In partial fulfillment of the requirements in

NCM 103 Care of Clients with Problem in

Oxygenation, Fluid and Electrolyte Balance,
Metabolism and Endocrine

NURSING CASE ANALYSIS

Diabetes Mellitus Type II, Non- Obese, Insulin Requiring; Poor

Control, Diabetes Neuropathy; Hypertension II, Controlled
(Diagnosis)

Presented by:

Alphabetical Order

Presented to:

The Members of the Panel

Month, Year

1
 GENERAL GUIDELINES:

1) The Case Presentation will focus on the diseases among the different concepts of Nursing Care Management (NCM 103
and NCM 104). The students will be assigned with concept through random selection (Draw Lots) as a basis of their case
study.

2) The students will also choose one Adviser to GUIDE them in the conduct of the case study. They will constantly submit
their drafts to the assigned adviser for additional recommendations and suggestions.

3) The students must observe protocol before the conduct of the study such as 1) Letter addressed to the Chief Medical
Officer thru the Chief Nurse to conduct case study endorsed by the Dean, 2) Written Consent (English and Ilocano), and, 3)
a copy of the Interview Questions.

4) The students will choose a patient ONLY at MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER
(MMMH&MC).

5) The students will wear their complete Clinical Duty Uniform whenever they follow up their patients.

6) The Panel for the Case Presentation will comprise of ALL clinical lecturers and preceptors in each level supervising
students in the hospital. The students must submit the final manuscript to the members of the panel one week
before the presentation.

7) The students’ output will be graded with the evaluation tool below. The evaluation tool has three parts, Content (50%),
Presentation (30%) and, Personal and Interpersonal Attributes (20%).

8) The Final Grade for each individual will be computed by their average evaluated by the respective members of the panel.

2
 9) after the presentation, all members of the group shall be involved in refining the manuscript by integrating all the
suggestions made by the panel members during the presentation. The final manuscript must be submitted to the panel one
week after the case had been presented.
CHAPTER DESCRIPTION PROPOSED CONTENT
This section introduces the case study, its
importance and impact into the nursing  It contains the goals and objectives of the case study
I. Introduction
practice. specific into the disease process of the patient.
It also provides the goals of the case study.
 It indicates the Patient’s Name, Date and Place of Birth,
Civil Status, Occupation, Age, Gender, Birthday,
Educational Attainment and Residence, , Religious
This portion contains the patient’s personal Affiliation, Hospital Number, Admitting Physician and
identifying information such as basic Socio- Diagnosis, Date and Time of Admission and chief
II. Personal Data
Demographic profile and other hospital complaint.
references  If discharged, indicate the patient’s Principal or Discharge
Diagnosis and date and time of discharge.
 The patient’s identity will not be disclosed for
confidentiality and respect for privacy.
III. Family Background  It includes the following information:
o The physical structure of the patient’s household
This part encompasses the data about the including its environment.
client’s family. o Dynamics of the family such decision-making,
The family background provides a general communications, roles and functions, affection and
picture of the patient’s current family and problem solving.
household. o Family members such as husband/wife, children or
siblings, and other extended members, living WITH the
patient.
o A breakdown of the family’s sources of income and
It includes their demographic and socio- expenditures. A family member who is working
economic profile, family structure and overseas and sending financial assistance to the family
lineage, as well as the family’s house and is also included in this section.

