PATTERN A.

Health Perception-Health Management

BEFORE Bathed 1-2x every day, shampooed hair and cleansed body with soap and towel. Brushed teeth 3x a day. Cut fingernails. Changed clothes and combed hair everyday.

DURING He does morning care, bathes once a day, accompanied by his mother.

B. Nutritional Metabolic Pattern

More often he ate salty foods (junk foods, soy sauce with rice). He did not like eating sour foods and vegetables.

His appetite changed due to his hospitalization, he still doesnt follow the required amount and kinds of food that the doctors adviced. (vegetables).

ANALYSIS Bathing provides relaxation and comfort and it gives most people a sense of well-being. Healthy feet are crucial in helping people stand and walk. Nails should be trimmed as needed. Proper oral hygiene includes daily brushing, flossing, and rinsing of teeth and care of dentures. Regular checkups ensure the health of the teeth and gums. Normal grooming patterns includes daily brushing and combing of hairs. (Craven and Hirnle. Fundamentals of Nursing.4th Edition.pp704-705) Different people need different amounts of food. The amount of food you need every day from the four food groups and other foods depends on your age, body size, activity level. Peer groups distinguished by age, sex, occupation, or other interest also influence by persons food choices. (pg. 1028) (Fundamentals of Nursing, Kozier, pp. 1067-1068)

C. Elimination

Client used to drink 8-9 glass of water a day and reports of every now and then urination. On the other hand, he defecated twice a day. (in the morning and before bedtime) .

Client drinks at least 8-9 glasses of water ,he defecates once a day. Urinates without difficulty and experiences no pain when voiding, urine is light amber in color, aromatic, and adequate in amount

Act of defecating must be free from any difficulties. Normal stool is semisolid in consistency. The amount and character of the stool is determined by the amount and kind of food ingested. (Fundamentals of Nursing, Phoebe Williams and Luz Tungpalan, pg. 321) Urination, Freshly voided urine is generally clear in appearance and pale to deep yellow. When formed, urine is sterile and aromatic. (Essentials of Human Anatomy and Physiology, Elaine Marieb, pg. 487-488) Activity- exercise pattern refers to a persons routine of exercise, activity, leisure and recreation. It includes ADL, that require energy expenditure such as hygiene, cooking and the type quality , and quantity of exercise including sports. Exercise is a type of physical activity defined as a planned, structured , and repetitive body movement performed to improved or maintain one or more components of physical fitness. (Fundamentals of Nursing pp. 1106- 1107) Self is defined in terms of the individuals, ability to fulfill societal roles, that is to perform his work. People usually fulfill several roles(mother daughter friend)and certain individual may consider none work roles paramount in their life. According to this model, people who can fulfill their roles are healthy even if they have clinical illness. -fundamentals of nursing

D. Activity/ Exercise

His usual activity according to her mother is surfing the computer ( facebook and playing online games) No regular exercise.

The client is now unable to perform his usual activities due to hospital confinement. He just needs to stay in bed for the meantime but sometimes he walks just within the unit.

E.Cognitive/ Perceptual

The patient is an elementary student. When asked about his cognitive skills, the patient said that he didnt have difficulty in understanding verbal or written instructions. As to his sense of hearing, the patient didnt experience any problem.

He still wants to go back to school to continue studying. According to the patient, he doesnt have any difficulty in writing nor reading before and during his hospitalization. During the interview, the patient is able to remember memories from his past years up to the most

recent.

koshier 297 Clients perceives that he is healthy as long as he is able to perform his function as a child.

F. Sleep/Rest

Stated that he usually had enough hours of sleep every night, about 8 hours.

Patients easily awaken because of environmental disturbances. He has inadequate hours of sleep.

Throughout childhood children typically get about 10 hours of sleep a night. This drops significantly at adolescence, but less for biological reasons than for socio-cultural reasons. Sleep researchers studying the optimal sleep periods of teenagers have found that when the sleep-wake cycle is studied in the laboratory under controlled conditions.
http://www.nasponline.org/re sources/health_wellness/sleep disorders_ho.aspx . Self-concept is ones mental image of oneself. A positive self-concept is essential to a persons mental and physical health. Individuals with a positive self-concept are better able to develop and maintain interpersonal relationships and resist psychological and physical illness. An individual possessing a strong selfconcept should be better able to accept or adapt to changes that may occur over the life span. How one views oneself affects ones interaction with others. (Kozier et al. Fundamentals of Nursing 7th Edition p. 957)

G. SelfPerception/ Concept

The patient described his self as a very masculine person. He said that he has a very strong personality.

