1

NORTH VALLEY COLLEGE FOUNDATION, INC.

Lanao, Kidapawan City, Province of Cotabato
Nursing Department

ALLERGY OR HYPERSENSITIVITY REACTION

An Undergraduate Case Presentation to the Faculty

of North Valley College Foundation, Inc.

In Partial Fulfillment of the Requirement for the degree

Bachelor of Science in Nursing

SAGADO, SHAINA MAGDALYN B.

SALARDA, ALKIANA C.
SALIGUMBA, MARISH P.
SALVAÑA, KEIN KAREN I.
SANCHEZ, JOHN LLOYD S.
SUWAIB, MAISA J.
TUSOY, MAXINE YOULAH P.
UDTOHAN, CRISTLE JOY L.
YSON, SHERYL L.

DECEMBER 2023
 2

ACKNOWLEDGMENT

The group would like to express their heartfelt gratitude, sincere appreciation

and profound regards to the following people who, in one way or another, gave guidanc

e, strength, and encouragement in making this case presentation possible.

First of all, to Almighty God the Father, who granted us the knowledge and skills,

who send forth the gift of Holy spirit that aided them in completing this study. Without

Him, none of these things would be possible.

To our family, friends, and classmates, for their consideration and unending

support, emotionally, spiritually and financially.

To the members of the group, for sharing ideas, cooperating and giving full effort

in making the case presentation successful.

Lastly, to our client and her family for their acceptance and willingness to share

time, effort and giving us the essential information needed for this case presentation
 3

TABLE OF CONTENT
Pages
Title Page i

Acknowledgment ii

Table of Content iii

I. INTRODUCTION

II. OBJECTIVES

General Objectives

Specific Objectives

III. PATIENT’S DATA

IV. FAMILY HISTORY

Family Health History

Effects and Expectations of Illness to Self/Family

Clients Health History

V. DEVELOPMENT DATA

VI. DEFINITION OF COMPLETE DIAGNOSIS

VII. PHYSICAL ASSESSMENT

VIII. ANATOMY AND PHYSIOLOGY

IX. PATHOPHYSIOLOGY

X. ETIOLOGY AND SYMPTOMATOLOGY

XI. DOCTOR’S ORDER

XII. DIAGNOSTIC EXAM

 4

XIII. DRUG STUDY

XIV. NURSING CARE PLAN

XV. DISCHARGE PLAN

XVI. RECOMMENDATION

XVII. REFERENCES
 5

I. INTRODUCTION

Background of the Study

Allergy is described as an exaggerated response from the body’s immune
system to otherwise inert substances present in the environment. Allergy is a broad
topic and speaks to the body’s immune response to foreign substances common in the
environment, and triggers a reaction from the body’s immune response described as
hypersensitivity (Vander et al., 2018).

Hypersensitivity is an inappropriate immune response to common, typically

harmless antigens, manifesting as a continuum from minor like atopic dermatitis and
rhinitis to severe manifestations such as anaphylaxis, anaphylactoid and asthma
(Fischer et al., 2018).

Food allergy is defined as an immune reaction to proteins in the food and can be
immunoglobulin (Ig)E-mediated or non–IgE-mediated. IgE-mediated food allergy is a
worldwide health problem that affects millions of persons and numerous aspects of a
person’s life (Tang et al., 2018).

Allergic reactions secondary to food ingestion are responsible for a variety of

symptoms involving the skin, gastrointestinal tract, and respiratory tract. Prevalence
rates are uncertain, but the incidence appears to have increased over the past three
decades, primarily in countries with a Western lifestyle (Loh et al., 2018).

Branum et al., (2008) of University of Nebraska Food Allergy Research and

Resource Program recently found that the symptoms of IgE-mediated reactions can
involve the gastrointestinal tract, skin, or respiratory tract. Gastrointestinal and
cutaneous symptoms are among the more common manifestations of IgE-mediated
food allergies. Accordingly, common gastrointestinal symptoms include abdominal
cramps, nausea, vomiting, and diarrhea.

According to Food Allergy Research and Education Facts and Statistic (2017)
every three minutes, a food allergy reaction sends someone to the emergency room.
Research also found out that each year in the U.S., 200,000 people required
 6

emergency medical care for allergic reactions to food. Studies published in 2018 and
2019 estimate the number of Americans of all ages who have convincing symptoms of
allergy to specific foods: Shellfish: 8.2 million; Milk: 6.1 million; Peanut: 6.1 million; Tree
nuts: 3.9 million; Egg: 2.6 million; Fin fish: 2.6 million; soy: 1.9 million; sesame: 0.7
million.

In the Philippines, Garcia et al., (2014) concluded that despite that the
Philippines is an archipelagic country, 81% of FIlipinos are allergic to seafoods. In
addition, population surveys show prevalence rates in teenagers in the Philippines.
Moreover, the over-all prevalence of allergy in Filipino adults is 20%. This value
considered to be within the range of the reported prevalence rates in the Asia-Pacific
Region.