3
  A Pie Graph is preferred in presenting the family’s income
natural environment. and expenses. A narrative report is also required to
explain the said graph.
This part contains the family health history,
IV. Health History and personal health history (Past and
Present Health History)
 This section does not include the health experiences of the
patient and his children and husband or wife.
 It also includes each of the family members’ nature and
causes of their morbidities and mortalities within the
family with emphasis on disease similar or related to the
condition of the patient. The health practices and beliefs
and other significant health information of the patient’s
family, vices and use of elicit, over the counter (OTC)
The Family Health History section herbal, and supplemental drugs, allergies, accidents or
exclusively discusses the relevant health injuries, immunizations and other significant lifestyle of
experiences of the patient’s Siblings, each family member.
Parents, Parent’s siblings, up to the third  The family’s use of health facilities and the management
A. Family Health
generation best presented in a genogram received which includes laboratory/diagnostic
History
examination, surgery, treatment and medications.
This area assists in identifying presence of  If the illness suffered by the members of the family were
genetic predisposition to diseases and managed by an indigenous health workers or thru self
environmental influences. medication, describe thoroughly the management done;
include the family’s reason for seeking such health
services.
 For Hereditary diseases include up to 3rd generation of the
client.
 For familial diseases it include the members of the
household.

 REFER TO APPENDIX E FOR A SAMPLE GENOGRAM.

B. Personal Health
History
i. Past Health History The Past Health History discloses  This involves the patient’s childhood diseases, health

4
 practices, heath beliefs and their management,
comprehensively relevant health
immunizations, history of hospitalization and surgical
experiences of the patient from birth to
interventions, accidents, injuries and allergies,
current health status that isn’t related or
pregnancies and deliveries, last physical examination,
associated with the current hospitalization.
common health illnesses and the use of drugs and home
remedies, vices and use of drugs.
 It starts on the earliest onset of signs and symptoms
associated with the disease, events and lifestyle practices
that might have contributed in the disease process, home
remedies and other significant therapeutic management,
its effect to the patient’s lifestyle and history of referral,
The Present Health History provides the
and laboratory findings that may lead to the present
ii. Present Health patient’s clear and full chronologic account
diagnosis/condition of the patient.
History of health experiences related to the present
 The present health history ends with the chief complaints
hospitalization of the patient.
of the client at the times of current admission in the
hospital but it does not include the interventions rendered
in the Emergency Room but includes the admitting
Diagnosis of the patient.

 The following criteria serves as a basis in the formulation

of the said section:

o The theory must be common developmental theory

The Developmental Data tackles the
o The developmental theory used must be properly and
patient’s development as a person in the
adequately justified
context of different developmental theories.
o The presenters must have at least 2 different
The presenters must provide a background
V. Developmental Data developmental theories.
of the theory and must focus on the
o Each theory must have tasks, requirements or virtue to
developmental tasks.
fulfill.

 Examples include: Erikson’s Theory, Havighurst Theory,

Levinson’s Theory and Gould’s Adult Developmental
Theory, Kohlberg’s Moral Theory of Development
 REFER TO APPENDIX G FOR SAMPLE

5
  Anatomy and Physiology
 Readings include related facts and/or updates regarding
the disease. It should contain discussions about the
definition, incidence, risk factors/etiologies (classified as
to modifiability), pathogenesis and clinical manifestations
of the disease. Information should be presented
completely and logically. This part should substantiate the
schematic diagram of disease development.
 Schematic diagram of the pathophysiology:
This section includes a discussion of the
 Develop this part by integrating the information contained
anatomy and physiology of the
in the reading
system/organ affected by the disorder,
VI. Pathophysiology  Make a general pathophysiology which clearly illustrates
readings related to the diseases, and
how the disease develops
schematic diagram of disease development.
 Strat from the risk factors/etiologies and end with the
.
cinical manifestations (alterations in structure and
function that can be determined through Physical
assessment, interview, lab exams, and diagnostic
procedures) including the possible complications
 Highlight the risk factor/s, manifestations and
complications present to the patient
 In here, arrows, straight/broken lines are used to depict
relationships of pathophysiological events

