GROUP 27 DAY CARE DUTY CASE STUDY

SCENARIO:
Marga is a 4 years and 9 months old preschool child at Brgy. Shillong Day Care Center. She belongs to a family of 6 having 2
older brothers ages 7 and 6 and a 1-year-old baby sister. Her father is a construction worker who most of the time goes home drunk
and her mother is a housewife helping in the family’s finances by selling banana cues every afternoon in front of their small “barong-
barong”.

Every after school, Marga is always seen alone at their front door while her 2 older brothers were playing with the other
children in the neighborhood. She would play with her ragged doll and talk as if she had a playmate.

At school, the teacher observes Marga to be silent and seldom follows attention. She will speak when she likes to and most
often grab toys being played with by her classmates.
GENERAL OBJECTIVE: TO FACILITATE MAINTENANCE OF NUTRITION TO ALL BODY CELLS.

Nursing Diagnosis 1:

ASSESSMENT DIAGNOSIS RATIONALE/ NURSING IMPLEMENTATION EVALUATION OF

PATHOPHYSIOLO THERAPEUTIC OF CARE THE PRESENTED
GY PLAN

Subjective Data: Risk for delayed Developmental - Within 1-2 hours Independent: After rendering
development delay indicates of health education 1. Teach the health teaching, the
● Patient’s mother related to extensive deficits the support system parents of the goal set was
verbalized that inadequate nutrition and lack of of the patient and patient on how to partially met:
"Ang iya tatay developmental the patient will make a cost-
construction skills that would be show an effective improvised 1. Parents were
worker na nga appropriate for understanding of electrolyte drink. able to verbalize
pirme lang ga children at a the health understanding
puli nga hubog, particular age. It teachings employed How: about the
ako naman ya may be exhibited in by the student 1 cup of water importance of good
ga baligya lang different domains, nurses. 1 tbsp sugar nutrition as
banana cue sa including motor 1tbsp salt evidenced by their
tubang balay." adaptive skills, - Within 1 week of Optional: Add ability to answer
● "Kulang gid language or duty the patient and flavoring (orange, questions asked
pirme amon personal and social support system will watermelon, etc.) after.
kwarta para behavior. be able to utilize the
mapakaon sang Malnutrition is a health approaches 2. Include the 2. The patient’s
chakto amon serious condition discussed by the mother or support support system is
mga bata, pirme that happens when student nurses. system when in the able to make
pa namon gina your diet does not process of taking improvised cost-
awayan sang contain the right - After 1 week duty, the patient's effective electrolyte
bana ko kung amount of nutrients. student nurses nutritional drinks.
diin kami maka It means "poor should be able to assessment.
pangita kwarta." nutrition" and can evaluate 3. The family
● "Kada tapos refer to remarkable findings 3. Encourage the showed an
skwela dira man undernutrition – not to the patient (e.g. patient's parents or understanding of
