INTRODUCTION

Gastroenteritis or infectious diarrhea is a medical condition characterized

by inflammation ("-itis") of the gastrointestinal tract that involves both
the stomach ("gastro"-) and the small intestine ("entero"-), resulting in some
combination of diarrhea, vomiting, and abdominal pain and cramping. Dehydration may
occur as a result. Gastroenteritis has been referred to as gastro, stomach bug,
and stomach virus. Although unrelated to influenza, it has also been called stomach
flu and gastric flu.
Signs and symptoms
Gastroenteritis typically involves both diarrhea and vomiting, or less commonly,
presents with only one or the other. Abdominal cramping may also be present. Signs
and symptoms usually begin 1272 hours after contracting the infectious agent. If due
to a viral agent, the condition usually resolves within one week. Some viral causes may
also be associated with fever, fatigue, headache, and muscle pain. If the stool is bloody,
the cause is less likely to be viral and more likely to be bacterial. Some bacterial
infections may be associated with severe abdominal pain and may persist for several
weeks.
Children infected with rotavirus usually make a full recovery within three to eight
days. However, in poor countries treatment for severe infections is often out of reach
and persistent diarrhea is common. Dehydration is a common complication
of diarrhea, and a child with a significant degree of dehydration may have a
prolonged capillary refill, poor skin turgor, and abnormal breathing. Repeat infections
are typically seen in areas with poor sanitation, and malnutrition, stunted growth, and
long-term cognitive delays can result.
Cause
Viral
Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral
gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and
produces similar incidence rates in both the developed anddeveloping world. Viruses
cause about 70% of episodes of infectious diarrhea in the pediatric age
group. Rotavirus is a less common cause in adults due to acquired immunity.
Norovirus is the leading cause of gastroenteritis among adults in America, causing
greater than 90% of outbreaks. These localized epidemics typically occur when groups
of people spend time in close physical proximity to each other, such as on cruise
ships, in hospitals, or in restaurants. People may remain infectious even after their
diarrhea has ended. Norovirus is the cause of about 10% of cases in children.
Bacterial
In the developed world Campylobacter jejuni is the primary cause of bacterial
gastroenteritis, with half of these cases associated with exposure to poultry. In children,
bacteria are the cause in about 15% of cases, with the most common types
being Escherichia coli, Salmonella, Shigella, and Campylobacterspecies. If food
becomes contaminated with bacteria and remains at room temperature for a period of
several hours, the bacteria multiply and increase the risk of infection in those who
consume the food. Some foods commonly associated with illness include raw or
undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and
soft cheeses; and fruit and vegetable juices. In the developing world, especially sub-
Saharan Africa and Asia,cholera is a common cause of gastroenteritis. This infection is
usually transmitted by contaminated water or food.
Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often
in the elderly. Infants can carry these bacteria without developing symptoms. It is a
common cause of diarrhea in those who are hospitalized and is frequently associated
with antibiotic use. Staphylococcus aureusinfectious diarrhea may also occur in those
who have used antibiotics. "Traveler's diarrhea" is usually a type of bacterial
gastroenteritis. Acid-suppressing medication appears to increase the risk of significant
infection after exposure to a number of organisms, including Clostridium
difficile, Salmonella, and Campylobacter species. The risk is greater in those
taking proton pump inhibitors than with H2 antagonists.
Parasitic
A number of protozoans can cause gastroenteritis most commonly Giardia lamblia
but Entamoeba histolytica andCryptosporidium species have also been implicated. As a
group, these agents comprise about 10% of cases in children. Giardia occurs more
commonly in the developing world, but this etiologic agent causes this type of illness to
some degree nearly everywhere. It occurs more commonly in persons who have
traveled to areas with high prevalence, children who attend day care, men who have
sex with men, and following disasters.
Transmission
Transmission may occur via consumption of contaminated water, or when people share
personal objects. In places with wet and dry seasons, water quality typically worsens
during the wet season, and this correlates with the time of outbreaks. In areas of the
world with four seasons, infections are more common in the winter. Bottle-feeding of
babies with improperly sanitized bottles is a significant cause on a global
scale. Transmission rates are also related to poor hygiene, especially among
children, in crowded households, and in those with pre-existing poor nutritional
status. After developing tolerance, adults may carry certain organisms without exhibiting
signs or symptoms, and thus act as natural reservoirs of contagion. While some agents
(such as Shigella) only occur in primates, others may occur in a wide variety of animals
(such as Giardia).
Pathophysiology
Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large
bowel. The changes in the small bowel are typically noninflammatory, while the ones in
the large bowel are inflammatory. The number of pathogens required to cause an
infection varies from as few as one (for Cryptosporidium) to as many as 10
8
(for Vibrio
cholerae).

