Case 1 example

I. Patient’s Profile

S.Q. is a female, 11/12 months old, residing at P2 Blk1 L38 Pabahay

Nanadero, Calamba City, Laguna. Her mother is J.Q., works part time in
a shop and her father is R.Q., factory worker. She has one sibling older
than her, K.Q., 3 years old. S.Q. was born on March 6, 2009, and born
at Calamba, Laguna, Filipino in nationality. Their whole family is Born
Again in religion. She weighs 8.7 kg. She’s admitted on January 30,
2010 at room 103-C, pedia ward with chief complaint of high fever for
2 days with emesis and has a diagnosis of Acute Gastroenteritis. And
she was discharged on January 6, 2010, Saturday at 1:30 pm. Their
attending physicians were Campos, Angelie, M.D. and Bonagua, Aireen,
M.D.

II. Health History & Chief Complain

Chief Complaint

She was admitted for having high fever for 2 days with vomiting.

Present Illness
 S.Q. was only admitted to the hospital due to gastrointestinal problem
now and was also suspected of urinary tract infection by Dra. Campos. Aside from
the diagnosis, no other disease or complication was seen or diagnosed.

Past Health History

Mrs. Q says “ eto first time nya ma-admit after nya ipanganak.” S.Q. gets
seasonal cough and colds at times but never serious because it usually last only
for a few days. They always consult their doctor once sick. She is complete in her
vaccinations except those which would be taken on her 1 year of age.

Family Health History

No one in the family had any respiratory illness or allergies. On her father’s
side, almost all have hypertension. One member of their family died on a heart
attack.

III. Gordon’s Pattern

Health Perception

As Mrs Q. stated, “lagi naman kami nagpapacheck up ni stephani.

Napunta talaga kami kay Dra. Campos. Malikot lang talaga yan pero
inaalagaan yan sa bahay.” S.Q. has a mannerism of sticking anything on
her mouth. Whatever she touches she directs it toward her mouth.
Although, she doesn’t practice hand washing every now and then. There
are some medications she takes easily but there are also those
medications which is hard for her because of the taste.
Nutritional-Metabolic

S.Q. weighs 8.7 kg. She eats soft foods. She drinks 6-7 bottles of
milk in a day. Mrs. Q provides her daughter milk and food in accordance to
age and doctor’s advise. She drinks formula milk. She stop being breastfed
when she was 10 ½ moths. She has no allergy.

Elimination

She defecates once or twice a day in her usual days. She changes
diaper 3-5 times in a day when full or had defecated. She was advise to
use Lactacid for her perennial wash and calmoseptin ointment on her
diaper rash.

Activity-Exercise

S.Q. is a very playful and active girl. She has lots of energy but cries
when she doesn’t like something. She smiles and laughs a lot. Her
coordination, gait, balance is not yet stable due to age. Her daily living
activities were provided by her parents. There is no musculoskeletal
impairment. She usually plays after she wakes up in the morning.

Sleep-Rest
 She sleeps at 8 P.M. in the evening and usually gets up 7 A.M. – 8
A.M. in the morning. After playing or eating she takes a nap. She has
straight undisturbed sleep at night.

Cognitive Perceptual

S.Q. has no sensory deficits. She response well to verbal stimulus by

looking at you or having facial expressions. “Bibo nga yan bata nay an,
makulit pero mabilis mo naman makuha attention,” as her mother stated.

Self-Perception

S.Q. is not afraid of new people around her. She is friendly and is
easy to accommodate.

Sexual-Reproduction

Prior to age, S.Q. is not yet oriented with any sexual matters.

Coping Stress

In her age, she usually cries when something is wrong about her.
Simple smile or cry is a sign of her comfort, distress or feelings. She is
familiarized to her family members and long for them when she doesn’t
want the situation like giving of medications or other procedures.
 Role-Relationship

She doesn’t know the concept of death yet due to age. Forms
words like “dede” and “dada”. She knows her family members and can
easily familiarize the people around her.

Value-Belief

The family is Born Again. They regularly attend church together

with all the members of the family. They don’t usually believe in “hilot”.
Once one is sick in the family, they go immediately to the hospital or for
check-up.

