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TABLES OF CONTENTS



I. Demographic data

II. #eason Ior Seeking Health

III. History Ior Present Illness

IV. Past Medical History

V. Heredo-Iamilial History

VI. Developmental History

VII. ordon`s Functional Health Patterns

VIII. omprehensive Physical Examination

O ephalocaudal Assessment
O Focused Assessment

IX. Diagnostic Test

X. #eview oI System

XI. ase Management


O Medical
O Surgical
O ursing management

XII. Appendices





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I. EMOGRAPHIC ATA
Initials of Clients` Name: Sn.L
Address: Langkaan II, Dasmarias ity, avite
Age: 2 months old
Birth ate: September 28, 2010
Birth Place: Langkaan II, Dasmarias ity, avite
Gender: Female
Religion: #oman atholic
ate of Interview: December 06 2010
Primary Informant: The mother oI the client
Secondary Informant: none
II. REASON FOR SEEKING HEALTH CARE:
The mother oI the client just wants to maintain her baby`s health.
III. HISTORY OF PRESENT ILLNESS
The client is not experiencing any illness.
IV. PAST MEICAL HISTORY
Childhood/ Adult iseases
ot applicable

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Injuries/Accidents
Baby Sn.L never experienced injuries and accidents.
Hospitalization
Baby Sn.L is not experience to be hospitalized but her mother carries her in the rural
health unit to administered vaccine.
Operation
Baby Sn.L was never undergoing in any operation.
Allergies
She has no allergies
Medication
She did not take medicine but she is now under oI administering vaccination.
Immunization
The client is not yet Iully immunized. She had B (September 29, 2010), DPT
(December 06, 2010), OPV (December 06, 2010) and Measles (December 06, 2010). She had no
Hepa B vaccine yet.
Last Examination:
Her last visited in Langkaan II #ural Health Unit was last December 06, 2010




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V. HEREO-FAMILIAL HISTORY


INTERPRETATION:

Family oI Mr.A.L is composed oI 4 members. The Iather is Mr. A.L, he is 39 years old,
and the mother is Mrs. MI.L, she is 30 years old and their two kids are Sh.L, their eldest son, he
is 3 years old and the youngest daughter is Sn.L 2 months. Their Iamily has not hereditary
disease both side.


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VI. EVELOPMENTAL HISTORY

A. 1. Piaget`s Cognitive evelopment

Stage Special task (s) Evidences of
Milestone
Achievement
1ustification
SENSORIMOTOR
Sub-stage:
First habits and
primary circular
reactions phase
6 weeks
4 oordination oI
sensation and two
types oI schemes:
habits (reIlex) and
primary circular
reactions
(reproduction oI
an event that
initially occurred
by chance). Main
Iocus is still on the
inIant's body
4 In this stage, this
type oI reaction,
an inIant might
repeat the motion
oI passing their
hand beIore their
Iace. Also at this
phase, passive
reactions, caused
by classical or
operant
conditioning, can
begin.
4 The inIant was not
do something, she
just do is staring at
m while I playing
with her.

B. E. Ericson`s Psychosocial evelopment
Stage Special task (s) Evidences of
Milestone
Achievement
1ustification
InIancy Trust vs. Mistrust 4 In this stage the
mother needs to
ready to teach her
daughter to trust
other and to get
rid oI the anxiety
to other
4 My client is only
two she have no
yet cares about
what happening to
her environment,
but when I
perIorm palmar
grasp reIlex she
reIused me but
when her mother
do the tester she
grasp the Iinger oI
her mother
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C. S. Freud`s Psychosexual evelopment
Stage Special task (s) Evidences of
Milestone
Achievement
1ustification
Oral 4 Center of
pleasure: mouth
(major source oI
gratiIication &
exploration)
4 Primary
need: Security
4 Major
conflict: weaning
4 In this stage the
inIant is always do
the sucking reIlex
because this is
their way to
satisIy their
curiosity and to
release their stress
4 hile I
interviewing her
mother I saw that
she sucks her own
Iinger.

. 1. Fowler`s Spiritual evelopment
Stage Special task (s) Evidences of
Milestone
Achievement
justification
Pre-stage:

UndiIIerentiated Iaith
4 Trust, hope and
love compete with
environmental
inconsistencies or
threats iI
abandonment.
4 In this stage the
inIant wants
always is with her
mother. She had
also anxiety to the
other or to the
person who is
stranger Ior her.
4 The inIant is
comIortable and
satisIy with her
mother hands.