Diagnosis
Gastroenteritis is typically diagnosed clinically, based on a person's signs and
symptoms. Determining the exact cause is usually not needed as it does not alter
management of the condition. However, stool cultures should be performed in those
with blood in the stool, those who might have been exposed to food poisoning, and
those who have recently traveled to the developing world. Diagnostic testing may also
be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and
young children, measuring serum glucose in this population is recommended.
Electrolytes and kidney function should also be checked when there is a concern about
severe dehydration.
Dehydration
A determination of whether or not the person has dehydration is an important part of the
assessment, with dehydration typically divided into mild (35%), moderate (69%), and
severe (10%) cases. In children, the most accurate signs of moderate or severe
dehydration are a prolonged capillary refill, poor skin turgor, and abnormal
breathing. Other useful findings (when used in combination) include sunken eyes,
decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral
fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the
degree of dehydration.



Prevention
Lifestyle
A supply of easily accessible uncontaminated water and good sanitation practices are
important for reducing rates of infection and clinically significant
gastroenteritis. Personal measures (such as hand washing) have been found to
decrease incidence and prevalence rates of gastroenteritis in both the developing and
developed world by as much as 30%. Alcohol-based gels may also be
effective. Breastfeeding is important, especially in places with poor hygiene, as is
improvement of hygiene generally. Breast milk reduces both the frequency of infections
and their duration. Avoiding contaminated food or drink should also be effective.
Management
The key treatment is enough fluids. For mild or moderate cases, this can typically be
achieved via oral rehydration solution (a combination of water, salts, and sugar). In
those who are breast fed, continued breast feeding is recommended. For more severe
cases, intravenous fluids from a healthcare centre may be needed. Antibiotics are
generally not recommended. Gastroenteritis primarily affects children and those in the
developing world. It results in about three to five billion cases and causes 1.4 million
deaths a year.
Gastroenteritis is usually an acute and self-limiting disease that does not require
medication. The preferred treatment in those with mild to moderate dehydration is oral
rehydration therapy (ORT). Metoclopramide and/or ondansetron, however, may be
helpful in some children, and butylscopolamine is useful in treating abdominal pain.
Rehydration
The primary treatment of gastroenteritis in both children and adults is rehydration. This
is preferably achieved by oral rehydration therapy, although intravenous delivery may
be required if there is a decreased level of consciousness or if dehydration is
severe. Oral replacement therapy products made with complex carbohydrates (i.e.
those made from wheat or rice) may be superior to those based on simple
sugars. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are
not recommended in children under 5 years of age as they may increase diarrhea. Plain
water may be used if more specific and effective ORT preparations are unavailable or
are not palatable. Anasogastric tube can be used in young children to administer fluids if
warranted.
Dietary
It is recommended that breast-fed infants continue to be nursed in the usual fashion,
and that formula-fed infants continue their formula immediately after rehydration with
ORT. Lactose-free or lactose-reduced formulas usually are not necessary.
[42]
Children
should continue their usual diet during episodes of diarrhea with the exception that
foods high in simple sugars should be avoided. The BRAT diet (bananas, rice,
applesauce, toast and tea) is no longer recommended, as it contains insufficient
nutrients and has no benefit over normal feeding. Some probiotics have been shown to
be beneficial in reducing both the duration of illness and the frequency of stools. They
may also be useful in preventing and treating antibiotic associated diarrhea. Fermented
milk products (such as yogurt) are similarly beneficial. Zinc supplementation appears to
be effective in both treating and preventing diarrhea among children in the developing
world.
Antibiotics
Antibiotics are not usually used for gastroenteritis, although they are sometimes
recommended if symptoms are particularly severe or if a susceptible bacterial cause is
isolated or suspected. If antibiotics are to be employed, amacrolide (such
as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to
the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by
discontinuing the causative agent and treating it with
either metronidazole or vancomycin Bacteria and protozoans that are amenable to
treatment includeShigella Salmonella typhi and Giardia species. In those
with Giardia species or Entamoeba histolytica,tinidazole treatment is recommended and
superior to metronidazole. The World Health Organization (WHO) recommends the use
of antibiotics in young children who have both bloody diarrhea and fever.
(http://en.wikipedia.org/wiki/Gastroenteritis)