Patient B, 18 years old, who was rushed to the Antipas Medical Specialists
Hospital Inc. last November 28, 2023 with a chief complain of difficulty of breathing,
abdominal pain with a pain scale of 8/10. Prior to arrival, emergency personnel noted
facial redness particularly around the eyes and mouth with diffuse and severe urticaria
on Patient B's arms, legs, and chest. The patient personally stated that he is aware in
the first place that he is allergic to shrimp. The symptoms started at a thanksgiving
celebration after his graduation, where he deliberately consumed shellfish, specifically
shrimp and without hesitation, his allergic reaction manifested severely and became
unbearable. We the students chose this case study to better understand the
manifestations and disease process of Allergy or Hypersensitivity Reaction specifically
in relation to Gastrointestinal Manifestation of Food Allergy.
 7

II. OBJECTIVES

The purpose of this study is to increase our understanding of food allergies as

student nurses by gathering enough data that may be used as a reference to improve
our attitudes and abilities in applying nursing procedures and managing food allergies.

These data will enable us to better care for patients who have experienced
allergic reactions by providing them with the information and critical thinking abilities
they need.

Specific Objectives:

At the end of this case presentation, the student nurses will be able to:

1. Present the patient’s data and family background

2. Discuss the developmental plan

3. Define the complete diagnosis of the patient.

4. Discuss the physical assessment

5. Explain the anatomy and physiology involved in a patient with Food allergy reaction.

6. Discuss the etiology and symptomatology; and pathophysiology.

7. Elaborate the doctor’s order as well as the diagnostic exam of the patient.

8. Identify the drugs administered to the patient with food allergy reaction and its

surgical procedure, if there’s any.

9. Develop a nursing theory and nursing care plan related to the patient’s condition.

10. Provide the summary, findings, and recommendations for better management

about food allergy reaction that will be helpful in the patient, patient’s family,

community, and future researchers.

 8

11. Provide the definition of medical terms and references/bibliograph

III. PATIENT’S DATA

Patient Code Name: Patient B

Age: 18 yrs. Old

Nationality: Filipino

Civil Status: Single

Occupation: Student

Sex: Male

Religion: Roman Catholic

Ward and Room Number: Nursing Station 1

Date of Admission: November 28, 2023

Vital Signs During Admission:

Blood Pressure: 110/80 mmHg Temperature: 36.2℃

Pulse Rate: 120 bpm Respiratory Rate: 30 bpm

O2Sat: 89% Weight: 48 kg

Height: 5’6

Date of Discharge: December 02, 2023

Chief Complaint: Ineffective breathing pattern, Abdominal pain, and Itchiness

Admitting Diagnosis: Allergic Reaction

 9

Attending Physician(s): Dr. T

IV. FAMILY BACKGROUND

Grandmother
(Mother side)
- with hypertension
Grandfather
and food allergy
(Father side)
- with asthma

Patient Father Patient Mother

- with hypertension - with allergic
food reaction

Patient
Brother
- with allergic
PATIENT
food reaction
- with allergic food reaction

Family health history

As we all asset the patient all the information, data, and sources that we used to
assess the patient’s condition were directly received from the patient’s own health
history and the health histories of his family members.

Patient B stated that when he was 16 years old, he used to eat a lot of different
 10

foods, especially chocolates and carbonated drinks. As a teenager, he was very active
in playing outside games. One day, when he got invited by his friend to a birthday party,
he became fascinated by a large amount of food. One dish caught his attention –
creamy garlic shrimp. He ate a lot, and that was his first encounter with a food allergic
reaction. He suffered from mouth and throat itching, lip swelling, and skin reactions,
such as hives, watery eyes, and skin redness, along with difficulty breathing. He said he
almost died when that happened, and he was carried to the emergency department
where he was injected with epinephrine. As he was getting into puberty, according to
Patient B, he avoided eating shrimps and other certain foods that could trigger his
allergy, as advised by his doctor, to prevent such a life-threatening experience.

According to Patient B, his family members also have a history of allergies. His
grandfather on his father’s side manifested asthma, and his grandmother on his
mother’s side has a peanut allergy along with other allergies to certain foods. Patient B
is aware that his family members, including his mother and sibling, have a history of
food allergies. He mentioned that his mother used to be strict when it came to cleaning
the house and preparing foods. He also stated that his mother was overprotective of
them, being a housewife. Patient B can still recall the moment when his mother
accidentally ate peanut butter, suffering at that time from skin reactions, nausea, and
vomiting. He remembered that his mother had a prescription for palforzia, which she
used to take every time her food allergy was triggered. The patient’s younger brother,
still in elementary school, also shows signs of allergies. His father was the only member
of the family without allergies; he works as an engineer.

Effects/Expectations of Illness to self/family:

The patient was identified as having an allergic reaction to eating shrimp,

resulting in signs and symptoms such as difficulty breathing, skin redness, sudden
itching, lip swelling, watery eyes, hives, and skin redness. The hives caused the patient
to become itchy. Continuous medical care is necessary, involving expensive and time-
consuming procedures, medication, and regular checks for breathing patterns and skin
 11

redness. The patient also experienced psychological and emotional effects, such as
distress and anxiety. According to the patient, there is fear about whether the condition
can be treated or not. The family is concerned about the patient's health, monitoring
their condition regularly to determine if it is within normal limits.