This area focuses on the complete physical  It starts with a 1) general health condition that involves
assessment of the patient using the four observation of patient’s physical appearance and hygiene,
different assessment techniques. body structure, body movement, emotional and mental
VII. Physical Assessment
This should be done during the initial status, and behavior, connected tubes such as IV fluid,
contact with the client closest to the time NGT, Tracheostomy or IFC, and
of admission  2) Head to Toe Assessment
VIII. On-Going Appraisal This section summarizes a 24-hour activity  It includes an appraisal of the patient’s main health
and progress of the during hospitalization. concern, ordered medications, surgeries, laboratory and
The primary basis of which is the chief diagnostic examinations.
complaint presented by the client at the  Monitoring such as Vital signs, CBG, Urine Output (UO),
time of admission in the hospital Stool, I and O, etc. are presented in lowest and highest

6
 However, in some instances, other health
problems arise and should also be reflected
ranges for the whole 24 hours.
in this part.
 Also includes occurrence of new signs and symptoms
This on-going appraisal should start the
associated with the disease process or not.
day after the physical assessment was
 It also includes Course of Confinement that covers the day
conducted
/s between the day of admission and the conduct of
physical assessment.
The data within 24 hour period (from 7:01
am – 7:00 am the next day) should be
included in the day to day appraisal.
IX. Patterns of  It will be presented in three categories namely, Before
Functioning This method utilizes Gordon’s Functional Illness, During Illness at Home and During Illness at
Health Patterns, a method used by nurses Hospital.
in the nursing process to provide a
comprehensive nursing assessment of the  Each functional pattern will have an analysis of the result.
patient
 It will consist of the Gordon’s 11 Functional Patterns
namely;
 Health Perception – Health Management Pattern -
describes client’s perceived pattern of health and well
being and how health is managed.
 Nutritional – Metabolic Pattern - describes pattern of food
and fluid consumption relative to metabolic need and
pattern indicators of local nutrient supply.
 Elimination Pattern - describes pattern of excretory
function (bowel, bladder)
 Activity – Exercise Pattern - describes pattern of exercise,
activity, leisure, and recreation.
 Cognitive – Perceptual Pattern - describes sensory,
perceptual, and cognitive pattern
 Sleep – Rest Pattern - describes patterns of sleep, rest,
and relaxation.
 Self-perception – Self-concept Pattern – describes self-
concept and perceptions of self (body comfort, image,

7
 feeling state)
 Role – Relationship Pattern - describes pattern of role
engagements and relationships.
 Sexuality – Reproductive Pattern - describes client’s
pattern of satisfaction and dissatisfaction with sexuality
pattern, describes reproductive patterns.
 Coping – Stress Tolerance Pattern - describes general
coping patterns and effectiveness of the pattern in terms
of stress tolerance.
 Value – Belief Pattern - describes pattern of values and
beliefs, including spiritual and /or goals that guide choices
or decisions.

 REFER TO APPENDIX H FOR SAMPLE

This section discloses health information
regarding the patient’s Laboratory
X. Medical Management examinations and Diagnostic Procedures,
Treatments, Surgical Interventions (if
applicable) and Drug study.
A. Laboratory and This section discusses the different  Laboratory findings from referring institutions shall be
Diagnostic laboratory and diagnostic examinations included
Examinations performed on the patient starting from  It will be presented in a chronological order. Relevant
referral up to hospitalization laboratory and diagnostic results that are present in the
Pathophysiology will be highlighted.
 The information will include: Ordering Physician, Date
and Time Ordered, Name and Purpose of Procedure,
Nursing responsibilities and its Rationale, and the
Analysis of the Result.
 The Analysis of the Result will elaborate the occurrence of
the laboratory and diagnostic result, and it is
supplemented with pathophysiological assessment data.
 It should include interventions before, during and after
the conduct of the laboratory/Diagnostic examination and
it should be clearly rationalized.