Meningitis
Meningitis is an acute inflammation of the protective membranes covering
the brain and spinal cord, known collectively as the meninges. The inflammation may be
caused by infection with viruses, bacteria, or other microorganisms, and less commonly
by certain drugs. Meningitis can be life-threatening because of the inflammation's
proximity to the brain and spinal cord; therefore, the condition is classified as a medical
emergency.
Signs and symptoms
In adults, the most common symptom of meningitis is a severe headache, occurring in
almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to
flex the neck forward passively due to increased neckmuscle tone and stiffness). The
classic triad of diagnostic signs consists of nuchal rigidity, sudden high fever, and
altered mental status; however, all three features are present in only 4446% of
bacterial meningitis cases. If none of the three signs are present, acute meningitis is
extremely unlikely. Other signs commonly associated with meningitis
include photophobia (intolerance to bright light) and phonophobia (intolerance to loud
noises). Small children often do not exhibit the aforementioned symptoms, and may
only be irritable and look unwell. The fontanelle (the soft spot on the top of a baby's
head) can bulge in infants aged up to 6 months. Other features that distinguish
meningitis from less severe illnesses in young children are leg pain, cold extremities,
and an abnormal skin color.
Nuchal rigidity occurs in 70% of bacterial meningitis in adults. Other signs
of meningism include the presence of positive Kernig's sign or Brudziski sign. Kernig's
sign is assessed with the person lying supine, with the hip and knee flexed to
90 degrees. In a person with a positive Kernig's sign, pain limits passive extension of
the knee. A positive Brudzinski's sign occurs when flexion of the neck causes
involuntary flexion of the knee and hip. Although Kernig's sign and Brudzinski's sign are
both commonly used to screen for meningitis, the sensitivity of these tests is
limited. They do, however, have very good specificity for meningitis: the signs rarely
occur in other diseases. Another test, known as the "jolt accentuation maneuver" helps
determine whether meningitis is present in those reporting fever and headache. A
person is asked to rapidly rotate the head horizontally; if this does not make the
headache worse, meningitis is unlikely.
Causes
Bacterial
The types of bacteria that cause bacterial meningitis vary according to the infected
individual's age group.
In premature babies and newborns up to three months old, common causes are group
B streptococci (subtypes III which normally inhabit the vagina and are mainly a cause
during the first week of life) and bacteria that normally inhabit the digestive tract such
as Escherichia coli (carrying the K1 antigen). Listeria monocytogenes (serotype IVb)
may affect the newborn and occurs in epidemics.
Older children are more commonly affected by Neisseria meningitidis (meningococcus)
and Streptococcus pneumoniae (serotypes 6, 9, 14, 18 and 23) and those under five
by Haemophilus influenzae type B (in countries that do not offer vaccination).
In adults, Neisseria meningitidis and Streptococcus pneumoniae together cause 80% of
bacterial meningitis cases. Risk of infection with Listeria monocytogenes is increased in
persons over 50 years old. The introduction of pneumococcal vaccine has lowered rates
of pneumococcal meningitis in both children and adults.
Recent skull trauma potentially allows nasal cavity bacteria to enter the meningeal
space. Similarly, devices in the brain and meninges, such as cerebral
shunts, extraventricular drains or Ommaya reservoirs, carry an increased risk of
meningitis. In these cases, the persons are more likely to be infected
with Staphylococci, Pseudomonas, and otherGram-negative bacteria.
[4]
These
pathogens are also associated with meningitis in people with an impaired immune
system. An infection in the head and neck area, such as otitis media or mastoiditis, can
lead to meningitis in a small proportion of people. Recipients of cochlear implants for
hearing loss risk more a pneumococcal meningitis.
Tuberculous meningitis, which is meningitis caused by Mycobacterium tuberculosis, is
more common in people from countries where tuberculosis is endemic, but is also
encountered in persons with immune problems, such as AIDS.
Recurrent bacterial meningitis may be caused by persisting anatomical defects,
either congenital or acquired, or by disorders of the immune system. Anatomical defects
allow continuity between the external environment and thenervous system. The most
common cause of recurrent meningitis is a skull fracture, particularly fractures that affect
the base of the skull or extend towards the sinuses and petrous
pyramids. Approximately 59% of recurrent meningitis cases are due to such anatomical
abnormalities, 36% are due to immune deficiencies (such as complement deficiency,
which predisposes especially to recurrent meningococcal meningitis), and 5% are due
to ongoing infections in areas adjacent to the meninges.
Viral
Viruses that cause meningitis include enteroviruses, herpes simplex virus type 2 (and
less commonly type 1), varicella zoster virus (known for
causing chickenpox and shingles), mumps virus, HIV, and LCMV.
Fungal
There are a number of risk factors for fungal meningitis, including the use
of immunosuppressants (such as after organ transplantation), HIV/AIDS, and the loss of
immunity associated with aging. It is uncommon in those with a normal immune
system
[19]
but has occurred with medication contamination. Symptom onset is typically
more gradual, with headaches and fever being present for at least a couple of weeks
before diagnosis. The most common fungal meningitis is cryptococcal meningitis due
to Cryptococcus neoformans In Africa, cryptococcal meningitis is estimated to be the
most common cause of meningitis and it accounts for 2025% of AIDS-related deaths in
Africa. Other common fungal agents include Histoplasma capsulatum, Coccidioides
immitis, Blastomyces dermatitidis, and Candidaspecies.
Parasitic
A parasitic cause is often assumed when there is a predominance of eosinophils (a type
of white blood cell) in the CSF. The most common parasites implicated
are Angiostrongylus cantonensis, Gnathostoma spinigerum, Schistosoma, as well as
the conditions cysticercosis, toxocariasis, baylisascariasis, paragonimiasis, and a
number of rarer infections and noninfective conditions.
Non-infectious
Meningitis may occur as the result of several non-infectious causes: spread of cancer to
the meninges (malignant or neoplastic meningitis) and certain drugs (mainly non-
steroidal anti-inflammatory drugs, antibiotics and intravenous immunoglobulins). It may
also be caused by several inflammatory conditions, such as sarcoidosis (which is then
calledneurosarcoidosis), connective tissue disorders such as systemic lupus
erythematosus, and certain forms of vasculitis(inflammatory conditions of the blood
vessel wall), such as Behet's disease. Epidermoid cysts and dermoid cysts may cause
meningitis by releasing irritant matter into the subarachnoid space. Mollaret's
meningitis is a syndrome of recurring episodes of aseptic meningitis; it is thought to be
caused by herpes simplex virus type 2. Rarely, migraine may cause meningitis, but this
diagnosis is usually only made when other causes have been eliminated
Diagnosis
CSF findings in different forms of meningitis
Type of meningitis Glucose Protein Cells
Acute bacterial low high PMNs,
often > 300/mm
Acute viral normal normal or high mononuclear,
< 300/mm
Tuberculous low high mononuclear and
PMNs, < 300/mm
Fungal low high < 300/mm
Malignant low high usually
mononuclear

