, either through criticism or control, children develop a sense of guilt. They may feel like a nuisance to others and will therefore remain followers, lacking in self-initiative.

Eim

inati

on

◌ No episodes of vomiting noted.

◌ Patient urinated 5 times with straw colored urine.

◌ Patient defecated once with well-formed, aromatic and brownish in color.

◌ No eye and nasal discharges noted.

◌ No episodes of vomiting noted.

◌ Patient urinated 3 times with straw colored urine.

◌ Patient defecated once with well-formed, aromatic and brownish in color.

◌ No eye and nasal discharges noted.

Acti

vit

y a

nd

R

est

◌ Fair in appearance◌ Patient lies on bed most of

the time and sits sometimes.

◌ The mother of the patient gives her a bath in the morning.

◌ Fair in appearance◌ Patient moves a lot from

bed to bed◌ The mother of the patient

gives her a bath in the morning.


Safe

ty

◌ She is being supervised by his mother and assist her in her needs

◌ Body temperature: 37.8 C febrile.

◌ No known food and drug allergy.

◌ With D5 0.3 NaCl ½ L regulated at 60 ugtts/min

◌ She is being supervised by his mother and assist her in her needs

◌ Body temperature: 37.3 C afebrile.

◌ No known food and drug allergy.

◌ With D5IMB ½ L regulated at 60 ugtts/min

Oxyg

en

ati

on

◌ Vital signs:PR: 91 bpmRR: 20 cpmTemp: 37.8 C

◌ She has normal breathing pattern, rate and depth.

◌ Capillary refill is 2 sec.

◌ Vital signs:PR: 94 bpmRR: 22 cpmTemp: 37.3 C

◌ She has normal breathing pattern, rate and depth.

◌ Capillary refill is 2 sec.

Nu

trit

ion

◌ She feels pain upon swallowing.

◌ She has decreased appetite

◌ She is under soft diet for his age.

◌ Preferred foods are any meat and vegetables.

◌ Increased fluid intake

◌ With good appetite as claimed.

◌ She is under soft diet for his age.

◌ Preferred foods are any meat and vegetables.

◌ Increased fluid intake


DIAGNOSTICS

Actual Diagnostic Examination

Complete Blood Count

Substance tested

Result Reference range

Implication Nursing Responsibilities

Hemoglobin 135 g/L 120-160 Check doctor’s order. Check patient’s

identity by asking her name.

Explain the procedure to the patient to promote cooperation.

Teach patient some relaxation techniques like deep breathing exercises to ease anxiety.

Always observe proper aseptic technique when obtaining blood sample.

Forward the blood to the laboratory immediately when it was obtained by a person other than the Med. Tech. for better and more accurate result.

Notify the physician as soon as the results are released.

Hematocrit .41 .4-.48WBC count 4.2 x 109

/ L

4.5-11 This indicates recent infection

Neutrophils .63 .54 - .70

It is one of the most commonly requested routine blood tests to check the function of the blood forming organs. The result of this test further confirms or rules out established diagnosis. It is the initial test performed in the study of blood cell diseases. The test is conducted in the pathology laboratory by a registered medical technologist or a pathologist.

Lymphocytes

.23 .25 - .33

Monocytes .12 .3-7

Platelet coun

t

189 x 109

/ L

150 – 350

Ideal Diagnostic Examinations


A). Rapid strep test?

The rapid strep test is a quick and accurate diagnostic tool used to

determine whether or not strep bacteria are present in the patient's throat.

The same test may be used to evaluate for the presence of Streptococci in

other infected areas (such as wound infections)

How is a rapid strep test done?

Obtaining a specimen is the same whether your doctor will do a throat

culture or rapid test for strep. A cotton swab (similar to a Q-tip) is quickly

rubbed over both tonsils as well as the back wall of the mouth (the posterior

pharynx). It is important to avoid contact with other structures inside the

mouth such as the tongue or cheeks. The swab is then placed in a

specialized container and the rapid test performed. Many people find that

obtaining the swab produces a gagging sensation. However, since the entire

swabbing process lasts less than five seconds this inconvenience is minimal.

B). Throat Swab Culture

A throat swab culture is a laboratory test done to isolate and identify

organisms that may cause infection in the throat.