The patient's family expresses concern about their loved one's health, stating
that food allergic reactions are easy to treat. On the mother's side of the patient, there is
a history of food allergies inherited from grandparents. As a result, they concentrate on
treating the patient's breathing pattern. They verbalize that it doesn't matter if they
spend a lot of time and money, as long as they can guarantee the patient's recovery
from this illness. In contrast, the patient believes they can overcome the sickness by
following the doctor's advice and relying on family support. The patient is confident in
recovery, adhering to medication, following the nurse's advice, and undergoing various
therapies for treating his allergies. The patient is committed to maintaining a healthy
lifestyle and avoiding allergic foods to ensure a full recovery.

Family members have confidence in the patient's ability to get well, witnessing
compliance with instructions and genuinely believing in the patient's efforts for a full
recovery. To provide the patient with necessary support, the family continues to assist
with everyday tasks, provide prescriptions, and ensure access to required medical
attention.

Client’s Health History

Past Health History

The patient had been identified as having an allergic reaction to food when he
was 16 years old, back in 2021. The doctor then gave him advice on how to treat food
allergies and live a healthy lifestyle, including eating healthier meals, avoiding allergic
food, and cutting back on restricted seafoods. Despite having these problems
diagnosed, the patient chose to disregard the results and carry on with his unhealthy
lifestyle habits, continuing to work because he wasn't experiencing any strange
symptoms at the time. Even though the patient had a history of allergy reaction, such as
 12

eating a lot of allergic food and restricted favorite seafood. The patient was unable to
keep track of his trigger on craving allergic food at the same time, and he wasn't taking
any medications to keep it there.

Present Illness/es

The patient's chief complaint of dyspnea, abdominal cramps accompanied by an

allergic reaction such as facial swelling and hives that are intensely pruritic and has
become unbearable that promptly made the mother rush him to seek medical attention
at the hospital. The patient is experiencing signs and symptoms of an anaphylactic
reaction, including difficulty of breathing, facial redness, and swelling to the point he
feels the intense itching throughout his entire body. Whenever he experiences difficulty
breathing, the mother would ask for assistance from the nurse, given the worried
situation he is currently facing. The patient has also expressed occasional scratching,
and in these instances, his mother, acting as the caregiver, prevents him from
scratching the itchy areas. She is there to manage the patient's emotions, balancing
irritation and calmness, particularly when the patient has watery eyes on his face.

V. DEVELOPMENTAL DATA
ERIKSON PSYCHOSOCIAL THEORY
Theory
Erikson's psychological
theory proposed the
human development that
occurs in stages from
childhood to old age.
According to him, the
idea of what is known
about how we develop,
how our circumstances
are made, especially our
families that affect our
lives, and why some
people experience
identity crisis is related to
how we build our
personalities depending
on where we started
13
Stages Justification and Result
Identity vs Confusion Based on the patient he was
playing basketball and video
Age 12 - 20 games with his friends.
(Adolescence) As they
transition from childhood Achieved
to adulthood, teens may
begin to feel confused or
insecure about
themselves and how they
fit into society. As they
seek to establish a sense
of self, teens may
experiment with different
roles, activities, and
behaviors. According to
Erikson, this is important
to the process of forming
a strong identity and
developing a sense of
direction in life.
 14

SIGMUND FREUD’S PSYCHOSEXUAL DEVELOPMENT THEORY

Theory Stages Justification and Result
Sigmund Freud proposed Genital Stage The patient begins to explore
that personality his sexual feelings by going out
development in childhood Puberty - Adult on a date and going to parties.
takes place during five During this stage,
psychosexual stages, individuals start to Achieved
which are the oral, anal, become sexually mature
phallic, latency, and and begin to explore their
genital stages. sexual feelings and
During each stage, desires more maturely
sexual energy (libido) is and responsibly.
expressed in different
ways and through
different body parts
 15

PIAGET’S DEVELOPMENT THEORY

Theory Stages Justification and Result
Piaget proposed that Formal Operational As the patient reached the
cognition developed Stage puberty stage, he started to
through distinct stages understand that shrimp is life
from birth through the The final stage of Piaget's threatening for him, so he
end of adolescence. theory involves an started to avoid it.
Piaget proposed four increase in logic, the
major stages of cognitive ability to use deductive Achieved
development, and called reasoning, and an
them (1) sensorimotor understanding of abstract
intelligence, (2) ideas.3 At this point,
preoperational thinking, adolescents and young
(3) concrete operational adults become capable of
thinking, and (4) formal seeing multiple potential
operational thinking. solutions to problems and
Each stage is correlated think more scientifically
with an age period of about the world around
childhood, but only them.
approximately.
 16