IV. Head-to-Toe Assessment

General Assessment: Playful and active, neat

Initial Vital Sign: T=36.4°C RR=27 PR=118

Area Assessed Technique Normal Findings Actual Findings Evaluation

Skin

Color Inspection Light brown, brown skin Normal

tanned skin (vary
according to race)
 Lips, nail beds, Lighter colored Lighter colored
soles and palms palms, soles, lips palms, soles, lips and
Inspection Normal
and nail beds nail beds

Moisture Inspection/ Skin normally dry Skin normally dry Normal

Palpation

Temperature Palpation Warm to touch 36.4 o C, warm to Normal

touch

Smooth, soft and Smooth, soft and

flexible palms and flexible palms and
Texture Palpation Normal
soles (thicker) soles (thicker)

Turgor Palpation Skin snaps back Skin snaps back Normal

immediately immediately 1-2
seconds

Skin appendages

a. Nails

Inspection Transparent, Transparent, smooth Poor

smooth and and convex grooming
convex cut and
Uncut and dirty
clean

Nail beds Inspection Pinkish Pinkish Normal

Nail base Inspection Firm Firm Normal

White color of White color of nail

nail bed under bed under pressure
pressure should returned to pink
Capillary refill Inspection/ return to pink within 2-3 seconds Normal
Palpation within 2-3
seconds
b. Hair

Distribution Inspection Evenly distributed Evenly distributed Normal

Color Inspection Black Black Normal

Texture Inspection/ Smooth Smooth and curly Normal

Palpation

Eyes

Eyes Inspection Parallel to each Parallel to each other May be a

other but slightly sunken sign of
dehydration

Visual Acuity Inspection PERRLA- Pupils PERRLA- Pupils Normal

(penlight) equally round equally round react
react to light and to light and
accommodation accommodation

Eyebrows Inspection Symmetrical in Symmetrical in size, Normal

size, extension, extension, hair
hair texture and texture and
movement movement

Eyelashes Inspection Distributed Distributed evenly Normal

evenly and curved and long curved
outward outward

Eyelids Inspection Same color as the Same color as the Normal

skin skin

Blinks Blinks involuntarily

involuntarily and and bilaterally up to
bilaterally up to 16 times per minute Normal
20 times per
minute
Do not cover the
 pupil and the sclera,
lids normally close
Do not cover the
symmetrically
pupil and the
Normal
sclera, lids
normally close
symmetrically

Conjunctiva Inspection Transparent with Transparent with Normal

light pink color light pink color

Sclera Inspection Color is white Color is white Normal

Cornea Inspection Transparent, Transparent, shiny Normal

shiny

Pupils Inspection Black, constrict Black, constrict Normal

briskly briskly

Iris Inspection Clearly visible Clearly visible Normal

Ears

Ear canal Inspection Free of lesions, Free of lesions, Normal

opening discharge of discharge of
inflammation inflammation

Canal walls pink Canal walls pink

Normal

Hearing Acuity Inspection Client normally Client normally hears

hears words words when
Normal
when whispered whispered

Nose

Shape, size and Inspection Smooth, Smooth, symmetric

skin color symmetric with with same color as
same color as the
 face the face Normal

Nasal septum Inspection Close to midline, Close to midline,

thicker anteriorly thicker anteriorly
Normal
than posteriorly than posteriorly

Nares Inspection Oval, symmetric Oval, symmetric and

and without without discharge
Normal
discharge

Mouth and
Pharynx

Lips
Inspection Pink, moist Pink, moist Normal
symmetric symmetric

Buccal mucosa Inspection Glistening pink Glistening pink soft Normal

soft moist moist

Gums Inspection Slightly pink Slightly pink color,

color, moist and moist and tightly fit
Normal
tightly fit against against each tooth
each tooth

Tongue Inspection Moist, slightly Moist, slightly rough

rough on dorsal on dorsal surface
Normal
surface medium medium or dull red
or dull red

Teeth Inspection Firmly set, shiny Firmly set, shiny Normal

No tooth decay, milk

 tooth present

Hard and soft Inspection Hard palate- Hard palate- dome-

palate dome-shaped shaped
Normal
Soft Palate- light Soft Palate- light pink
pink

Neck

Symmetry of Neck is slightly Neck is slightly hyper

neck muscles, hyper extended, extended, without
Inspection Normal
alignment of without masses masses or asymmetry
trachea or asymmetry

Neck Rom Inspection Neck moves Neck moves freely, Normal

freely, without without discomfort
discomfort

Thyroid gland Palpation Rises freely with Rises freely with Normal
swallowing swallowing