8
  The nursing responsibilities will also include nursing
interventions to correct abnormal results.
REFER TO APPENDIX I FOR SAMPLE
 It consists of Intravenous Therapy, Surgical Interventions,
This section composed of medical
Diet Therapy, Monitoring (Diet, CBG, Stool) each has its
B. Treatments treatments received by the patient starting
own brief background, individual purpose and nursing
from admission up to discharge.
responsibilities including its rationale and analysis.
C. Surgical This section consists of surgical  If consists all surgical interventions performed to the
Interventions interventions (minor or major) patient.
 Starts with the earliest prescribed medication up to the
latest.
 Includes nursing responsibilities on drug to drug and food
interaction.
 Pharmacologic classification is classified on the specific
chemical components / structure of the drug.
 Physiologic classification is classified as how the drug
affects the body.
 Indicate the date and time when the drug was ordered,
discontinued, changed and total number of administered
This section studies ALL the pharmacologic
D. Drug Study dose.
interventions given to the patient.
 In case it is a generic drug, disregard the brand name.
 In the mechanism of action, explain how the drug exerts
its therapeutic effects
 Desired effect explains the reason why the drug is given
to the client. The explanation about the desired effect
relates the drug to the client’s condition
 Appropriate nursing responsibilities include interventions
that could potentiate, enhance and ensure safe us of the
drug.
 REFER TO APPENDIX J FOR SAMPLE
XI. Nursing Care Plan Care plans provide direction for  It should be prioritized nursing problems according to
(NCP) individualized care of the client. A care priority (actual, potential, risk, possible and wellness
plan flows from each patient's unique list of problems).

9
  It should provide justification in prioritizing nursing
problems based on the principles of ABCs and Maslow’s
Hierarchy of Needs.
 It should follow the PES Format
diagnoses and should be organized by the
 If administration of drug is included as one of the nursing
individual's prioritized specific needs.
interventions, specify the drug, dose, route, and frequency
and derive the rationale from the mechanism of action and
the desired effect of the drug.
 REFER TO APPENDIX K FOR SAMPLE
 The discussion on this part highlights the description of
the client’s condition on the day of discharge which
This section describes briefly the condition signifies improvement or deterioration of condition as
XII. General Evaluation
of the client from admission to discharge outcomes of management done throughout hospitalization
 Also it indicates the date and time f discharge and mode
of transportation from the ward.
This section consists of all bibliographic
XIII. References  References should follow an APA format
and web references of information data.

APPENDICES
Appendix A. FLOW CHART IN CONDUCTING CASE STUDY

LEVEL CLINICAL
STUDENT DEAN
CHAIR COORDINAT
S
OR  DETERMINE
 PREPARES  ENSURES
 CORRECTS S THE
NECESSARY THE
DOCUMENTS CORRECTNE
DOCUMENT CORRECTNE
AND ENSURE SS AND
S IN THE SS AND
THE 10 COMPLETEN
CONDUCT COMPLETEN
CONPLETION ESS OF THE
OF CASE ESS OF THE
OF DOCUMENTS
ANALYSIS DOCUMENTS
REQUIREMEN WITH
.
Appendix B. SAMPLE LETTER TO CONDUCT CASE STUDY

Dr. MA. LOURDES K. OTAYZA, MD, MHA, CESCO V, FPOGS

Medical Center Chief
Marian Marcos Memorial Hospital and Medical Center
City of Batac, Ilocos Norte

Thru: Mrs. MIRIAM I. RAMONED, RN, MAN

Chief Nurse
Marian Marcos Memorial Hospital and Medical Center

Madam:

Christian Greetings.

The Level III Bachelor of Science in Nursing are currently enrolled in

NCM 103. One of the requirement of the subject is to present a nursing case
analysis.

Anent this, the members of group __ as represented by the undersigned,

would like to seek permission to select a patient with disorders on Oxygenation
from your institution.

Rest assured that the privacy and confidentiality of the patient's identity
and data that will be gathered be utilized solely for educational purposes.

We anticipate with gratitude your favorable response on this request.

More Power and God bless.

Very truly yours,

___________________
Group Leader

Noted:

ALTROY VAN AGTANG, RN, MAN MARNIE U. DELA CRUZ,

RN, MAN
Chair, Level III Dean, College of Nursing

11
Appendix C. INFORMED CONSENT

Patpatgen mi nga Pasyente;

Kablaawan dakaman ti mailbag nga aldaw!