How is a Throat Swab Culture done?

You will be asked to tilt your head back and open your mouth wide. The

health care provider rubs a sterile cotton swab along the back of your throat

near the tonsils. You need to resist gagging and closing the mouth while the

swab touches this area.

The health care provider may need to scrape the back of the throat with the

swab several times. This helps improve the chances of detecting bacteria.

Why the Test Is Performed

The test is performed when a throat infection is suspected, particularly strep

throat. A throat culture can also help your doctor determine which antibiotics

will work best for you.


http://health.nytimes.com/health/guides/disease/strep-throat/overview.html

http://health.nytimes.com/health/guides/disease/strep-throat/overview.html

http://www.medicinenet.com/script/main/art.asp?articlekey=9075





PATHOPHYSIOLOGY


Ingestion of food with microorganism

Airborne Droplets

Group A beta haemolytic streptococcus

Tonsil/Pharynx

Lymphocytes IgM

Inflammatory Process

Neutrophils / Macrophages

Pyrogen secretion

Stimulates fever production

Reset Hypothalamus Regulator

Histamine/Kinins Secretion (causes vascular permeability and vasodilator)

Malaise

Loss of appetite

Fever

Dysphagia

MANAGEMENT

Actual Medical Management

for CBC

for urinalysis

IVF of D5 0.3 NaCl ½ L x 60 uggts/min

paracetamol 9ml IV q 4 PRN for temperature greater than or equal to

38.5 C (can be shift to oral paracetamol 125mg/5ml 3 ml q4 PRN for

temperature greater than or equal to 37.8 C)

give penicillin sodium 350,000 units IV q 4 ANST (antibiotic)

monitor vital signs every 2 hours

TSB for fever


CuesNursing

diagnosisAnalysis Planning Intervention Rationale Evaluation

Subjective:

“nasakit jay karabukob” as verbalized by the patient

“haan unay makakaan tattay gapota agsakit kano karabukob na” as verbalized by the mother.

Objective:

With tolerable pain when swallowing

With slight swelling with slight

P> Acute pain

E>related to swelling of the uvula

S>as evidenced by tolerable pain when swallowing

Inflammation

swelling

nerve compres

sion

acute pain

June 21, 2011

8:00 amAfter 30 minutes

of nursing intervention, the patient will be relieved from pain as evidenced by verbalization of relived from pain.

Independent

Assess the etiology and precipitating contributory factors

Perform routine comprehensive pain assessment, including location, characteristics, onset/duration, frequency, quality, severity of the pain.

Accept child’s description of pain

Investigate

To determine the possible cause of pain and to know the appropriate

nursing care plan

Assessment of children involves

observational skills and may require

enlisting the aid of parent/caregiver to

clarify cues and verbalizations.

Pain is subjective and cannot be experienced by

others

May signal worsening of condition or

development of complications

GOAL MET

June 21, 2011

8:30 amAfter 30 minutes

of nursing intervention, the patient was relive from pain as evidenced by verbalization of relived from pain.


swelling at the uvula

With facial grimacing

changes in frequency or description of pain

Observe for guarding, rigidity and restlessness

Note location or type of trauma

Provide comfort measures such as repositioning, warm compress

Encourage diversional activities;

Nonverbal expressions may

signal pain or changes in pain

severity

Influences degree of pain

manifestation

Nonpharmacological pain

management promotes

relaxation, may reduce level of

pain and enchance coping.

Helps distract child’s attention from pain and

reduces tension.


e.g., music therapy, playing quiet games

COLLABORATIVE

Encourage rest periods

Helps reduce fatigue and

enhances coping capability


CuesNursing


SUBJECTIVE:

“haan unay makakaan tattay gapota agsakit kano karabukob na” as verbalized by the mother.

OBJECTIVE:

V/SBT – 37.8 CPR – 91 bpmRR – 20 cpm

With tolerable pain upon swallowing.

With decreased appetite

P> Risk for imbalance nutrition, less than body requirements

E> related to inability to eat comfortably leading to decreased appetite

Pain when swallowi

ng

Decreased appetite

Risk for imbalanc

ed nutrition, less than

body requirem

ent

June 21, 20118:30

After 30 minutes of nursing intervention, the patient will ingest nutritionally adequate diet for her age and activity level

INDEPENDENT

Determine ability to chew, swallow, and taste

Determine child’s current nutritional status.