Blood tests and imaging
In someone suspected of having meningitis, blood tests are performed for markers of
inflammation (e.g. C-reactive protein, complete blood count), as well as blood cultures.
The most important test in identifying or ruling out meningitis is analysis of the
cerebrospinal fluid through lumbar puncture (LP, spinal tap). However, lumbar puncture
is contraindicated if there is a mass in the brain (tumor or abscess) or the intracranial
pressure (ICP) is elevated, as it may lead to brain herniation. If someone is at risk for
either a mass or raised ICP (recent head injury, a known immune system problem,
localizing neurological signs, or evidence on examination of a raised ICP),
a CT or MRI scan is recommended prior to the lumbar puncture. This applies in 45% of
all adult cases. If a CT or MRI is required before LP, or if LP proves difficult,
professional guidelines suggest that antibiotics should be administered first to prevent
delay in treatment especially if this may be longer than 30 minutes. Often, CT or MRI
scans are performed at a later stage to assess for complications of meningitis.
In severe forms of meningitis, monitoring of blood electrolytes may be important; for
example, hyponatremia is common in bacterial meningitis, due to a combination of
factors, including dehydration, the inappropriate excretion of the antidiuretic
hormone (SIADH), or overly aggressive intravenous fluid administration.
Bacterial meningitis
Antibiotics
Empiric antibiotics (treatment without exact diagnosis) should be started immediately,
even before the results of the lumbar puncture and CSF analysis are known. The choice
of initial treatment depends largely on the kind of bacteria that cause meningitis in a
particular place and population. For instance, in the United Kingdom empirical
treatment consists of a third-generation cefalosporinsuch
as cefotaxime or ceftriaxone In the USA, where resistance to cefalosporins is
increasingly found in streptococci, addition of vancomycin to the initial treatment is
recommended. Chloramphenicol, either alone or in combination with ampicillin,
however, appears to work equally well.
Empirical therapy may be chosen on the basis of the person's age, whether the infection
was preceded by a head injury, whether the person has undergone
recent neurosurgery and whether or not a cerebral shunt is present. In young children
and those over 50 years of age, as well as those who are immunocompromised, the
addition of ampicillin is recommended to cover Listeria monocytogenes. Once the Gram
stain results become available, and the broad type of bacterial cause is known, it may
be possible to change the antibiotics to those likely to deal with the presumed group of
pathogens. The results of the CSF culture generally take longer to become available
(2448 hours). Once they do, empiric therapy may be switched to specific antibiotic
therapy targeted to the specific causative organism and its sensitivities to
antibiotics. For an antibiotic to be effective in meningitis it must not only be active
against the pathogenic bacterium but also reach the meninges in adequate quantities;
some antibiotics have inadequate penetrance and therefore have little use in meningitis.
Most of the antibiotics used in meningitis have not been tested directly on people with
meningitis in clinical trials. Rather, the relevant knowledge has mostly derived from
laboratory studies in rabbits. Tuberculous meningitis requires prolonged treatment with
antibiotics. While tuberculosis of the lungs is typically treated for six months, those with
tuberculous meningitis are typically treated for a year or longer.
Steroids
Adjuvant treatment with corticosteroids (usually dexamethasone) has shown some
benefits, such as a reduction ofhearing loss, and better short term neurological
outcomes in adolescents and adults from high-income countrieswith low rates of
HIV.
]
Some research has found reduced rates of death while other research has not.
They also appear to be beneficial in those with tuberculosis meningitis, at least in those
who are HIV negative.
Professional guidelines therefore recommend the commencement of dexamethasone or
a similar corticosteroid just before the first dose of antibiotics is given, and continued for
four days. Given that most of the benefit of the treatment is confined to those with
pneumococcal meningitis, some guidelines suggest that dexamethasone be
discontinued if another cause for meningitis is identified. The likely mechanism is
suppression of overactive inflammation.
[