Dakami ket estudyante ti Northern Christian College nga mangal-ala ti

kudos nga Bachelor of Science in Nursing. Maysa nga kasapulan ti sabjek mi
nga NCM 103, ket mangipresentar kami ti maysa nga pasyente para ti case
study mi.

Pangeg kadaytoy, kayak mi kuma nga sika ti alaen mi nga agbalin nga
pasyente mi. Ipakaammo mi pay nga masapol daka nga umay sarungkaran
manipud panagyan mo yanta ospital aginggana nga makaawid ka. Kadagiti nga
oras ket umay mi kumustaen ti kasasaad mo, agaa iti impormasyon nga agappo
kenka ken iti chart mo.

Ipasigurado mi nga ti kinataon ket konpidensyal. Maisigurado mi pay

kenka nga dagiti impormasyon nga maadaw mi ket agserbi laeng ti pinagadal
mi ken awanen ti sabali pay a rason.

Agyaman kami ti oras nga ited mo kadakami. Dios unay ti agngina!

___________________
Representante ti
Grupo

Base kadagitoy nga didkosyon siyak ni ______________________, agtawen

______ ti Brgy. ___________________________________ ikkak pammalubos daytoy
nga grupo it estudyante nga umay mangsarungkar kanyak ti kasasaad ko
manipud ti panagyan ko yanta ospital agingga nga madischarge nak.
Palubosak pay ida nga manuals iti impormasyon maipanggep ti kondisyon ko
ken agsakar ti chart ko.

Maisigurado la ketdi nga amin nga impormasyon nga maited ket agserbi
laeng ti panagadal ken kapakanak.

___________________ ___________________

12
 SAKSI
PASYENTE

Appendix D. Interview Guide Questions

INTERVIEW GUIDE QUESTIONS

PART I. BIOGRAPHIC DATA

1. What is your name? (Anya ti nagan mo?)

2. What is your address? (Intoy ti pagtaengam?)
3. How old are you? (Mano ti taken?)
4. When is your birth date? (Kaano ti panagkasangay mo?)
5. Where is your place of birth? (Intoy ka naiyanak?)
6. What is your civil status? (Anya ti kasasaad mo?)
7. What is your religion? (Anya ti relihiyon mo?)
8. What is your educational attainment? (Anya ti naturpos mo?)
9. What is your occupation? (Anya ti pagsapulam?)

PART II. PATIENT'S HEALTH HISTORY

[Link] Health History

1. What is the reason why you came here in the hospital? (Anya ti rason nu
apay immay ka nagpaospital?) What did you feel? (Anya ti mariknam?)
2. Have you taken any medication or management to ease the pain? (Anya
dagiti agas nga tinumtumar mo wenno inubram tapnun maikkat ti sakit
mo?)
3. How many days did you suffer before consultation? (Mano nga aldaw
deta nga sakit nga mariknam sakbay ka nagpaospital?)
4. What are those activities you did or food you ate that might have
contributed pain? (Anya dagitay inub-ubram wenno kinnan mo nga
agbalin nga naka alam ti sakit?)

[Link] Health History

1. Had you experienced any childhood illnesses? (Ana dagitay sakit mo idi
ubing ka?)
a. Mumps (gabbi)
b. Measles (supot-supot)

13
 c. Chicken pox (toko)
d. Hives (kamuras)
2. How did you manage them? (Kasanum nga inagasan ida?)
3. Had you felt better after doing such management? (Naimbagan ka kadi
idi nagagas ka?)
4. Have you ever hospitalized? (Naospital ka kadin?)
5. Have you experience injury or accident? (Napadasam kadin ti
naaksidente?)
6. Do you have any other illnesses? (Adda kadi pay sabali nga sakit mo?)
7. Had you experienced common illnesses? (Ana dagidyay kangrunaan nga
saksakit nga napadasam?)
a. Cough and colds (uyek ken panateng)
b. Fever (gurigor)
c. Headache (sakit ti ulo)
d. Sore eyes (labbaga ti mata)
e. Other (dadduma pay)
8. How did you manage the illness? (Kasanu ti pinag-agas mo?)
9. Do you have allergies? (Adda kad allergies mo?)
a. Food (makan)
b. Things (banbanag)
10. Do you have complete vaccines and what are those? (Kompleto
kadi iti bakunam ken ana dagidyay?)