Elicit information from child/parent regarding typical daily food intake, determining foods and beverages normally

These factors can affect ingestion/desire to eat

Identifies individual nutritional needs and provides comparative baseline.

Baseline information to determine adequacy of intake. Knowledge of child’s specific likes/dislikes may be helpful in meeting child’s nutritional needs during a time when appetite is supressed or child has no interest in food.

GOAL MET

June 21, 20119:00

After 30 minutes of nursing intervention, the patient ingested nutritionally adequate diet for her age and activity level


consumed. Note types of snacks. Discuss eating habits and food preferences (likes and dislikes)

Note characteristics of stool

Advise mother to give her child soft diet

Provides information about digestion/bowel function and may affect choice/timing of feeding

This may help meet the nutritional needs of the child and the child will experience decreased pain when taking in food.


CuesNursing


SUBJECTIVE:

“medyo nabara isuna ading” as verbalized by the mother

OBJECTIVE:

V/SBT – 37.8 CPR – 91 bpmRR – 20 cpm

With dry and warm skin.

P> Hyperthermia

E> related to infection

S> as evidenced by skin warm to touch and with a body temperature of 37.8

Ifectious agents

Monocytes

Pyrogenic Cytokines

Ant. Hypothala

mus

Elevated thermoregulatory set

point

Increased heat conservati

on(Vasoconstrictio

n/Behavior

changes)Increased Heat

production (involuntary muscular contractio

n

June 21, 20118:30

After 4 hrs. Ofnursinginterventions,the patient willmaintain coretemperaturewithin normalrange.

INDEPENDENT

Promotesurface coolingby means oftepid spongebath.

Maintain bedrest.

Provide highcalorie diet.

Wrapextremities

withblankets.

Increase fluid intake

To decreasetemperatureby meansthroughevaporationandconduction

To reducemetabolicdemands andoxygenconsumption

To meetmetabolicdemands.

To minimizeshivering.

To prevent

GOAL MET

June 21, 201112:30

After 4 hrs. Ofnursinginterventions,the patientmaintained coretemperaturewithin normalrange.


Fever dehydration as well as cooling the body.


PREVENTIVE MANAGEMENT

PREVENTIVE AND PROMOTIVE MANAGEMENT

For faster recovery, the patient should do the following:

Follow doctor’s order with his/her prescribed home medications.

Get plenty of rest.

Drink warm liquids (tea or broth) or cool liquids.

Avoid irritants that might affect your throat, such as smoke from

cigarettes, cigars, or pipes, and cold air.

Drink at least 6 to 8 glasses (8 oz.) of fluid a day to replace fluids lost

when you have a fever and to loosen mucus secretions in your throat

for a more productive cough. Warm beverages, such as tea with

lemon, may help soothe your throat.

Gargle with warm salt water (¼ tsp. in ½ cup warm water) every few

hours. If you have postnasal drip, gargle frequently to prevent throat

irritation.

Eat and drink cold foods and liquids.

Suck on a piece of hard candy or a lozenge with menthol.

Avoid smoke, alcohol, and caffeine. Both alcohol and caffeine can

increase your likelihood of becoming dehydrated.

Use a cool-mist vaporizer or humidifier in the room where you spend

the most time. Steam from a hot shower or a pan of water placed near

a heater will also increase the humidity.

Elevate your head with extra pillows at night.

PREVENTIVE:

Here are ways to reduce your chance of getting a TONSILLOPHARYNGITIS:


Wash your hands frequently, especially after blowing your nose or after

caring for a child with a sore throat.

If someone in your home has a sore throat, keep his eating utensils

and drinking glasses separate from those of other family members.

Wash these objects in hot, soapy water.

If a toddler with a sore throat has been sucking on toys, wash the toys

in soap and water.

Immediately get rid of used tissues, and then wash your hands.

If you have hay fever or another respiratory allergy, see your doctor.

Avoid the substance that causes your allergy.