VI. DEFINITION OF COMPLETE DIAGNOSIS

The pt was identified as having an allergic reaction to a certain food which he has
symptoms of difficulty of breathing, skin redness ,sudden itching and puffy eyes. The
patient appeared weak due to classical manifestation such as difficulty of breathing this
was confirmed by his lab results; Eosinophils level with normal range of 0.5-5.0% while
the patient resulted of 9.0 % which means his high eosinophil numbers may indicate
mild condition such as a drug reaction or allergy, or a severe condition could cause it,
including some blood disorders together with his basophils result 2.0 which is higher
than a normal range of 0.0 – 1.0 indicator of autoimmune disease or an allergic
reaction. While his food intolerance test which his blood sample appeared positive for
allergens to shellfish with 126 U/ml value, added on that is his skin prick testing which
also an allergy testing resulted positive of allergen reaction in food with a value of 6.5
mm in diameter.
 17

VII. PHYSICAL ASSESSMENT

Personal Data

Patient B is an 18 years old male admitted on November 28, 2023 with a chief
complaint of Ineffective breathing pattern, abdominal pain and facial redness.

General Survey

Received patient on bed coherence with ongoing IV infusion of Epinephrine at 1

mg/hr along with D5W 1 L 16 cc/hr on right metacarpal vein infusing well not in
respiratory distress (+) redness

Vital signs

-Temperature: 36.2℃ -RR: 30 cpm

-B/P: 110/80 mmHg -O2Sat: 89 %

-PR: 120 bpm -Weight: 48 kg -Height: 5’6

Appearance of the patient: Patient appeared weak due to classical manifestations

such as difficulty of breathing

Skin: The patient's entire body has signs of urticaria on the face, neck, chest arms, and
legs and pallor was noted.

Hair: His hair appears to be in black and curly. No signs of redness

Face: The patient's face is round asymmetrical with facial swelling noted.

Eyes and Vision: Eyebrows are symmetrically aligned. Upon inspection of corrective
 18

lenses, pupils are mildly red and watery, reactive to light and in accommodation.
Patient’s visual acuity appeared weak due to his state.

Ears and hearing: Upon inspection, ears are symmetrically aligned with each other,
and are aligned with the outer canthus of each eye. No unusual discharge noted.
Patient is cooperative when hearing questions.

Nose: Upon inspection, the patient’s nose is refined.

Mouth: The patient's outer lips are swollen and red.

Neck: (-) lymphadenopathy (LAD). No masses, lesions or any unusuality were noted.
Shoulder muscles had symmetry from an anatomical perspective. (+) Signs of urticaria.

Chest: Clear to auscultation. (+) Signs of urticaria.

Nails: The fingertips and toes of the patient appear pink. Epidermis surrounding the
nails was intact and trimmed; no lesions were noted.

Abdomen: (+) Signs of urticaria. No scars or lesions can be seen.

Extremities: (+) Signs of urticaria. Full range of motion is noted to all joints.
 19

VIII. ANATOMY AND PHYSIOLOGY

Immune System

The immune system is a complex network of organs, cells and proteins

that defends the body against infection, whilst protecting the body's own cells. When a
harmless substance such as dust, mold, or pollen is encountered by a person who is
allergic to that substance, the immune system may overreact by producing antibodies
that attack" the allergen.

● Antibodies are proteins that protect you when an unwanted substance enters
your body. Produced by your immune system, antibodies bind to these unwanted
substances in order to eliminate them from your system.
 20

● Leukotrienes (LTs) are lipid mediators that play pivotal roles in acute and chronic
inflammation and allergic diseases.
● Cytokines are small proteins that are crucial in controlling the growth and activity
of other immune system cells and blood cells. When released, they signal the
immune system to do its job. Cytokines affect the growth of all blood cells and
other cells that help the body's immune and inflammation responses.
● T-cells are a type of white blood cell called lymphocytes. They help your immune
system fight germs and protect you from disease.
● B lymphocytes, also called B cells, create a type of protein called an antibody.
These antibodies bind to pathogens or to foreign substances, such as toxins, to
neutralize them.
● Immunoglobulin E (IgE) antibodies are well known for their role in mediating
allergic reactions, and their powerful effector functions activated through binding
to Fc receptors FcεRI and FcεRII/CD23.
● Mast cell functions as part of the body's innate immune system. When
membrane-bound IgE binds a foreign substance and two Fc receptors crosslink,
the mast cell immediately releases a large number of mediators into the nearby
extracellular space via degranulation.
● Histamine regulates a plethora of pathophysiological and physiological
processes, such as secretion of gastric acid, inflammation, and the regulation of
vasodilatation and bronchoconstriction.
● Basophils are a type of white blood cell that works closely with your immune
system to defend your body from allergens, pathogens and parasites. Basophils
release enzymes to improve blood flow and prevent blood clots.