[Link] Health History

1. What is your parent's name? (Ana ti nagan ti nagannak mo?)
2. Who are your family members? (Sino dagidyay miyembro iti pamilya
yo?)
3. Had they experienced any childhood illnesses? (Ana dagitay sakit da
idi using da?)
a. Mumps (gabbi)
b. Measles (supot-supot)
c. Chicken pox (toko)
d. Hives (kamuras)
4. How did you they them? (Kasanu da nga inagasan ida?)
5. Had they felt better after doing such management? (Naimbagan da
kadi idi nagagas ka?)
6. Have they ever hospitalized? (Naospital da kadin?)
7. Have they experience injury or accident? (Napadasan da kadin ti
naaksidente?)
8. Do they have any other illnesses? (Adda kadi pay sabali nga sakit da?)
9. Had they experienced common illnesses? (Ana dagidyay kangrunaan
nga saksakit nga napadasan dan?)
a. Cough and colds (uyek ken panateng)
b. Fever (gurigor)
c. Headache (sakit ti ulo)
d. Sore eyes (labbaga ti mata)
e. Other (dadduma pay)
10. How did they manage the illness? (Kasanu ti pinag-agas da?)
11. Do they have allergies? (Adda kad allergies da?)
a. Food (makan)
b. Things (banbanag)
12. Do they have complete vaccines and what are those? (Kompleto
kadi iti bakuna da ken ana dagidyay?)

PART III. FAMILY BACKGROUND

14
 1. Who are your family members? (Sino dagidyay miyembro iti pamilya yo?)
2. How old are they? (Mano ti tawen dan?)
3. When is their birthdays? (Kaano ti panagkasangay da?)
4. What is their civil status? (Anya ti kasasaad da?)
5. What is their religion? (Anya ti relihiyon da?)
6. What is their educational attainment? (Anya ti naturpos da?)
7. What is their occupation? (Anya ti pagsapulan da?)
8. What is their address? (Intoy ti pagtaengan da?)
9. What is the type of your family structure? (Ana ti klase ti pamilya yo?)
10. What type of housing structure do you have? (Ana nga klase ti
pannakaaramid ti balay yo?)
11. How many rooms do you have? (Mano ti kwarto yo?)
12. What are the appliances do you have? (Ana dagiti adda nga
alikamen yo?)
13. Do you have any motor vehicle? (Adda lugan yo?)
14. How much is your average monthly income? (Mano ti
masapsapulan yo ti makabulan?)
15. What are the sources of your income? (Paggapuan na ti
pamastrekan yo?)
16. What are your monthly expenses? (Anya dagitay paggastuan yo ti
makabulan?)