E. L. Kohlberg`s Moral evelopment
Stage Special task (s) Evidences of
Milestone
Achievement
1ustification
(Pre-Conventional)

Level :Obedience
and punishment
orientation

4 (Obedience and
punishment
driven),
individuals Iocus
on the direct
consequences oI
their actions on
themselves.
4 In this stage the
mother will be
ready to educate
her daughter to be
obedient.
4 The mother oI the
client doesn`t need
to discipline her
daughter at this
time because her
baby is still
innocent.
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F. R. Havighurst`s evelopment Task
Stage Special task (s) Evidences of
Milestone
Achievement
1ustification
Infancy 4 Dependent with
the mother
4 In this stage it is
normal to be
dependent to the
mother
4 The client cannot
do anything; she
cannot do
anything without
her mother. Like
Ior example; to
Ieed her, to
dressed her, to
bathe her and
other

G. illiams Metro Manila evelopment Screening Test (MMST)
PERSONAL-
SOCIAL
SCORE AMINISTRATION 1USTIFICATION
#egards Face Passed I place the child on his
back. Then I come Iace
to Iace within 12 inches
oI the inIant.
The inIant looks at me and
she stares ay me
Smiles #esponsively #eIused I smile and talk to the
inIant but I do not touch
her.
hile talking to the inIant
the inIant make sounds. It
looks like that she is talking
to me.
Smiles spontaneously #eIused During the test observe
iI the inIant smiles at
tester or parent without
any stimulation either
by touch or sound.
During the test regards Iace
the inIant always stare at
me when I look into her.
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Feed SelI racker Failed I asked the parent iI the
child Ieeds herselI a
cracker.
She cannot Ieed herselI
#esist toy pull Failed I give the inIant a rattle.
hile she is playing
with it I gently pull it
away Irom her.
The inIant didn`t do the
activity
Plays Peek a Boo Failed I make a small hole in
the middle oI the paper
with a pen. hen the
inIant is looking at me I
hide my Iace within the
paper. Then, I look
around within the paper
twice and says, 'peek a
boo. I look through the
hole too see iI the child
is waiting Ior me to
reappear.
The inIant didn`t do the
activity
orks Ior toy out oI
reach
Failed I place the rattle on the
table a little out oI her
reach. (do not leave the
toy out oI reach too long
or too Iar away this may
upset the child)
The inIant didn`t do the
activity
FINE-MOTOR
AAPTIVE
SCORE AMINISTRATION 1USTIFICATION
Follows to Midline Failed I hold the red scarI The inIant didn`t Iollow the
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about 6 inches in Iront
oI the child`s Iace, and
then I shake the scarI to
attract the child`s
attention. Then I move it
Irom one side in an arc
over the midline oI the
inIants head to the other
side. Then I repeated it 3
times.
red scarI
Follow past midline Failed Same as the
administration oI the
test Iollows to midline.
The inIant didn`t Iollow the
red scarI
Hands together Passed hile the assessment is
going on, I observed iI
the inIant can put her
hands together.
Based on what I observed
the inIant can put her hands
together.
rasp #attle Passed hile the inIant is being
held by her parent. I
place the rattle touching
the tips oI the child`s
Iinger.
The inIant grasp the rattle
Ior a Iew seconds.
LANGUAGE SCORE AMINISTRATION 1USTIFICATION
#esponds to bell Passed I hold the bell where the
child doesn`t see it. I
Iirst put the bell in her
leIt and ring it. Then to
her right and ring it
The inIant turns her head in
the leIt side where I Iirst
ring the bell. Then turns her
head to the right where I
ring the bell again. This
10
again. shows that the child is
looking Irom where the
sound is coming.
Vocalizes not crying Passed I asked the mother
'panu nyo po nalalaman
pag nagugutom na si
baby? Eh pag inaantok?
Eh pag naiinitan?.
According to the mother
the inIant is crying when
she is hungry
Laughs Failed During the assessment I
observe the inIant iI she
will laugh.
I asked the mother
'tumatawa napo ba sya
ng malakas kahit hindi
kinikiliti?
The inIant doesn`t laugh
during the assessment
Squeals Passed During the assessment I
observe iI the inIant will
make high-pitched
happy squealing sounds.
I asked the mother
'Tumitili nap o ba sya
ng parang masayang
Masaya? Paano po sya
natili?.
The inIant doesn`t make
any high- pitched sound.



