I.

INTRODUCTION

A toddler is a young child who is of the age of learning to walk between infancy
and childhood. Toddling usually begins between the ages 12 months. During the toddler
stage, most children learn to walk, talk, solve problems, relate to others, and more. It is
also during the toddler stage that the child also learns a great deal about social roles,
develops motor skills, and first starts to use language.
A case of a 1 year and 7 months old toddler patient who was admitted at
Camiguin General Hospital and had been diagnosed of nosocomial pneumonia and
suppurative meningitis is the subject of this pediatric care study.
?incidence of nosocomial pneumonia and suppurative meningitis
?predisposing and precipitating factors of diseases

The goal of this study is directed to improve the students to make an effective
nursing care plan based on the understanding of the actual condition of a patient having
the disease.

Scope and Limitation:

The scope and limitation of this care study was established on the foundation of the
following:
 The interaction with the client and family members at least 8 hours a day in the
hospital and 1 hour in home visit

 The sources of information are the client, family members, and medical records

 The participation of the family members is limited to their knowledge and actual
observation to the client

Objectives and Purposes

At the end of 56 hours of nursing care in the hospital and 1 hour of home visit, the
students will be able to:
 Assess and obtain information related to patients condition including the possible
predisposing factors and precipitating factors that contributed to the development of
the disorder
 Observe and identify the signs and symptoms manifested by the client
 Create a nursing care plan and implement nursing interventions appropriately
 Develop the students skills, knowledge, and understanding towards the patient’s
medical condition
 Provide guidance and health teachings significant others of the child
 II. DEMOGRAPHIC DATA

Baby JA is a 1 year and 7 months old boy, toddler. He was born on June 13,
2008 at Camiguin General Hospital. He is a Filipino and a Roman Catholic. His father is
Roger Orillo. He has an unstable job but he is usually working as a farmer and often as
a laborer. He has an income of P500 per day whenever he has a work. With regards to
the mother’s identity, we didn’t get the chance to get information about her since the
father and his relatives were hesitant to spill the beans. What we know is that his father
and mother are not living together. We did our best already to know her more, yet the
family is not cooperative enough regarding the aforementioned and so we just respect
their decision.
Baby JA is currently living with his father at Soro-Soro, Mambajao, Camiguin
which is one of the 15 barangays in the municipality of Mambajao. Their place is
approximately 4 kilometres from Camiguin General Hospital. It takes one ride through a
“habal-habal” to reach the patient’s house at a payment of P20.00 for the regular fee
and just P10.00 for the students and senior citizens. The road going to their residence is
concrete.
?accessibility to health center
?environmental factors
?total population
?common source of income
Their house is partly made of bamboo tree (kitchen area) and of cement. They
have electricity yet they don’t have any appliances. They have a vegetable garden in
their backyard which serves as their additional income. It also helps them whenever
they do not have viands. Their water needs is being supplied by CEWASCO for P10
per month. On the other hand, their electricity needs is being supplied by Camiguin
Electric Cooperative and they usually pay P50 per month.

Agriculture is the main source of income to the barangay folks. The place is

blessed with abundant agricultural products ranging from rice, corn, vegetables, fruits,

nuts and livestock. The barangay has its own heath center. The government also
provided them with a fenced and covered basketball court & a barangay hall. They also

have their own chapel wherein once a month, a mass is held officiated by the parish

priest. The means of transportation going to the barangay is the “habal-habal”. Since

the barangay is located uphill, the air is very fresh, pollution is absent since it is not

visited frequently by motorists.