CNS is protected by the immune system, including cells that reside directly within the
CNS and help to ensure proper neural function, as well as cells that traffic into the CNS
with disease. The CNS-resident immune system is comprised mainly of innate immune
cells and operates under homeostatic conditions.
 21

Kidneys clear circulating cytokines and bacterial toxins such as lipopolysaccharide

(LPS) and continuously sample blood‐borne proteins, contributing to homeostasis of the
immune system.

The lung's immune system plays a crucial role in protecting the body from all these
respiratory pathogens while tolerating small particulate matter and mechanical forces
from respiration.

The gastrointestinal tract (GI tract) plays dual roles in human physiology: digestion and
uptake of nutrients and the more daunting task of maintaining immune homeostasis
(protecting the body from potentially harmful microbes, while inducing tolerogenic
responses to innocuous food, commensals and self-antigens).

Lymphatic vessels are well known to participate in the immune response by providing
the structural and functional support for the delivery of antigens and antigen presenting
cells to draining lymph nodes.
 22

IX. PATHOPHYSIOLOGY

PREDISPOSING FACTOR: PRECIPITATING FACTOR:

 Age (18 y.o)
 Male  Diet
 Hereditary  Lifestyle

Exposed to a
sensitizing allergen

Mast Cell Allergic

Response

Release of Histamine

Allergic Reactions
 23

S/S

 Itching, Rash
 Sneezing, runny nose
 Inflammation
 Cough
 Diarrhea
X. ETIOLOGY AND SYMPTOMATOLOGY

ETIOLOGY
BASIC PRESENT RATIONALE ACTUAL
ETIOLOGY /
ABSENT
PRECIPITATING
FACTORS

Family History ✓ Individuals with a family The patient's mother

of Food Allergy history of allergic informed us that, in
reactions, such as addition to other
asthma and food symptoms, she and his
allergies, may face a other son both manifested
slightly higher risk of a food allergy.
developing a food Furthermore, she
allergy. Recognizing acknowledged the
this, there is a hereditary connection in
heightened focus on the family's health history.
food management. This
includes educating both
patients and caregivers
about food allergies
and providing self-
administration training.
These measures aim to
prevent allergic
reactions, enhance
safety, and foster a
confident and
empowered approach
to managing food
 24

allergies

Age ✓ The genetic makeup The patient’s mother

affects both the mentioned his son
process of aging and attending a friend's
the development of birthday party, where he
allergies. As individuals was captivated by a
age, changes in their variety of foods. His
immune system and indulgence in creamy
inflammatory garlic shrimp during the
responses may occur, event triggered his first
potentially affecting food allergic reaction.
their susceptibility to
food allergies.

SYMPTOMATOLOGY
SYMPTOMS PRESENT/ RATIONALE ACTUAL
ABSENT

Urticaria ✓ Hives, or urticaria, Our patient’s significant

result from the release other (S.O.) stated that
of histamine triggered before admission, one of
by allergens, foods, the chief complaints was a
medications, or other skin reaction
factors. This release characterized by red welts
causes itchy welts on that were very itchy.
the skin due to blood
vessel leakage.
Managing hives
involves identifying
triggers and may
require medical
intervention.

Difficulty of ✓ Difficulty in breathing Our patient's significant

Breathing during an allergic other (S.O.) stated that
 25

reaction is due to the before admission, his

release of chemicals initial complaint was
like histamine. This difficulty in breathing,
causes airway characterized by an
inflammation and inability to breathe rapidly
constriction, leading to or deeply enough. This
respiratory symptoms. symptom became
Identifying triggers unbearable and led to the
and seeking timely decision to seek medical
medical intervention attention at the hospital.
are essential for
management.

Abdominal Pain ✓ Abdominal pain in Our patient's significant

allergic reactions is other (S.O.) stated that
primarily due to the before admission, his
release of initial complaint was
inflammatory difficulty in breathing,
mediators like characterized by an
histamine, causing inability to breathe rapidly
smooth muscle or deeply enough.
contraction, increased
sensitivity of nerve
endings, inflammation,
and potential disruption
of normal digestive
processes.

Swollen Lips ✓ Swollen lips in an Our patient stated that his

allergic reaction stomach started to ache
happen due to after eating a lot of shrimp
increased blood flow in thanksgiving.
and fluid accumulation
triggered by allergens,
leading to
inflammation.

Watery Eyes ✓ Watery eyes in Our patient’s significant

allergies also occur other (S.O.) stated that
 26

when the immune prior to admission the

system releases mother is present to
histamine, prompting provide comfort, even
increased tear though the patient was
production. This feeling irritated due to his
response is the body's watery eyes.
attempt to flush out
allergens

XI. DOCTOR’S ORDER

Date Ordered Doctor’s Order Rationale Remarks

11/28/23 Admit pt under ER DEPT For a high standard Done
 27

8:25 AM of care for severe or

sudden emergency
treatment.
Secure consent Patient has the right Done
to be consented in all
procedures to
bedone
TPR with BP q4 To monitor vital signs Done
so that any
unusualities will be
referred as follows
Done
● IM epinephrine @ Epinephrine: To treat
0.5 mg/min very serious allergic
reactions to insect
stings/bites, foods,
drugs, or other
substances. And
quickly improve
breathing, stimulate
the heart, raise a
dropping blood
pressure, reverse
hives, and reduce
swelling of the face,
lips, and throat.