PART IV. PATTERNS OF FUNCTIONING

1. How is your eating pattern before illness? (Kasanu ti pinnangan mo

sakbay nagsakit ka?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
2. How is your drinking pattern before illness? (Kasanu ti panaginom mo
sakbay nagsakit ka?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
3. How is your bladder elimination before illness? (Kasanu ti panagisbom
sakbay nagsakit ka?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
4. How is your bowel elimination before illness? (Kasanu ti pinagtakkim
sakbay nagsakit ka?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
5. How is your sleeping pattern before illness? (Kasanu ti panagturog mo
sakbay nagsakit ka?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
6. How is your bathing pattern before illness? (Kasanu ti pinagdigos mo
sakbay nagsakit ka?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
7. Can you do activities in accordance to your physical abilities before
illness? (Maaramid mo kadi dagiti ban-banag nga maubra para iti bagim
sakbay ka nagsakit?) Before and during hospitalization? (Sakbay ken
agdama nga naospital ka?)
8. How do you overcome problems before illness? (Kasanum nga risoten
dagiti problrmam sakbay nagsakit ka?) Before and during
hospitalization? (Sakbay ken agdama nga naospital ka?)
9. How do you socialize with others before illness? (Kasanu ka makilangrn-
langen sakbay nagsakit ka?) Before and during hospitalization? (Sakbay
ken agdama nga naospital ka?)
10. Are you aware what happens in your surrounding before illness?
(Ammom met laeng iti mapaspasamak ti law-law mo sakbay nagsakit

15
 ka?) Before and during hospitalization? (Sakbay ken agdama nga
naospital ka?)
11. Is goodness inherent in you before illness? (Naipalasag kadi ti
nasayaat kenka sakbay nagsakit ka?) Before and during hospitalization?
(Sakbay ken agdama nga naospital ka?)

Appendix E. SAMPLE GENOGRAM

16
Appendix F. CASE PRESENTATION RUBRIC

17
 EVALUATION TOOL FOR CASE PRESENTATION

Name: ___________________________________Group: ________ Date:

__________

Direction: Please rate the group/student with the following scale:

5 Outstanding Presentation is correct, complete and relevant.

4 Very Presentation is correct, relevant but complete
Satisfactory
3 Satisfactory Presentation is complete but some are irrelevant
2 Needs Presentation is complete but most are irrelevant
Improvement
1 Unsatisfactory Presentation is incomplete and irrelevant

*CONTENT (50%)
CHAPTER Tasks Sco
re
I. Family 1. Assesses the family as a whole and as a single unit.
Backgroun 2. Provides a significant clinical picture of the family
d 3. Identified family income and expenditure
4. Enumerated family morbidities and mortalities
5. Traced family interventions/management to
Family identified morbidities and mortalities
6. Provided a schematic diagram of the family tree
7. Identified client’s morbidities and mortalities
8. Enumerates traditional/cultural/medical
II. Health Past interventions to identified problems
History 9. Identified other significant health experience of
the client
10. Traces the earliest onset of the disease
11. Identified interventions/management to
Presen
alleviate signs and symptoms
t
12. Identified significant health lifestyle that
contributes in the development of the disease
13. Explained clearly the basis of choosing their theory
III. Developm 14. Utilized the theory to explain the development of the
ental Data patient
15. Accurate interpretation/analysis was provided.
16. Clear and concise schematic diagram of the disease
process
IV. Pathophys 17. Expounded the pathophysiological process to
iology audience and panelist
18. Related the symptomatology of the patient in the
schematic diagram
19. Monitored the patient’s health progress
V. On-going
20. Relates the outcome of management to current health
Appraisal
status of the patient
21. Identified the client’s pattern of functioning before
VI. Pattern of
and during illness
functionin
22. Formulated critical analysis in the changes of the
g
client’s pattern of functioning
VII. Physical 23. Performs comprehensive physical assessment of the
Assessme client as basis of problem identification
nt 24. Performed assessment with correct method

18
 25. Utilized different techniques/styles to elicit pertinent
data
26. Related the diagnostic/laboratory examination to the
VIII. Laborator
client’s indications.
y and
27. Adequately enumerated nursing responsibilities that
Diagnostic
suffice safe nursing practice
Examinati
28. Provided critical analysis in the interpretation of the
ons
results
IX. Medical 29. Determined different medical/surgical management
Managem 30. Identified nursing responsibilities that suffice safe
ent nursing practice
31. Followed complete format/content
32. Clearly explained the mechanism of action of the drug
33. Identified principles of drug administration with
X. Drug
adequate knowledge and understanding of prescribed
Study
medications
34. Enumerated adequate amount of nursing
responsibilities that suffices safe drug administration
35. Formulates and prioritizes identified problems based
on gathered data
36. Integrates health promotion, disease prevention, cure
XI. Nursing and rehabilitation with specific rationale in the plan of
Care Plan care
37. Explains different nursing interventions with
corresponding rationale in carrying out plan of care.
38. Nursing Care Plan is SMARTER