According to him, he perceives himself as a healthy individual even though he had undergone surgical operation.

H. Role Relationship

He lived with his parents (mother and father). His mother was the one who brought her to hospital.

He is now being taken care of by her beloved mother and eager to go home to be able to continue his usual daily activity.

The effectiveness if family communication determines the familys ability to function cooperative, growth-producing unit. Messages are constantly being communicated among family members both verbally and nonverbally. The information transmitted influences how members work together, fulfill their assigned roles in the family, incorporate family values and develop skills to function in society. Intrafamily communication plays a significant role in the development of self-esteem which is necessary for the growth of personality. (Kozier et al. Fundamentals of Nursing 7th Edition p. 193)

I. Coping/ Stress Tolerance

According to the client, whenever he experienced problems or stress, he just kept quiet.

Whenever he feels stressed or got irritated he just tell it to his mother.

Coping may be described as dealing with the problems and situations or contending with them successfully. It is the cognitive and behavioral effort to manage specific external and/or internal demands that are appraised exceeding the resources of the person. It also varies among individuals and is often related to the individuals perception of the stressful event. Successful coping requires the person to deal effectively with the stressful events and minimizes distress associated with them that result in adaptation. (Kozier et al. Fundamentals of Nursing 7th Edition p 1020)

J. Value -Belief

The client is said to be family oriented and a religious person.

The patient believes that God is with him through all the time of confinement.

All clients have need that reflects their spirituality. These needs are often brought forward by an illness or other health crisis. Client who have well defined spiritual beliefs may find their belief as challenged by their health situation -fundamentals of nursing kozier 995 Clients spiritual needs can also enhance coping behaviors and expand valuable resources available to the client

Introduction Deep incisional surgical site Infection occurs within 30 days after the operation if no implant 3 is left in place or within one year if implant is in place and the infection appears to be related to the operation and infection involves deep soft tissues (e.g., fascial and muscle layers) of the incision and at least one of the following: 1. Purulent drainage from the deep incision but not from the organ/space component of the surgical site. 2. A deep incision spontaneously dehisces or is deliberately opened by a surgeon when the patient 3. Has at least one of the following signs or symptoms: fever (>38 C), localized pain, or tenderness, unless site is culture-negative. 4. An abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation, or by histopathology or radiologic examination. 5. Diagnosis of a deep incisional SSI by a surgeon or attending physician. Notes: 1. Report infection that involves both superficial and deep incision sites as deep incisional SSI. 2. Report an organ/ space surgical incisional infection that drains through the incision as a deep incisional SSI. In 2002, in the United States, an estimated 14 million NHSN operative procedures were performed (CDC unpublished data). SSIs were the second most common healthcare associated infection, accounting for 17% of all HAIs among hospitalized patients. A similar rate was obtained from NHSN hospitals reporting data in 2006-2008 (15,862 SSI following 830,748 operative procedures) (CDC, unpublished data) with an overall rate of nearly 2%. In Philippines, Wound infection represents one of the most common serious complications after surgery, accounting for approximately 5% of women who deliver by cesarean section and 8% of gynecologic surgical hospitalizations. A number of risk factors associated with increased postoperative surgical site infection have been identified. Our study focused in a case of a Deep incision surgical site infection of patient mr.22 A 17 year old male who had appendectomy. This study will enlighten and clarify questions and misconceptions about the disease. It also very helpful especially to the members of health team in rendering quality services to client.

OBJECTIVES OF THE STUDY

GENERAL OBJECTIVES Client Centered To assess the health of the patient To develop, implement, and evaluate plans for health promotion To provide client education and involve patient in implementing therapeutic regimen to promote understanding and compliance. Nurse Centered To apply the nursing process in the care of the hospitalized patient To describe effects of illness on individuals and family members roles and functions SPECIFIC OBJECTIVES Client-Centered Discuss nursing implications for medications commonly prescribed for surgical site infection Describe nursing care for the client Support client and family, and encourage them to ask questions so that information could be clarified and understood Nurse-Centered Identify major risk factors influencing the said condition. Identify the risk factor contributing to the occurrence of the disease. Learn the pathophysiology and manifestations of surgical site infection Identify common diagnostic tests used for the said condition and their nursing implications. Identify and describe nursing measure to promote awareness in the condition