Early complications
Additional problems may occur in the early stage of the illness. These may require
specific treatment, and sometimes indicate severe illness or worse prognosis. The
infection may trigger sepsis, a systemic inflammatory response syndrome of fallingblood
pressure, fast heart rate, high or abnormally low temperature, and rapid breathing. Very
low blood pressure may occur at an early stage, especially but not exclusively in
meningococcal meningitis; this may lead to insufficient blood supply to other
organs. Disseminated intravascular coagulation, the excessive activation ofblood
clotting, may obstruct blood flow to organs and paradoxically increase the bleeding
risk. Gangrene of limbs can occur in meningococcal disease. Severe meningococcal
and pneumococcal infections may result in hemorrhaging of theadrenal glands, leading
to Waterhouse-Friderichsen syndrome, which is often fatal
The brain tissue may swell, pressure inside the skull may increase and the swollen
brain may herniate through the skull base. This may be noticed by a decreasinglevel of
consciousness, loss of the pupillary light reflex, and abnormal posturing. The
inflammation of the brain tissue may also obstruct the normal flow of CSF around the
brain (hydrocephalus). Seizures may occur for various reasons; in children, seizures are
common in the early stages of meningitis (in 30% of cases) and do not necessarily
indicate an underlying cause. Seizures may result from increased pressure and from
areas of inflammation in the brain tissue. Focal seizures (seizures that involve one limb
or part of the body), persistent seizures, late-onset seizures and those that are difficult
to control with medication indicate a poorer long-term outcome.
Inflammation of the meninges may lead to abnormalities of the cranial nerves, a group
of nerves arising from the brain stem that supply the head and neck area and which
control, among other functions, eye movement, facial muscles, and hearing. Visual
symptoms and hearing loss may persist after an episode of meningitis. Inflammation of
the brain (encephalitis) or its blood vessels (cerebral vasculitis), as well as the formation
of blood clots in the veins (cerebral venous thrombosis), may all lead to weakness, loss
of sensation, or abnormal movement or function of the part of the body supplied by the
affected area of the brain. (http://en.wikipedia.org/wiki/Meningitis)

BACKGROUND OF THE STUDY
1. Incidence, Race, gender, age, ratio and proportion
Globally, most cases in children are caused by rotavirus.