lang na sya ga getting enough weight gain, support system to what foods to be
 pungko sa nutrients. increased nutrient prepare healthy consumed.
tubang pirtahan overnutrition – intake, and meal plans for daily
namon bitbit iya getting more enhanced immune living. 4. The family is able
nga manika kag nutrients than system). to acknowledge the
sturya sturyahon needed. . 4. Teach parents importance of good
ya na." Malnutrition and the patient on nutrition.
● "Hambal sang constraints rapid how to achieve
maestra ya brain development adequate nutrients 5. The parents are
kahiposon man by adversely and proper portion able to identify
na nga bata affecting its sizes intake on a malnutrition as a
galing kis a lang structural and daily basis. risk factor to the
ga pamati sa functional capacity, child’s
klase." resulting in 5. Assess the developmental
● "Hambal pa gid developmental patient for muscle process.
sang 1 ka deficits among and bone
maestra ya ga children in all weakness. 6. The patient and
sabat sabat man domains. An support system
na sya sa klase unhealthy external 6. Observe the displayed a
kaso kung san o environment also patient’s eating willingness to
ya lang gusto has a negative environment. participate in the
kag may pag ka impact on children’s health regimen
sutil kuno kay ga ability to learn 7. Measure the process by listening
pang agaw sa social and patient's actual attentively to the
halampanganan developmental body weight. health teaching and
sang mga skills. planning.
classmates ya". 8. Assess the
Our patient patient's body 7. The patient
Objective Data: manifested a low weight with gained 3 pounds at
BMI range correlation to the the end of the week
● Weight: 14 kg classified as patient's age and upon weighing.
● Height: 3' 2" underweight which height.
● BMI: 16.7 is due to
(underweight) inadequate nutrient 9. Educate the
● Pale intake that resulted parents and the
● Brittle nails and in malnutrition patient on the
hair which could lead to importance of a
● Sunken eyeballs the patient's healthy meal plan in
● Capillary refill developmental the developmental
time- 3s (<2s) delays or deficits in stages.
● Dry lips the future.
● Dry skin 10. Educate
● Patches of slow Reference: parents on the
healing wounds Saleem, J., Zakar, importance of
noted on Left R., Bukhari, G.M.J. creating a relaxing
lower leg and et al., (2021, July feeding atmosphere
elbow of the right 15). Developmental for the patient.
arm. Delay and Its
Predictors Among 11. Encourage the
Children Under patient's support
Five Years of Age system to seek or
with Uncomplicated ensure continuous
Severe Acute counseling and
Malnutrition: A follow-up care.
Cross-Sectional
Study in Rural 12. Monitor the
Pakistan. BMC patient’s behavior in
Public Health 21, the daycare setting.
1397. Retrieved last
August 30, 2022 13. Discuss with the
from parents how to
https://doi.org/10.11 utilize their
86/s12889-021- resources in
11445-w selecting and
preparing food.