GROSS- MOTOR
BEHAVIOR
SCORE AMINISTRATION 1USTIFICATION
Stomach liIts head Passed I put the inIant on her
stomach in a Ilat
The inIant liIts her head up
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surIace. to 90 degrees.
Stomach chest up
arm support
Passed Same as the procedure
oI stomach (sto) liIts
head.
AIter the inIant liIts her
head up to 90 degrees she
perIorms chest up arm
support.
Sit head steady Passed hile the inIant is
sitting in the mother`s
lap. I observe iI she can
liIt her head upright and
steady.
The inIant can carry the
weight oI her head because
she can liIt her head in
upright position and she
can hold it steadily.
Bear weight on legs Failed I asked the mother to
hold her baby in upright
position so that her Ieet
rest on the Iloor. Then I
asked her to slowly
loosen her hand support
but do not release the
inIant completely.
The inIant can`t stands by
her two legs her








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VII. GORON`S FUNCTIONAL HEALTH PATTERNS\

. Health Perception- Health Management Pattern
Interaction:
Her mother takes her daughter with breastIeed.
Observation:
During the interview, I noticed that Sn.L is have a good appetite in breastIeeding
Measurement:
A
. Nutrition and Metabolic Pattern
Interaction:
Baby Sn.L only takes Irom now is breastIeed Irom her mother.
Observation:
The client is completely nourished.
Measurement:
ot applicable
3. Elimination Pattern
Interaction:
She had regular deIecates. According to her mother her stool is yellowish in color.
Observation:
ot applicable
Measurement:
The client deIecates once or twice a day.
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. Activity- Exercise Pattern
Interaction:
ot applicable.
Observation:
ot applicable.
Measurement:
ot applicable.
. Sleep-Rest Pattern
Interaction:
She is always sleeping. AIter her breastIeed she takes her sleep it last an hour.
Observation:
A
Measurement:
She has no standard sleeping.
. Cognitive- Perceptual Pattern
Interaction:
ot applicable.
Observation:
ot applicable.
Measurement:
ot applicable.


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. Self-Perception- Self- Concept Pattern
Interaction:
ot applicable.
Observation:
ot applicable.
Measurement:
ot applicable.
8. Role- Relationship Pattern
Interaction:
ot applicable.
Observation:
ot applicable.
Measurement:
ot applicable.
. Sexuality- Reproductive Pattern
Interaction:
ot applicable.
Observation:
ot applicable.
Measurement:
ot applicable.


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.Coping- Stress Tolerance Pattern
Interaction:
ot applicable.
Observation:
ot applicable
Measurement:
ot applicable
.Value- Belief Pattern
Interaction:
ot applicable.
Observation:
ot applicable
Measurement:
ot applicable

I. COMPREHENSIVE PHYSICAL EXAMINATION
A. Vital Signs ate / Time of Exam: December 06, 2010
T 36.9
PR 152 bpm
RR 56 cpm
CR 152


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B. Anthropometric ata
eight: 4.4 kg
Head circumference: 39 cm
Chest circumference: 41 cm
Abdomen circumference: 40 cm

C. General Appearance
General Appearance
. Body build and height-weight proportionality

The client`s appearance is appropriate to her age. She has a normal growth
according to her InIancy and Development ard.

. Over-all hygiene and grooming
Based on my observation the client has a good hygiene and grooming. She looks
very neat and presentable when I arrived.

3. Body and breath odor
The client has no bad breath and body odor.






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. Cephalocaudal Assessment
Body Part
Examined
Actual Finding Normal Finding Clinical Significance
INTEGUMENT
$in
O Color and
uniformity






















O Edema


Her skin is pinkish
white in color &
uniIorm
She has small
birthmark in her
right leg. It is color
brown.

















She is negative in


The skin is brown
and pinkish white in
color in color
Inspection reveals
evenly colored skin
tones without
unusual or
prominent
discoloration.















Skin rebounds and


Small amount oI
melanin are common
in whiter skins, while
large amounts oI
melanin are common
in olive and darker
skins. arotene
accounts Ior a yellow
cast. Pallor skin is
seen in arterial
insuIIiciency,
decreased blood
supply, and anemia.
entral cyanosis
results Irom
cardiopulmonary
problem whereas
peripheral cyanosis
results Irom
vasoconstriction.
1aundice mostly
results Irom liver
problem.