SPOT MAP
 III. DEVELOPMENTAL DATA

?physical development
?psychosocial development
?cognitive development
?gross and fine motor development
?language development
Physical Development
Toddlers are usually chubby, with relatively short legs and a large head. The face
appears small when compared to the skull, but as the toddler grows, the face seems to
grow from under the skull and appears better proportioned. Toddlers have a
pronounced lumbar lordosis and a protruding abdomen. The abdominal muscles
develop gradually with growth, and the abdomen flattens.
The weight gain is about 2 kg (5 lb) between ages 1 and 2 years. A toddler’s
height can be measured as height or length. Height is measured while the toddler
stands, and length is measured while the toddler is in a recumbent position. Between
ages 1 and 2 years, the average growth in height is 10 to 12 cm (4 to 5 in).
The patient is thin, especially his limbs. He has a flat abdomen. His head
appears proportioned with his body. (See NURSING ASSESSMENT for client’s physical
development findings)
Psychosocial Development

There are several other important milestones that are achieved in this time period
that parents tend to not emphasize as much as walking and talking. Gaining the ability
to point at whatever it is the child wants you to see shows huge psychological gains in a
toddler. This generally happens before a child's first birthday.

According to Erik Erikson, the developmental task of toddlerhood is autonomy

versus shame and doubt. The patient has a poor socialization with others as he fears
and doesn’t want other people to be near him. He wants his father to be always beside
him. As a toddler, the patient achieved these developmental tasks:
 Display negativism like crying and getting angry when he disapproves something
  View paternal person as a significant other as he gained closeness and bond
with him

Cognitive Development
According to Piaget, a child moves from the sensorimotor stage of infancy and
early toddlerhood to the longer, preoperational stage. Sensorimotor stage progresses
from reflex activity, through repetitive behaviors, to imitative behaviors; the concepts to
be mastered include object permanence, causality and spatial relationships. In
preoperational stage, child is egocentric and employs magical thinking; the concepts to
be mastered include representational language and symbols and transductive
reasoning.
The patient did achieve these developmental tasks expected to a child of his age:
 Aware of the relationship between two events

 Obey simple commands

 Imitates actions of family members

 Engages in imitative play

Gross and Fine Motor Development

As a 1 year and 7 months old child, the patient’s gross and fine motor
development falls between a 1 and 2 year-old child. He did not display these
expected gross motor skills:
 Walks alone

 Runs without falling most of the time

 Throws something (e.g. ball) overhand without losing his balance

 Jumps with both feet

 Walks up and down stairs

 Climbs on furniture
  Uses push and pull toys

 Rides on his tricycle

But he displays these fine motor skills:

 Uses a spoon when eating but not using it well

 Drinks from a cup or glass

 Sips using a straw

 Helps undress self and pull on simple clothes

Language Development

A toddler's first word most often occurs around 12 months, but again this is only
an average. The child will then continue to steadily add to his or her vocabulary until
around the age of 18 months when language increases rapidly. He or she may learn as
many as 7-9 new words a day. Around this time, toddlers generally know about 50
words. At 21 months is when toddlers begin to incorporate two word phrases into their
vocabulary, such as "I go", "mama give", and "baby play". Before going to sleep they
often engage in a monologue called crib talk in which they practice conversational skills.
At this age, children are becoming very proficient at conveying their wants and needs to
their parents in a verbal fashion.

During toddlerhood, the ability to understand speech is much more developed than
the ability to speak. My patient has achieved these language developments:
 Learns about 50 words

 Usually speaks 2-syllable words, like “mama”, “papa”

 Uses 2-4 words in a sentence, like “wala mama”

 Frequently repeats words

 Labels or names object upon seeing them, like “jolen” (marble)

  Associate actions with words, like saying “ba-bye” when waving goodbye

 Uses expressions to identify something, like “yayay” for pain, “lami” for food

 Indicates when diaper is wet

NORMAL ANATOMY AND PHYSIOLOGY

Respiratory System

The respiratory system provides the oxygen necessary to sustain life. It consists
of both upper and lower respiratory tracts. It is divided into two functions: conducting
and respiration.

The function of the respiratory system is to give us a surface area for exchanging
gases between the air and our circulating blood. It moves that air to and from the
surfaces of the lungs while it protects the lungs from dehydration, temperature changes
and unwelcome pathogens. It also plays a part in making sounds such as talking,
singing, other nonverbal sounds and works with the central nervous system for the
ability to smell.