DRUG STUDY


Name of Drug Frequency

Indication Contraindication

Side Effects Mechanism of Action Nursing Responsibi

litiesParacetamol

125mg/5nl

Paracetamol 300mg/a

mp

3ml every 4

hours (BT 37.8)

9ml every 4

hours (BT 38.5)

Fever Hypersensitivity to drug

Nausea, allergic reactions, skin rashes, acute renal tubular necrosis.Potentially Fatal: Very rare, blood dyscrasias

Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.

Follow the ten rights of drug administration

Monitor the body temperature of the patient

Penicillin Sodium

350,000 units

Every 6 hour

s after negative skin test

Infection Hypersensitivity severe hepatic

impairment;

Neutropenia, agranulocytosis; GI upsets;

rash. Sore mouth or tongue

Absorption: Incompletely absorbed from the GI tract with peak plasma concentrations after 1-2 hr (oral); may be reduced in the presence of food. Completely absorbed with peak plasma concentrations after 30 min (IM).Distribution: Pleural and synovial fluids and bone (therapeutic concentrations), CSF (small amounts except

Follow the ten rights of drug administration

Advise mother to increase fluid intake of child


when the meninges are inflamed; crosses the placenta and enters the breast milk. Protein-binding: 94%Metabolism: Minimal metabolism.Excretion: Via the urine by glomerular filtration and renal tubular secretion (35% of an oral dose); via the bile (Up to 10%). Not removed by dialysis; 0.5-1 hr (elimination half-life).


DISCHARGE PLANNING

Medication

Medications should be taken regularly as prescribed, on exact dosage, time, & frequency, making sure that the purpose of medications is fully disclosed by the health care provider. It should be taken with the assistance of her mother for her safety.

Exercise

Exercise should be promoted in a way by stretching all body parts every morning. Patient should be encouraged to keep active on different physical activities at home or at school. It is also advisable for her to be with her playmates few hours in a day to promote not only physical development but also her social capabilities.

Treatment

FEVER TREATMENT: Check temperature regularly. If febrile,

a. Perform TSB,b. Remove excess clothing and covering,

Treatment of the patient after discharge should be continued for full recovery. The patient’s significant others play an important role in the promotion and also prevention for the patient not to acquire this kind of illness again.

Health teachings

PROMOTE PROPER HYGIENE/PREVENTIONOF INFECTION Since the immune system is compromised, every effort

should be maintained to prevent infection. Frequent hand washing is the best way to control infection. Wash hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer during times when water is not available.

ADHERE TO TREATMENT REGIMEN

Adherence to the treatment regimen is essential in order to prevent relapse. Most common cause of relapse is loss to compliance. Medications should be administered at proper time and proper dosage.

MEETING NUTRITIONAL AND FLUID NEEDS

Bear in mind the food preferences of the child when planning for menus. Presenting the food in an attractive manner increases the interest of the patient. Increase intake of protein-rich foods for further healing and food rich in fiber and Vitamin C.

OPD- check

up

OPD such as follow-up check-up as ordered by the physician should be greatly encouraged for the patient to determine if she already fully developed and for them to know if she will continue her medication and treatment which was ordered during her hospitalization.

DietHIGH PROTEINProtein is for tissue repair since patient has some tissue damage

giving high protein diet aids in healing.


HIGH IN VITAMINSVitamins protects the child from infection that can cause fever

and if there is a fever, therefore, attacks of seizure may occur.

UPDATES

UPDATES (By agrimonia)

Feb 24, 2011

In that uses most often galazolin,sanorin,but causes a spasms peryphery vessels,mint oil with drops not too use,but effectivity is lemon drops,juice lemon drip for baby incline head.

Professor ozarovski is advices in bronchitis,cold,ache throat use balsam,like camhorae 0.3 gr,ol.terebinthinae 10 gr,ol.sojae 10 gr,ol.lavandula 1 r,ol.jumiperus 0.5 gr,ol.calami 0.5 gr,ol.thymi 0.3 gr,aethylli acetici 0.5 gr,sol.jodi spirit .5 percent gutt.nr 5.M.F.balsaminum ,to 6 y.old childrens rub 12 drops balsam for age depends in breast cell,and in complicated ,causes bronchitis same in between shoulder bladde sides,close blanket a baby,2 times/day repeat for 5 days.

or methyli salycili 10 gr,camphor 3 gr,ol.eucaliptus 17 gr,ol.pini sylv.5 gr,ol.lavandulae 3 gr,ol.thyme 3 gr,M.F.balsamum.

same use.

tbl.sp.cammomile in l.hot water or mixing herbs sage,herb thyme,flowers cammomile,leafs melissa,flowers lavender for inhalations,closed towel a baby face,incline under pan with herbs and breath in 10 min,and care take off a sweat,or use bath with straw oats .