Dependent:
1. Instruct the
parents or support
system of the
patient on how to
properly administer
dietary
supplements like
iron, zinc, iodine,
and vitamins as
appropriate and per
doctor’s order.

Collaborative:
1. Consult with a
dietitian and
structure a healthy
diet meal plan
considering the
patient’s financial
status and total
energy
requirement.

2. Collaborate with
social workers to
find means and
ways to grant the
family dietary
supplements like
iron, zinc, iodine,
and vitamins.
Nursing Diagnosis 2:

ASSESSMENT DIAGNOSIS RATIONALE/ NURSING IMPLEMENTATION OF EVALUATION OF

PATHOPHYSIOL THERAPEUTIC CARE THE PRESENTED
OGY PLAN

Subjective Data: Imbalanced The body needs to After 2 hours of Independent: After rendering the
nutrition: less than be supplied with health teaching nursing
● Patient’s mother body requirement, the right kind and and promotion, 1. Discuss: interventions, the
verbalized that related to the right amount of the parents are a. The implications of goals set were
"ang iya tatay inadequate food fuel. Nutrients we expected to fully the signs and partially met: the
construction supply. ingest through understand the symptoms of family were able to
worker na nga food should be in family’s nutritional Malnourishment verbalize
pirme lang ga adequate amounts condition and be observed in the understanding
puli nga hubog, to essentially meet able to address it. family members. about the different
ako naman ya our body’s b. The consequences methods to
ga baligya lang metabolic After nursing of malnourishment. improve the
banana cue sa demands. When a interventions, the family’s nutritional
tubang balay". person loses family’s nutritional 2. Health Teaching: condition,
● "Kulang gid weight condition, a. Give some health especially their 4
pirme amon unintentionally, it especially their 4 teaching with a years old child as
kwarta para can be an indicator years old focus on basic evidenced by:
mapakaon sang of poor health and daughter is nutrition and proper
chakto amon an inability of the expected to handling of foods. a. The parent’s
mga bata, pirme body to fight off improve after six b. Give suggestions verbalizations
pa namon gina infection. Also, months. to the family “Na intyindihan
awayan sang when a person regarding better nagid namon
bana ko kung gains weight, it can ways of budgeting subong nga
diin kami maka indicate poor family income. amu na gale
pangita kwarta" nutritional ang gakalatabo
● "Kada tapos practices. 3. Identify and give sa amon bata”
skwela dira man suggestions about
lang na sya ga Lack of resources cheaper, nutritious, and b. The family is
pungko sa due to poverty healthy foods. able to
tubang pirtahan results in a understand the
namon bitbit iya nutrition deficit. 4. Give suggestions consequences
nga manika kag Their body was not about having a garden of of malnutrition.
sturya able to meet the fruits and vegetables.
sturyahon ya nutrition needed. a. Discuss the c. Parents are
na" benefits of able to share
● "Hambal sang Reference: gardening to the their insights
maestra ya family’s health and regarding the
kahiposon man GIL WAYNE, BSN, financial situation. situation.
na nga bata R.N.(MAY 9, 2022) d. Parents are
galing kis a lang Imbalanced 6. Discuss with parents able to cite
ga pamati sa Nutrition: Less on how to have enough ways on how to
klase" Than Body supply in preparing the achieve proper
● "Hambal pa gid Requirements quantity and quality of nutrition
sang 1 ka Nursing Care Plan food. (gardening).
maestra ya ga https://
sabat sabat nurseslabs.com/ 7. Encourage the parents e. The parents
man na sya sa imbalanced- to apply to any are able to
klase kaso kung nutrition-less- government realize and find
san o ya lang body- financial/beneficiary ways on how to
gusto kag may requirements/ programs. properly
pag ka sutil budget their
kuno kay ga Dependent: family income.
pang agaw sa
halampanganan 1. Seek help from a f. The parents
sang mga guidance counselor for are able to
classmates ya". services to be rendered identify
for the family, especially cheaper
Objective Data: to the patient. nutritious and
healthy foods
● Weight: 14 kg Collaborative: but fail to
● Height: 3' 2" demonstrate
● BMI: 16.7 1. Together with the the importance
(underweight) other health care of food
● Pale provider in the day care preparation
● Brittle nails and center, visit the family’s due to the
hair home for assessment to location of their
● Sunken identify and plan the kitchen and the
eyeballs interventions needed. lack of
● Capillary refill necessary
time- 3s (<2s) 2. Associate with the utensils.
● Dry lips Barangay or nearest
● Dry skin Health Care Office for g. The parents
● Patches of slow any financial help. are able to
healing wounds acknowledge
noted on Left about seeking
lower leg and help from any
elbow of the government
right arm. financial/benefi
ciary programs.

h. The family
thankfully
acknowledged
help from the
barangay
guidance
counselor.
Nursing Diagnosis 3:
Impaired verbal comm r/t lack of social interaction
ASSESSMENT DIAGNOSIS RATIONALE/ NURSING IMPLEMENTATION OF EVALUATION OF
PATHOPHYSIOL THERAPEUTIC CARE THE PRESENTED
OGY PLAN