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O Lesions
edema



She has no lesions
cephalocaudal
does not remain
indented when
pressure is released

Smooth without
lesions. Stretch
marks (striae),
healed scars,
Ireckles, moles or
birthmarks are
common Iindings.

` H.A. - page 33
OMoisture






OTemperature







O Turgor


Her skin is soIt and
smooth and it is not
dry.




Her skin temperature
in body and
extremities is
uniIorm and in
normal range



ormal turgor in her
skin.
Skin is moist
skin temperature
should be uniIorm
within normal range



Skin is normally a
warm temperature.






Skin pinches easily
and immediately
returns to its
Increase moisture or
diaphoresis may occur
in condition such as
Iever. Decreased
moisture occurs with
dehydration.

old skin may
accompany shock or
hypotension. ool skin
may accompany
arterial disease. Very
warm skin may
indicate a Iebrile state

Decreased turgor is
seen in dehydration.
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original position.

` H.A. - page 33
air
O Evenness of
growth







O Body hair


Her hair is short,
thin, soIt and shiny.
It is brown in color
and it grows
evenly.




Positive presence oI
lanugo in her back
especially in her
shoulder. It is Iine,
downy hair and it is
very dark black color
hair.

Hair may Ieel thin,
straight, coarse,
thick or curly
Hair should grow
evenly.
Should be soIt and
shiny.
O H.A. - page 3

Lanugo is Iine,
downy hair can be
present on the skin.
This is most
prominent over the
temples oI the
Iorehead and on the
upper arms,
shoulders, back and
the pinna oI the
ears.

( `H.A - page )

utritional
deIiciencies may
cause patchy gray
hair in some clients.





Lanugo helps to the
inIant to maintain the
body temperature.
ail
OPlate and shape




The clients nail is
properly attach to the
nail bed and she has
rounded nail shape

The nail is
approximately 160
angle and it is
rounded and also the

II there is an early
clubbing (180-degree
angle w/ spongy
sensation) and late
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O Bed color








OSurrounding
tissues








Her nails both hand
and toenails is color
pinkish white.






SoIt tissue and intact
skin.


nail is properly
attach to the nail bed





ail bed is pink or
brown







SoIt tissue and
without any lesions.

` H.A. - page 3
clubbing (greater than
180-degree angle) can
occur Irom hypoxia.
Spoon nails may be
present w/ iron
deIiciency anemia.

Pale or cyanotic nails
may indicate hypoxia
or anemia. Yellow
discoloration may be
seen in Iungal
inIections or psoriasis.
ail pitting is common
in psoriasis.

The cuticle provides
protection.
O Blanch test


The color oI her nail
bed return into its
normal color within
2 seconds

Pink tones returns
immediately to
blanched nailbeds
when pressure is
released

` H.A. - page 3
II there is slow
(greater than 2 sec.)
capillary reIill w/
respiratory or
cardiovascular
diseases that cause
hypoxia.
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HEA
$:ll and Face
OSize, Symmetry
and Shape










OEyes for edema
and hollowness



The client head is
symmetrical, not
deIormed and has a
normal size
proportional to her
body.






Absence oI edema
and hollowness


Head is symmetrical
o deIormities
Head size and
shape vary,
especially in accord
with ethnicity.






Absence oI edema
and hollowness



` H.A. - page 3 &
3


II there is
acromegaly, the skull
and Iacial bones are
larger and thicker
because oI increased
production oI growth
hormone.
Acorn-shaped,
enlarged skull bones
are seen in Paget`s
disease oI the bone.

Presence oI
hollowness may be
due to lack oI sleep
or rest, and stress.



es and Jision
OEyebrows Ior
distribution &
alignment,
quality &
movement


Evenly distributed
hair in the
eyebrows, aligned,
Iine and able to
move

Aligned, evenly
distributed hair,
Iine and able to
move eyebrows.


` H.A. - page 3

Their Iunction is to
protect the eye Irom
sweat and rain, and it
is also used as a
Iacial expression.