100 gr herb for night add in cold water,warm,add in bath,use warm 10 min.

keep at home twigs pine,fir for microbes fight.

A leafs nasturcia eating is fight microbes 1/2 leaf ,like salad in kind of,half leaf for baby shreded in sour milk mixing,or 1/2 tea.sp.nettle leafs juice in flue fight,or in cough cold leafs coltsfoot press juice,3 big onions cut,press juice,mix with 0.25 l.red wine,mix all,col,shake,use 3 times/day tbl.sp.in 5 tbl.sp.boiled water,warm,in strong cough mix leafs coltsfoot,leafs plantain lancet,roots shreded licorice,herb viola fragrant.

tbl.sp.herbs in glass hot water,close,warm use 1/2 glass /day,adding lemon juice,thermos in keep.


http://www.allvoices.com/users/agrimonia

in dry cough.

glass shrede onion,1/4 glass shreded garlic,add 1/2 glass honey,add in jar,close,warm infuse 3 hours,juice received tea.sp.for children give every 3 hours.

in cucumber brine garlic cooked is use 1/2 tea.sp.every 4 hours after meal.

juice leaf plantain in honey tea.sp.a few times/day.

or washed 4 leafs plantain,press,add water,0.5 kg honey,steam to evaporate,thick mass in jar add,cold,use tea.sp.3 times/day to meal,cold keeping.

in weak babies.

in glass cold water add juice lemon half,tbl.sp.honey,lead to boil,add tbl.sp.herbs ,like 1/2 tbl.sp.plantain,with 1/2 tbl.sp.thyme,close,infuse,drink gulps for min,hot,if not help,cook 3 times/day and drink to help.

in strong whooping cough handful fresh viola leafs fragrant in glass hot water,close,infuse,10 min after use 2 tbl.sp.

in throat aches that for rinse throat.

boiled potato knead,apply in gauze on throat compresses.

althaea,mallow forest is antispasm,expectorate ,like 2 tbl.sp.cut in adding 2 glasses cold water,infuse 8 hours,mixing,filter,warm,use glass for a day,rinse throat.

angine,aches throat,ears,breast aches mallow forest in cow herb flowers use for inhalations,steam baths in cold,bronchitis,or in any throat aches from leafs sage,herb horse tail.

tea.sp.10 perc.propolis solution in 1/2 glass boiled water,2 tea.sp.lemon juice in 1/3 glass boiled water,powder clay 1/2 tea.sp.in 1/2 glass water,warm liquid rinse throat.

BIBLIOGRAPGY

BOOKS:

Burke, S.RHuman Anatomy and Physiology in Health and Disease. 1992.

Deglin, J. H. (2004). Davis Drug guide for Nurses.

Doenges , M. E. Nursing Care Plans Guidelines for Individualizing Client Care Across the Life Span 7th

edition


Marieb, E. N. (2006). Essentials of Human Anatomy and Physiology.

Pillitteri, Adele.Materbal Child Nursing.Care of the Childbearing and Childbearing

Family.Volume II.

Smeltzer, Suzanne C. And Brenda G. Bare.Brunner & Suddarth’sTextbook of Medical-Surgical

Nursing.Volume 2.10th Edition.

Spratto, George R and Adrienne L woods.PDR Nurse’s Drug Handbook.2007 Edition.

INTERNET:

Microsoft ® Encarta ® 2009. © 1993-2008 Microsoft Corporation. All rights reserved.

http://www.nlm.nih.gov/medlineplus/

www.slideshare.net/.../lungs- anatomy-and-physiology

www.enotes.com


http://www.slideshare.net/.../lungs-anatomy-and-physiology

http://www.nlm.nih.gov/medlineplus/

ETO NA TALAGA - Tapos Na Ang Lahat !!!

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Transcript of ETO NA TALAGA - Tapos Na Ang Lahat !!!