Subjective Data: Impaired verbal Verbal After 2 hours of Independent: After rendering the
communication communication is health teaching, 1. Promote participation nursing
● Patient’s mother related to lack of the act of giving the parents of the in non-food-related interventions,
verbalized that social interaction. and receiving, 4 year old patient activities such as playing goals set were
"ang iya tatay information or in would be able to with other kids and partially met as
construction other words, understand the exercising. evidenced by:
worker na nga talking, writing, importance of
pirme lang ga and listening or social interaction 2. Encourage parents a. The parents are
puli nga hubog, reading. Impaired with their child. and support system to able to understand
ako naman ya verbal join meals together and the importance of
ga baligya lang communication After 6-8 months, establish a daily social interaction
banana cue sa describes an the patient is conversation, with their child, as
tubang balay". inability to receive, expected to therapeutically, with the verbalized by the
● "Kulang gid relay, or process improve her child. mother: “Na
pirme amon language. The verbal intyindihan ko na
kwarta para reasons for this communication 4. Assess what causes ngaa kahipos sina
mapakaon sang can range broadly and would be the patient to isolate kay Marga, ka
chakto amon from a language able to interact herself from others. busy gid bi sa
mga bata, pirme barrier to a with others. akon pirme amu
pa namon gina physical barrier 5. Educate the patient on na gakapabay-an
awayan sang impeding speech. After 8-10 months why making friends and ko sila. Subong
bana ko kung Some impairments patient is able to socializing is important at kabalo nako nga
diin kami maka can be overcome use a form of her age. importante gid gale
pangita kwarta" with therapy and communication to mag istorya sa
● "Kada tapos therapeutic get needs met 6. Promote the mga bata ko,
skwela dira man devices while and to relate importance of social bangud maka
lang na sya ga others may be effectively with interaction between apekto ini sa ila
pungko sa permanent. The persons and his family members and the pagdako”
 tubang pirtahan nurse supports the or her people in the community.
namon bitbit iya patient with environment. b. The patient was
nga manika kag impaired verbal 7. Allow the support able to engage in
sturya communication by Involve family system the opportunity to conversations with
sturyahon ya meeting them and significant ask questions about the other kids in the
na" where they are. others in the plan patient’s communication daycare center.
● "Hambal sang The nurse remains of care as much problem.
maestra ya patient, always as possible. c. The patient is
kahiposon man attempting to 9. Discuss with the showing signs of
na nga bata communicate parents the risks of social improvement in
galing kis a lang effectively, and isolation such as her actions
ga pamati sa using any devices depression and poor towards others:
klase" or techniques cardiovascular function. - Responding to
● "Hambal pa gid available to them. the nurse’s
sang 1 ka 10. Maintain a calm, questions.
maestra ya ga Maegan Wagner, unhurried manner. - Smiling while
sabat sabat BSN, RN, CCM Provide sufficient time for talking.
man na sya sa (January 17, 2022) the patient to respond.
klase kaso kung Impaired Verbal d. The patient was
san o ya lang Communication 11. Speak slowly and able to verbalize
gusto kag may Nursing Diagnosis use short sentences, and her emotions as
pag ka sutil & Care Plan ask only one question at evidenced by:
kuno kay ga https:// a time. - “owkey!” , when
pang agaw sa www.nursetogethe asked by the
halampangan r.com/impaired- 13. Provide practice nurse if the
sang mga verbal- sessions with the patient patient is okay.
classmates ya". communication- within the day.
nursing-diagnosis-
Objective Data: care-plan/ 14. Encourage the
parents of the patient to
● Weight: 14 kg seek medical
● Height: 3' 2" consultation.
● BMI: 16.7
(underweight) 15. Encourage the
● Pale patient to verbalize
● Brittle nails and feelings of discomfort
 hair during social situations.
● Sunken
eyeballs 16. Use and assist
● Capillary refill patient or significant
time- 3s (<2s) others to learn
● Dry lips therapeutic
● Dry skin communication skills of
● Patches of slow acknowledgment, active-
healing wounds listening, and Imessages.
noted on Left
lower leg and
elbow of the
right arm.