IVF:
● D5W 2 L at 16cc/hr IV: D5W – A solution
● IV infusion: that helps to replace
Epinephrine @ 5 lost fluids and
ml/hr provide
carbohydrates to the
body.
Start O2 at 8 L/min via To provide a method Done
facemask to transfer breathing
oxygen gas from a
storage tank to the
lungs.
Laboratory: CBC with PC Done
CBC PC determines the
quantity of each
quantity of blood cell
in a given specimen
of blood,often
including the amount
 28

of hemoglobin,
hematocrit, and the
proportion of various
white blood cells. To
know any deviations
or abnormalities in
the blood
Chest X-ray (PA) An imaging test that
looks at the
structures and
organs in your chest.
Rapid Antigen Test To detect certain viral Done
antigen, in which
recent cases of
SARS-CoV-2
Blood Test: A test that examines Done
the cells, chemicals,
● Sodium (Na) proteins or other
● Potassium (K) substances in the
● Calcium (Ca) blood.
● Magnesium (Mg)
● Albumin
● Creatine
● BUN,
● SGPT,
● HGT

U/A with Fecalysis To screen patient's Done

urine and stool for
detect substances
Medication: To treat sneezing, Done
● Benadryl 25 mg runny nose, watery
over 15 min every eyes, hives, skin
4 hours rash, itching, and
other cold or allergy
symptoms.
● Methylprednisolone A corticosteroid Done
10 mg every 6 medication to
hours decrease the immune
system's response to
various diseases to
reduce symptoms
such as swelling,
pain, and allergic-
type reactions.
● Famotidine 20 To treat stomach Done
 29

mg/day every 12 ulcers (gastric and

hours duodenal), erosive
esophagitis
(heartburn or acid
indigestion), and
gastroesophageal
reflux disease
(GERD).
I/O every shift To indicate the fluid Done
balance for the
patient
11/29/23 Follow up lab results -
7:50 AM
Skin Prick Test To detect IgE
mediated type I
allergic reactions like
allergic rhinitis, atopic
asthma, acute
urticaria, food allergy
etc.
Food intolerance Test To identify whether
your body is
hypersensitive
towards a certain
food, which could
cause an adverse
reaction to your
system.
Continue IVF at same rate IV: D5W – A solution Done
that helps to replace
lost fluids and
provide
carbohydrates to the
body.
V/S every 4 hours of HR To have a baseline Done
and SO2 data and to assess
the heart rate and
oxygen saturation of
the patients health
status.
11/30/23 Shift benadryl to cetirizine An antihistamine Done
8:30 AM HCI 10 mg PO once daily medicine that helps
the symptoms of
allergies. It's used to
treat: hay fever.
conjunctivitis (red,
 30

itchy eye)
I/O every shift To indicate the fluid Done
balance for the
patient
Refer back as needed To refer to any Done
casualties and
maintain professional
accountability
towards physicians
and other healthcare
staff.

12/01/23 Repeat Skin prick test To diagnose and

9:20 AM better manage food
allergies.
D/C oxygen mask shift to To relieve symptoms
inhalation: Salbutamol 1 such as chest
neb every 4 hours tightness, wheezing,
shortness of breath
and coughing in
some other chest
diseases too, such as
COPD
Continue medication
12/01/23
10:00 AM No objective from
psychology service for
discharge:

Secure bill for possible

discharge
 31

XII. DIAGNOSTIC EXAM

LABORATORY RESULT

COVID-19 RAPID ANTIGEN TEST

Date Ordered Exam Result Interpretation

A negative
COVID-19 test
November. 28, COVID-19 NEGATIVE means the test
2023 RAPID did not detect the
ANTIGEN TEST virus.
(ICHROMA)

URINALYSIS

Date Ordered Test Patient’s Result

November 28, 2023 URINALYSIS Macroscopic Result

◆ Color: Yellow

◆ Sugar: Negative

◆ Transparency: Clear

◆ Albumin: Negative

◆ Reaction: 7.0

◆ Specific Gravity:
 32

1.005

Microscopic Result

PUS CELLS = 0-2/HPF

RBC = 0-2/HPF

FECALYSIS

Date Ordered Test Patient’s Result

November 28, 2023 FECALYSIS MACROSCOPIC

RESULT

Color: Brown

Consistency: Soft

MICROSCOPIC
RESULT

No Ova/Intestinal
Parasite Seen

DIAGNOSTIC IMAGING DEPARTMENT

(X RAY REPORT)

Date Ordered Exam Impression Interpretation

Chest PA: Heart

is normal in size.
Hili are normal.
November 28, CHEST PA NORMAL Pulmonary
2023 CHEST vasculatures are
intact. Both lung
fields are clear.
Lateral
 33

costophrenic
sinuses are
intact.