In
adults,norovirus and Campylobacter are more common. Less common
causes include other bacteria (or their toxins) and parasites. Transmission
may occur due to consumption of improperly prepared foods or
contaminated water or via close contact with individuals who are
infectious. Prevention includes the use of fresh water, regular hand
washing, and breast feeding especially in areas where sanitation is less
good. The rotavirus vaccine is recommended for all children.
It is estimated that three to five billion cases of gastroenteritis
resulting in 1.4 million deaths occur globally on an annual basis, with
children and those in the developing world being primarily affected. As of
2011, in those less than five, there were about 1.7 billion cases resulting in
0.7 million deaths with most of these occurring in the world's poorest
nations. More than 450,000 of these fatalities are due to rotavirus in
children under 5 years of age Cholera causes about three to five million
cases of disease and kills approximately 100,000 people yearly.

In the
developing world children less than two years of age frequently get six or
more infections a year that result in clinically significant gastroenteritis.
(Webber, Roger (2009). Communicable disease epidemiology and control : a
global perspective (3rd ed.). Wallingford, Oxfordshire: Cabi. p. 79. .)

Gastroenteritis is associated with many colloquial names, including
"Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint",
among others. It has played a role in many military campaigns and is
believed to be the origin of the term "no guts no glory".
Locally, In July 22, 2004, the Department of Health (DOH), Philippines
declared an epidemic (outbreak) of a water/food-borne disease called
acute gastroenteritis in 45 towns in Central Pangasinan. Acute
gastroenteritis is a human enteric (intestinal) disease primarily caused by
ingestion of spoiled www.scribd.com/doc/143216255/Introductionor bacterial
contaminated water or food.

2. OBJECTIVES
General:
To improve the knowledge and skills that the nursing students have
learned on their Related Learning Experience in approaching to the
clients condition, also to apply the attitude that they should have in
rendering care to the patient To gather important and pertinent
information regarding the clients data
Specific:
a) To understand the disease process, the nature, the signs
and symptoms, and the treatment for the problem of to
consider bacterial meningitis age with moderate sign of
dehydration ruled out electrolyte imbalance the patient.
b) To determine pharmacologic interventions including their
therapeutic effect and the adverse effects.
c) To enhance skills in doing independent and defective
nursing interventions to the clients
3. Rationale for Choosing the case
The group decided to make this case as their chosen one, for this case is
one of the unique cases that they have encountered in our duty within the
hospital not just because of the predisposing factors but also by its
precipitating factors affecting it. Also, since the client is a pre-school, his
mother can give relevant information which may support the study.
4. Significance of the studies
The importance of the study is that, it will enhance the skills of the student
nurses in assessing the patient and also it will be added to their
knowledge according to the case of the chosen case of the client. The
study will also teach the students to learn how to interconnect with other
health care providers and to be more familiar with those documents that
the hospital has with their clients
5. Scope of limitation of the study
The study will only focus about the case of the client which is t/c bacterial
meningitis AGE with moderate sings of dehydration R/O electrolyte
imbalance which is the condition of the chosen client and to the other
relevant information about the case of the client.

Conceptual and Nursing Theory

DOROTHEA ELIZABETH OREM
(SELF-CARE DEFICIT NURSING THEORY)

Since that Orems theory, defines self-care as the practice of activities that individuals
initiate and perform independently on their behalf in maintaining life, health, and well-
being. (Udan, 2011)
According to Orem, you can say that a person is having a self-deficit when he is unable
to carry out his own self-care. (Udan, 2011)
In our case, the patient lacks care to himself. Even though he is a child the patient
should be able to do basic self care like going to the bathroom and taking a bath and
eating by himself , he is very active and was always on the move the mother doesnt
seem to have any control of her child when it comes to eating , thats why its maybe he
reason of his hospitalization
For our client, Orem stated 5 methods of helping him to conquer self-care deficit. First,
is acting for and doing for others, as his student nurse, we should help him in things he
cant do while hes confined. Doing dependent activities wherein we can help him. Also
by providing an environment to promote patients ability and teaching him the proper
things to do for his situation.