Nursing Diagnosis 4:
Impaired verbal comm r/t lack of social interaction
ASSESSMENT DIAGNOSIS RATIONALE/ NURSING IMPLEMENTATION OF EVALUATION OF
PATHOPHYSIOL THERAPEUTIC CARE THE PRESENTED
OGY PLAN

Subjective Data: Inappropriate Cognitive After 1-2 hours of Independent: After rendering the
behavior related to dysfunction is not rendering nursing nursing
● Patient’s mother cognitive an illness, but a interventions, the 1. Encourage the patient interventions, the
verbalized that dysfunction. description of client will not and the family members goals set were
"ang iya tatay someone's engage in any to early interventions like partially met as
 construction condition. It means aggressive therapy, exercises, and evidenced by:
worker na nga they have trouble behavior. activities for child
pirme lang ga with things like development to progress a. The parents
puli nga hubog, memory or paying (e.g. communication, were able to
ako naman ya attention. They show and tell, set limits, understand the
ga baligya lang might have trouble etc.) things that needed
banana cue sa speaking or to be done like
tubang balay". understanding. 2. Educate the child with communication
● "Kulang gid And they might proper self-care abilities and show and tell
pirme amon have difficulty such as brushing teeth, to the patient.
kwarta para recognizing proper hygiene, and self-
mapakaon sang people, places, or feeding activities. b. The patient was
chakto amon things, and might able to understand
mga bata, pirme find new places or 3. Encourage the patient really well the
pa namon gina situations to play with fellow proper self-care
awayan sang overwhelming. children and exercise abilities as known
bana ko kung This can cause daily. when she is doing
diin kami maka significant what the nurse
pangita kwarta" problems and 4. Encourage the patient tells her to do.
● "Kada tapos restrictions in the to socialize with fellow
skwela dira man family, social children and family c. The patient was
lang na sya ga activities, school, members. able to show signs
pungko sa employment, and of improvement
tubang pirtahan other functional 5. Encourage the parents when it comes to
namon bitbit iya roles. To work out to seek medical playing and
nga manika kag if someone has consultation for the interacting with
sturya cognitive patient. other children in
sturyahon ya impairment, health the daycare
na" professionals 6. Encourage parents to center.
● "Hambal sang might ask emphasize the everyday
maestra ya questions to test needs of a child such as d. The parents
kahiposon man memory, love, playing, attention, could significantly
na nga bata concentration, and and social interaction. understand the
galing kis a lang understanding. importance of
ga pamati sa They may also ask 7. Assess the causes of seeking medical
klase" questions of family the client’s inappropriate help from
● "Hambal pa gid or carers, who behavior such as public/government
sang 1 ka might have noticed grabbing the toys of her health care
maestra ya ga changes in the classmates. centers.
sabat sabat person's behavior
man na sya sa over time. Doctors 8. Keep the activities e. The parents
klase kaso kung may ask simple to avoid the were able to
san o ya lang questions, frustration of the client understand and
gusto kag may examine the due to complex activities. properly discuss
pag ka sutil person, and how to utilize their
kuno kay ga organize additional 9. Approach the client in resources (eg.
pang agaw sa tests to try to find a consistent manner in Philhealth).
halampangan the cause. all interactions.
sang mga Treatment will
classmates ya". depend on what is 10. Encourage the client
causing the to explore feelings and
Objective Data: cognitive concerns (e.g., identify
impairment. If it is fears, loneliness, self-
● Weight: 14 kg caused by an hate).
● Height: 3' 2" illness or condition,
● BMI: 16.7 then that will need Collaborative:
(underweight) to be treated. 1. Communicate with the
● Pale Physical activity, Local Health
● Brittle nails and healthy sleep and Government for the
hair relaxation family to afford checkups
● Sunken techniques can in the health center.
eyeballs help. Familiar
● Capillary refill objects might also 2. Work with social
time- 3s (<2s) be comforting. workers to help the
● Dry lips patient and indigent
● Dry skin Australian family to utilize resources
● Patches of slow Commission for like PhilHealth and
healing wounds Safety and Quality Malasakit center
noted on Left in Healthcare assistance.
lower leg and (Caring for
elbow of the cognitive 3. Collaborate with the
right arm. impairment) (June client, as well as the
2022) multidisciplinary team, to
https:// establish a reward
www.healthdirect.g system for compliance
ov.au/cognitive- with clearly defined
impairment#:~:text expectations.
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