CLINICAL CHEMISTRY REPORT

Date Test Patient’s Normal Clinical Nursing

Ordered Result Value Significanc Responsibili
e ties

November URIC 160.46 155 - 357 The patient’s

28, 2023 ACID umol/L umol/L Uric Acid
level is
9:08 AM 160.46
umol/L.

The result
shows a
normal
value.

SGPT 23.02 U/L 4-34 U/L The patient’s

SGPT level
is 23.02 U/L.

The results
shows a
normal
value.

BUN 15 mg/dL 7-20 The patient’s

mg/dL SGPT level
is 15 mg/dL.

The results
shows a
normal
 34

value.

CREA 110.1 61.9 - The patient’s

umol/L 114.9 Creatinine
umol/L level is 110.1
umol/L.

The results
shows a
normal
value.

SERUM ELECTROLYTES

Date Test Patient’s Normal Clinical Nursing

Ordered Result Value Significance Responsibili
ties

Nov. 28, Sodium 144.7 135-148 The patient’s

2023 mmol/L mmol/L Sodium level
(Na+) is 144.7
mmol/L. The
results
shows a
normal
value.

Nov. 29, Potassi 7. 34 3.50-5.30 The patient’s

◆ Administ
2023 um mmol/L mmol/L Sodium level
is 7.34 er
(K+) (H) mmol/L medicatio
 35

where the ns as
normal value prescribe
level is within d
the range of
3.50-5.30 ◆ Monitor
mmol/L. The Ins and
results Out
shows
abnormality. ◆ Assess

Hyperkalemi the
a may patient
include for signs
nausea, and and
difficulty of symptom
breathing. s of
toxicity

◆ Educate
the
patient
related to
diet

Nov. 29, Calciu 1.10 1.13-1.32 The patient’s

2023 m (Ca+ mmol/L mmol/L Sodium level
+) is 1.10
mmol/L. The
results
shows a
normal
value.

Nov. 29, Chlorid 100.0 98-107 The patient’s

2023 e (Cl-) mmol/L mmol/L Chloride
level is 100.0
mmol/L. The
results
 36

shows a
normal
value.

COMPLETE BLOOD COUNT

Date Test Patient’s Normal Clinical Nursing

Ordered Result Value Significance Responsibili
ties

Nov. 28, Hemogl 147 g/L 110-150 The patient’s

2023 obin g/L Hemoglobin
level is 147
g/L. The
results
shows a
normal
value.

Hemat 47% 37.0 -48.0 The patient’s

ocritt % Hematocritt
level is 47%.
The results
shows a
normal
value.

RBC 4.80 4.50-5.00 The patient’s

mmol/L RBC level is
mmol/L 4.80 mmol/L.
The results
shows a
 37

normal
value.

MCV 92.7 fL 80.0- The patient’s

100.0 fL MCV level is
92.7 fL. The
results
shows a
normal
value.

MCH 33.3 pg 27.0-34.0 The patient’s

pg MCH level is
33.3 pg. The
results
shows a
normal
value.

MCHC 359 g/L 310-370 The patient’s

g/L MCHC level
is 359 g/L.
The results
shows a
normal
value.

WBC 14.22 4.00 - The patient’s

◆ Provide
12.00 WBC count
10^9/L 10^9/L is 14.22 baseline
mmol/L assessm
(H)
where the ent of
normal value pulmonar
level is within y and
the range of neurologi
 38

4.00-12.00 cal
mmol/L. The function
results
shows
abnormality.
◆ Assess
Signs & the
Symptoms of general
fatigue, pain, condition
rashes, of the
difficulty patient
breathing
that cause
leukocytosis.
◆ Closely
monitor
the lab
value

◆ Provide
psycholo
gical
support

◆ Encourag
e patient
to
increased
fluid
intake

◆ Monitor
labs

◆ Monitor
VS
 39

Neurtro 92.0% 40.0 - The patient’s

◆ Administ
phils 70.0% Neutrophils
(H) count is 92% ered
where the medicatio
normal value n as
level is within prescribe
the range of d
40-70%. The
results
shows ◆ Provide
abnormality.
patient
Usually with
happens relaxation
when body and
consumes calming
immune cells technique
more quickly s.
than it
creates them
or when the
bone marrow ◆ Provide
is creating rest to
them patient
improperly
meaning the
body is
under stress.
 40

Lymph 34.5% 20.0- The patient’s

ocytes 40.0% Lymphocytes

count is
34.5%. the
results show
a normal
value.

Monoc 11.2% 3.0- The patient’s

ytes 12.0% Monocyte
count is
11.2%. The
results
shows a
normal
value.