O Eyelashes Ior
evenness oI
Evenly distributed
hair in the
Eyelashes are
equally distributed
Their Iunction is to
protect the eye Irom
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distribution &
direction oI
curl

eyebrows, aligned,
Iine and able to
move.
and sweeping
upward Irom the
upper lids and
downward Irom the
lower lids

` H.A. - page
sweat and rain, and it
is also used as a
Iacial expression.
OEyelids Ior
surIace
characteristics,
position in
relation to cornea

The color oI her
eyelids is like the
color oI her skin.
Absence oI
swelling, lesions,
and discharges.
Eyelids depend on
the color oI skin
tone, absence oI
swelling, lesions
and discharges.

` H.A. - page
II there is presence
oI lesions or
swelling it is caused
by trauma.
ars and earing
OAuricles Ior
color, symmetry
and position


Her ears is also
pinkish white in
color same as her
skin. It is positioned
normally and
proportional to her
head.

The ear should
match the Ilesh
color oI the rest oI
the patient`s skin
should be
positioned centrally
and in the
proportion oI the
head. The top oI the
ear should cross an
imaginary line
drawn Irom the
outer canthus oI the
eye to the occiput

` H.A. - page

Misaligned or low-set
ears may be seen with
genitourinary
disorders or
chromosomal deIects
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O External canal
Ior cerumen,
lesions, pus or
blood


The client has no
cerum and her ear
has no discharges
and no lesions and
swelling.
erumen should be
moist and not
obscure the
tympanic membrane
no Ioreign bodies,
redness, deIormities
and lesions

` H.A. - page -

Foul-smelling, sticky,
yellow discharge otitis
externa or impacted
Ioreign body.
ose and $in:ses
O Nose deviation
in shape, size,
color, flaring,
discharge;


ose is
symmetrically in the
middle oI the Iace,
same as the color oI
her skin, no
deIormities and no
discharge.


ose is
symmetrically in
the middle oI the
Iace
color is depends upon
the race
no deIormities
no discharge

` H.A. - page

Flaring or discharges
is an abnormal signs.
Mouth /
Oropharynx
O Lips Ior
symmetry oI
contour, color,
texture,
moisture,
lesion


Her lips have parts
that have whitish
color.



pink and moist
smooth
no evidence oI
lesions
Ilaccid

` H.A. - page


It shows that the inIant
is in healthy condition.
O A: breath normal breathing air rushing through It clariIies that she got
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sounds

sounds the respiratory tract
during inspiration
and expiration are
as Iollows:
4 bronchial
4 bronchovesicular
4 vesicular

` H.A. - page 38
a normal Iinding
because she has a
normal breathing
pattern.

E. Focused Assessment
Reflex mechanism of the infant
Reflex Actual Finding Normal Finding Clinical Significance
O Rooting reflex The inIant would
turn her head
toward the side
that was where my
Iinger is.
Up until 3 or 4
months oI age, the
will turn the head
toward the side
that was stroked.
entral nervous
system disease
such as Irontal
lobe lesions
accounts Ior an
absent rooting
reIlex.
O Sucking reflex The inIant sucks
her mother breast
The sucking reIlex
occurs up to
approximately 10
months.
A premature
inIant or a breast-
Ied inIant oI a
mother who ingest
barbiturates does
not exhibit the
reIlex secondary
to central nervous
system depression.
O Palmar Grasp
reflex
The inIant grasp
the Iinger oI her
mother
ormally, the
inIant grasps the
Iinger in Ilexion
The etiology is
attributed to
Irontal lobe
lesions
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O Tonic Neck reflex The head oI the
inIant turned
extend to the leIt
while her upper
and lower
extremities was on
the side
The upper and
lower extremities
on the side to
which the jaw is
turned extend, and
the opposite arm
and leg Ilex.
erebral damage
is suspected iI the
tonic neck reIlex
is seen
O Plantar Grasp
reflex
The inIant toes
was curl down
when I give
pressure to her
Ieet
The inIant toes
curl down until 8
months oI age
An obstructive
lesion such as an
abscess or tumor
can cause the
plantar grasp
reIlex to be absent
on the aIIected
side. Bilateral
absence can occur
in P

VIII. IAGNOSTIC TEST
/A
IX. REVIE OF SYSTEM
INTEGUMENTARY/ SKIN
O 'malambot at makinis ang balat ng baby ko, mabango po kaya masarap halikan.

HAIR
O 'ayy naku kalbo yan, sabagay sanggol pa naman siya.
.