The upper respiratory system consists of the nostrils (external nares), nasal
cavity, nasal vestibule, nasal septum, both hard and soft palate, nasopharynx, pharynx,
larynx and trachea. Within the nostrils, course hairs protect us from dust, insects and
sand. The hard palate serves to separate the oral and nasal cavities. There is a
protective mucous membrane that lines the naval cavities and other parts of the
respiratory tract. It is secreted over the exposed surfaces and then the cilia sweeps that
mucus and any microorganisms or debris to the pharynx, so it is swallowed and then
destroyed in stomach acids.

The trachea branches off into what is known as the bronchi (more commonly
called bronchial tubes). These two main bronchi have branches forming the bronchial
tree. Where it enters the lung, there is then secondary bronchi. In each lung, the
secondary bronchi divides into tertiary bronchi and in turn these divide repeatedly into
smaller bronchioles. The bronchioles control the ratio of resistance to airflow and
distribution of air in our lungs. The bronchioles open into the alveolar ducts. Alveolar
sacs are at the end of the ducts. These sacs are chambers that are connected to
several individual alveoli, which make up the exchange surface of the lungs.

The human respiratory system has two lungs, which contain lobes separated by
deep fissures. Surprisingly, the right lung has three lobes while the left one has only two
lobes. The lungs are made up of elastic fibers that give it the ability to handle large
changes in air volume. The pleural cavity is where the lungs are located. The diaphragm
is the muscle that makes up the floor of the thoracic cavity and plays a major role in the
pressure and volume of air moving in and out of the lungs.

Anatomy of the Nervous System

If you think of the brain as a central computer that controls all bodily functions,
then the nervous system is like a network that relays messages back and forth from the
brain to different parts of the body. It does this via the spinal cord, which runs from the
brain down through the back and contains threadlike nerves that branch out to every
organ and body part.

When a message comes into the brain from anywhere in the body, the brain tells
the body how to react. For example, if you accidentally touch a hot stove, the nerves in
your skin shoot a message of pain to your brain. The brain then sends a message back
telling the muscles in your hand to pull away. Luckily, this neurological relay race takes
a lot less time than it just took to read about it.

Considering everything it does, the human brain is incredibly compact, weighing

just 3 pounds. Its many folds and grooves, though, provide it with the additional surface
area necessary for storing all of the body's important information.

The spinal cord, on the other hand, is a long bundle of nerve tissue about 18
inches long and ¾ inch thick. It extends from the lower part of the brain down through
spine. Along the way, various nerves branch out to the entire body. These are called the
peripheral nervous system.
 Both the brain and the spinal cord are protected by bone: the brain by the bones
of the skull, and the spinal cord by a set of ring-shaped bones called vertebrae. They're
both cushioned by layers of membranes called meninges as well as a special fluid
called cerebrospinal fluid. This fluid helps protect the nerve tissue, keep it healthy, and
remove waste products.

PATHOPHYSIOLOGY

Nosocomial pneumonia is the type of pneumonia acquired in the hospital.

Pneumonia is an infection of lungs in which the lung tissue of an infected person is filled
with fluid or pus.
Suppurative meningitis is the type meningitis characterized by purulent
inflammation of the meninges. Meningitis is an infection of the meninges, the
membranes covering the brain.

PNEUMONIA

Predisposing Factor: Precipitating Factor:

--age --malnourishment/undernutrition
--development --weak immune system
--immune response --contact with persons
having respiratory illness
--poor hand hygiene of caregivers

Etiologic agent:
pathogens (bacteria, virus, fungi)

exposure and transmission of pathogens

entry of pathogens into the respiratory tract

pathogens respiratory surface membrane barriers

pathogens reaches lungs

immune response:
--inflammation of lungs and alveoli
--increased mucus production
--fluid leaks from capillaries
--white blood cells

mucus plugs and alveoli filled with fluid or pus

less functional O2 and CO2 exchange

Signs and Symptoms:

--tachypnea
--dypnea
--productive cough
--chest pain

SUPPURATIVE MENINGITIS

pathogens enters blood circulation

spread of pathogens into the cerebrospinal fluid

infection of meninges

inflammation of meninges and WBC accumulation

purulent exudation

Signs and Symptoms:

--fever
 --headache
--neck/back pain
--irritability
--seizures
--poor feeding
--nausea and vomiting
--photophobia