Eosino 9.0 % 0.5-5.0% The patient’s

◆ Administ
phils
(H) Eosinophils ered
Count is medicatio
6.0% where n as
the normal prescribe
value level is d
within the
range of 0.5- ◆ Educated
5.0%. The the
results patient
shows regarding
abnormality. healthy
High lifestyle
eosinophil
numbers ◆ Monitor
may indicate vital
mild signs for
 41

condition sign of
such as a infection
drug reaction
or allergy, or ◆ Monitor
a severe for early
condition signs of
could cause localized
it, including and
some blood systemic
disorders. infection
for
patients

◆ Encourag
e patient
to
increased
fluid
intake

◆ Provide
rest to
patient

Basoph 2.0 0.0-1.0 The patient’s

◆ Monitor
ils Basophils
(H) level is 2.0 labs
The results
shows a ◆ Monitor I
normal value &O
where the
normal value ◆ Administ
level is within ered
the range of medicatio
0.0-1.0%. ns as
The results prescribe
shows d
 42

abnormality.
◆ Monitor
Basophils vital
happens signs
when your
body ◆ Provide
produces too rest and
many comfort
basophils,
the white
◆ Encourag
blood cell
type that e patient
manages to
your body’s increased
reactions to fluid
allergens. intake

Platelet 198 10^9/L 150-350 The patient’s

10^9/L Platelet level
is 198
10^9/L.

The results
shows a
normal
value.

FOOD INTOLERANCE TEST

Test Report: Order of Reactivity

DATE ORDERED TEST KIT USE VALUE INTERPRET

ATION

Elevated
Food
Nov. 29, 2023 Blood FOOD Order of Detected.
Sample INTOLER Reactivity: IgG
 43

ANCE 126 U/ml = antibodies

TEST Shellfish detected
against
sample food.
Positive for
Allergens to
Shellfish.

Color
Coding: RED

SKIN PRICK TEST

Allergy Testing

Date Performed TEST KIT USE VALUE INTERPRETA

TION

Nov. 29, 2023 Skin Prick High Wheal 6.5 There is a

Allergy Precision mm in POSITIVE
Testing Skin Prick diameter response to
Kit food allergen,
Testing with a wheal
6.5 mm in
diameter. No
reactions to
other
substances
 44

are noted.

XV. DISCHARGE PLAN (M.E.T.H.O.D)

Medication. Carefully explain to the patient the prescribed drug action, time, schedule,
side effects and adverse reactions. Do not take any other drugs, supplements, vitamins,
or herbs without asking the provider about them first.

Exercise. Patients should perform minimal activities.

Treatment. Avoid exposure to the food altogether. If the patient eats food and has a mild
reaction, over-the-counter antihistamines may help relieve symptoms and if the patient
has a more severe reaction as well as any signs and symptoms of anaphylaxis may be
used to prescribe medication like adrenaline.

● antihistamines – used to treat mild to moderate allergic reactions.

● adrenaline – used to treat severe allergic reactions (anaphylaxis)
 45

Health Teaching. Instruct the patient to regularly monitor his food intake especially to
the food that may be able to trigger her allergy. Emphasize the value of rest, lead a
healthy lifestyle, and attend medical checkups, as well as doing as the doctor
prescribes.

Outpatient. Keep a follow-up appointment. Close follow-up is important to stroke

rehabilitation and recovery.

Diet. Instruct to eat more fiber containing fruits and vegetables. Maintaining a proper
diet is essential for long-term relief. Allergies can be managed through identifying
dietary triggers and eliminating them from the diet.

XVI. RECOMMENDATION

Based on the outcome of this study, the following will benefit:

Community. This study will be helpful and intended to the most appropriate kinds
of community programs to share the source of information for those interested in
gaining a greater understanding of the knowledge of Allergy, its symptoms, causes, and
treatments.

Patients. The patients must consult with a health care practitioner for complete
information about their health, medical concerns, and treatment options. They must be
fully informed on the condition to decide which treatments and interventions are most
appropriate for the patient. Additionally, this study might help the reader understand
what changes they should make or what behaviors they should avoid.

Nurses. This study is important for nurses because it will serve as a guide for
them to give scientifically valid measurements of knowledge and performance
competencies through clients with varying degrees and types of educational preparation
and experiences.

Future Researcher. The study's results were used as a source of information and
 46

a manual for future researchers who wished to carry out the same study or any study
concerning Allergy patients.

XVII. REFERENCE/BIBLIOGRAPHY

● Branum AM, Lukacs SL. 2008. Food allergy among U.S. children: trends in
prevalence and hospitalizations. NCHS Data Brief:1-8.
● Food Allergy Research and Education. Facts and Statistics. NCHS Data Brief:1-
8. 2017 Oct 21; 14(4)
● Fischer D, Vander Leek TK, Ellis AK, Kim H. Anaphylaxis. Allergy Asthma Clin
Immunol. 2018;14(Suppl 2):54.
● Loh W, Tang MLK. The Epidemiology of Food Allergy in the Global Context. Int J
Environ Res Public Health. 2018 Sep 18;15(9)
● Tang MLK, Loh W. The Epidemiology of Food Allergy in the Global Context. Int J
Environ Res Public Health. 2018 Sep 18;15(9)
● Vander Leek TK, Fischer D, Ellis AK, Kim H. Anaphylaxis. Allergy Asthma Clin
Immunol. 2018;14(Suppl 2):54.