EYES
O 'wala naman akong nakikita masama sa mata niya, lagi lang yan nakatingin sa taas.

EARS
O 'walang problema to sa tenga, bata pa ehh

NOSE
O 'wala din siyang problema sa ilong ko.
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MOUTH
O 'ayun lagi lang maputi ang mga labi, nadede kasi skin.

THROATH
O 'wala naman, at saka ang bata pa nito, hindi pa ito nagsasalita

RESPIRATORY
O 'ayan mabilis huminga, pero dib a normal lang naman tung ganun sa mga sanggol.

CARIOVASCULAR
O 'wala naman, tsaka wala kaming lahing may sakit sa puso.

GASTROINTESTINAL
O 'madalas iyang dumudumi halos araw araw.

GENITOURINARY
O 'ayy kung madalas siyang dumumi, mas madalas iyang umihi, maraming beses sa isang
araw


II. CASE MANAGEMENT
A. Medical (ot Applicable)
. Pharmacologic Intervention (ot Applicable)
. ietary Prescription / Restriction (ot Applicable)
3. Procedures (ot Applicable)
B. Surgical (ot Applicable)
. Pre-operative
. Intra-Operative
3. Post-Operative
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C. Nursing Management
A. List of Nursing Problems
. EIIective breastIeeding related to basic breastIeeding knowledge
B. Prioritization of Nursing Problems
Effective breastfeeding related to basic breastfeeding knowledge
Cues/data eight Computation Actual
score
1ustification
. Nature and extent - ellness
State
1/3 * 3 0.9 The inIant is in the
wellness state. She is Ieed
by breastIeed oI her
mother which is good Ior
her.
. Modifiability - Easily
ModiIiable
2/2 * 2 1 It is easily modiIiable
because they don`t need to
spend some money Ior the
milk oI the inIant.
3. Preventive
potential
- Low
Preventive
Potential
1/3 * 3 0.9 It is low preventive
because they don`t have to
prevent in breastIeeding.
. Salience - ot perceived
as a problem
0/2 * 2 0 It is not perceived as a
problem because
breastIeeding is very well
Ior the inIant`s health.
Total 2.8






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C. Plans for Nursing Action
a) Nursing Care Plans
Effective breastfeeding related to basic breastfeeding knowledge
Assessment iagnosing Planning Implementation
Subjective:
O'malakas
dumede to
OSa akin lang
siya dumedede,
hindi iyan
nadede sa
bote

Objective:
OInIant is
content aIter
Ieedings
EIIective
breastIeeding
related to
basic
breastIeeding
knowledge as
maniIested by
maternal
verbalization
oI satisIaction
with the
breastIeeding
process.

AIter 1 hour oI
nursing
intervention,
the mother will
be able to:

O Verbalize
understandi
ng oI
breastIeedin
g techniques

O Demonstrate
eIIective
techniques
Ior
breastIeedin
g
The student nurse
conducted health
teaching regarding:

O Demonstrate
how to support
and position
inIant


O eep inIant with
the mother



O Encourage the
mother to drink
at least 2000ml
oI Iluid per day
or 8oz every
hour.


O ive handouts
about the
eIIective
techniques Ior
breastIeeding





O To give
comIortable and
saIe position to
the inIant


O For unrestricted
breastIeeding
duration and
Irequency.

O To avoid
dehydration Ior
the mother and
to increase the
milk in the
breast oI the
mother

O To have more
knowledge about
the eIIective
breastIeeding

b) Teaching Plan
ot applicable
c) ischarge Plan
ot applicable
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ONGOING APPRAISAL

st
day
hen I arrived, I introduced myselI to the mother oI my client and explain to her what I
am going to do. I also told her that I am going to assess her baby and Iortunately she agreed.
AIter that, I interviewed her and ask some questions regarding to her baby such as demographic
data, Heredo-Familial Data and data`s that can help me to build the inIant`s ordon`s Functional
Health Patterns. AIter that, I decided to do the assessment to the client, I try to the client the
reIlex iI she can passed but when I give my Iinger to her she reIused me but when her mother do
that she grasp immediately her mother Iinger. hile doing the interviewing I also observe their
environment. AIter I completing the interviewing, assessing I decided to go and bid a goodbye to
Mrs. MI.L and then beIore I live them I show her an appreciation Ior her cooperation and
kindness to me.

Pictures of baby Sn.L














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