Score ___
205
Rating
PRESENTATION (30%)
Task Sco
re
1. Displays physical preparedness as to manuscripts and visual
materials
2. Discerns psychological preparedness for the presentation
3. Shows mastery on assigned individual report for the presentation
4. Demonstrates proficiency regarding contents on the other parts of
the case analysis aside from the assigned report
5. Answers question regarding own report accurately
6. Responds appropriately to queries regarding other parts of the
case analysis
7. Answers with honesty and accuracy in reporting of client’s
documents.
____
Score 35
pts
Rating
PERSONAL AND INTERPERSONAL ATTRIBUTES (20%)
Task Sco
re
1. Observes punctuality in submitting case analysis output.
2. Reports and started on time for the presentation
3. Shows interest in learning

19
 4. Establishes good interpersonal relationship within the group
5. Communicates effectively within the group and audience, as well as
the panelist.
6. Accepts criticism constructively

____
Score
30
pts
Rating

Percentage Equivalent

FINAL GRADE
* - Evaluated as a whole group

____________________________________________________
NAME AND SIGNATURE OF EVALUATOR
Computation for rating: = Percentage / PS x Score
Computation for final grade: Add all rating

20
Appendix G. DEVELOPMENTAL DATA FORMAT

Below is an example of information on Developmental Data using Havighurst Theory with a patient categorized as a Middle
Adult.

Background of the Theory and Category:

Virtues/ General Developmental Tasks:

TASKS RESULT JUSTIFICATION

1. Learning physical skills necessary for
ordinary games.
2. Building wholesome attitudes toward
oneself as a growing organism
3. Learning to get along with age-mates
4. Learning an appropriate masculine or
feminine social role
5. Developing fundamental skills in
reading, writing, and calculating
6. Developing concepts necessary for
everyday living.
7. Developing conscience, morality, and a
scale of values
8. Achieving personal independence
9. Developing attitudes toward social
groups and institutions

Analysis: _____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

21
Appendix H. PATTERNS OF FUNCTIONING FORMAT

PATTERN OF FUNCTIONING: Gordon’s Functional Health Patterns

BEFORE ILLNESS/ REGULAR DURING ILLNESS

PATTERN
AT HOME HOSPITALIZATION

ANALYSIS:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

22
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

23
 Appendix I. LABORATORY AND DIAGNOSTIC EXAMINATION FORMAT

Date Ordered: Date Performed:

Name of Diagnostic and Laboratory Examination:

Definition:

Purpose of the Study:

Result:

Nursing Responsibilities Rationale

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Analysis of the Result:

24
Appendix J. DRUG STUDY FORMAT

Generic Name:

Brand Name:

Date Ordered:

Dosage/Route/Frequency:

Pharmacologic Classification:

Physiologic Classification:

Mechanism of Action:

Indication:

Desired Effect:

Contraindication:

Side Effects:

Adverse Desired Effect:

Nursing Responsibilities Rationale

1.

2.

3.

4.

5.

6.

7.

8.

9.

25
 10.

Appendix K. NURSING CARE PLAN (NCP) FORMAT

NURSING ASSESSMENT:

Subjective Data

Objective Data

NURSING DIAGNOSIS:

NURSING INFERENCE:

NURSING GOAL:

NURSING INTERVENTION:

INTERVENTION RATIONALE

INDEPENDENT INTERVENTIONS
1.
2.
3.
4.
5.
6.
7.
8.
DEPENDENT INTERVENTIONS
9.
10.
11.
12.
13.
14.
15.

26
NURSING EVALUATION:

27