Trachea Inspection Midline Midline Normal

Thorax and Lungs Auscultatio Clear breath Clear breath sounds Normal
n sounds

Abdomen Inspection Skin same color Skin same color with Normal
with the rest of the rest of the body
the body

Clicks or gurling
Clicks or gurling sounds occur
Bowel sounds Auscultatio sounds occur irregularly and range
n irregularly and from 5-35 per minute
Normal
range from 5-35
per minute

Neurology
system

Level of Inspection Fully conscious, Fully conscious,

consciousness respond to respond quickly to
Normal
questions quickly, stimulus
perceptive of
events
Unstable gait,
balance and
coordination
Normal for
age (11
months)

Behavior and Inspection Makes eye Makes eye contact

appearance contact with with examiner,
examiner, hyperactive
hyperactive expresses feelings Normal
expresses feelings with response to the
with response to situation
the situation
 CASE 2
EXAMPLE
III. Biographical Data

Patient’s Name : SMP

Age : 1 year old

Gender : Male

Status : Single

Date of Birth : May 9, 2010

Place of Birth : La Union (lying-in)

Nationality : Filipino

Religion : Roman Catholic

Address : Makati City

Date of Admission : April 25, 2011 (11:12AM)

Hospital : Ospital ng Makati

 Informant : Mother

Percentage of Reliability: 80%

IV. Chief Complaint

“Masyado na kasing liquid yung tae na lumalabas sa colostomy bag niya” as verbalized
by the mother

V. History of Present Illness

The patient is a known case of intussusception, s/p exploratory laparotomy, ileal

resection with ileostomy, appendectomy. (December 19, 2010)

History revealed that 10 days prior to admission, patient was discharge for acute
gastroenteritis. Prior to discharge, the consistency of the stool was soft, non-bloody, and
the patient was active, no fever and vomiting.

On the 9th day until the 2nd day prior to admission, the patient didn’t experience
any signs of further symptoms of acute gastroenteritis.

One day prior to admission, patient had loose watery yellowish stools via
ileostomy bag. He had fever of 39oC, 3-4 episodes of vomiting of milk amounted 2-3 tbs.

Symptoms persisted until few hours prior to admission; patient was noted to be
irritable. Thus patient brought to Ospital ng Makati for re-admission.

VI. Past Medical History

The patient was delivered NSD at one of the lying-in at La Union and was fully
immunized. He had previous case of intussusceptions, s/p exploratory laparotomy, ileal
resection with ileostomy, appendectomy last December 19, 2010.
 VACCINE Age of Vaccination

BCG At birth

Hepa B At birth

Vit. K At birth

DPT 6 weeks

OPV 6weeks

AMV 9 months

VII. Family Medical History

No significant family medical history.

VIII. Personal and Social History

A. Health Perception and Health Management Pattern

The mother considers the patient’s health so important. She assures that
the patient receives enough nutrition and is alert to any abnormal condition his
son is experiencing. Whenever her son has cough, she gives him home remedies
in which if does not alleviate makes her decide to bring him on private clinics.
She ensures that she is focused on the patient’s health.

B. Nutritional and Metabolic Pattern

Patient SMP is exclusively breastfed from birth up to 6 months old. When
he is 6 months old, he started to eat solid foods like rice and biscuits such as
wafer, eggnog, breadstick and bravo. His appetite is good. He is not eating salty
foods yet fond of eating fruits like orange and banana. Her mother then gave him
formula milk and its brand is Pediasure. He drinks a lot of water. When he was
hospitalized, this routine was changed since he’s no longer fond of eating fruits
and drinking water but is still given formula milk.

C. Elimination pattern
The mother changes his diaper three times a day. According to the mother,
the patient defecates three times a day with yellow colored stool. The consistency
of his stool is condensed, soft and slightly formed. When he was hospitalized, her
mother then changes his diaper two times a day and his stool is watery.

D. Activity and Exercise Pattern

According to the mother, he wants to walk but needs assistance. He plays
many toys but he loses eagerness and gets easily tired and plays another toy.
E. Sleep and Rest Pattern
He sleeps in the morning up to lunch, two naps in the afternoon and sleeps
in the whole night. When he was hospitalized, his sleep pattern changed. He
sleeps on and off for about every two hours at night and just take naps if not
disturbed.

F. Cognitive and Perceptual Pattern

The patient is active and is oriented with the people around him. He could
recognize his mother and father.

G. Role and Relationship Pattern

According to the mother, he is a very active child and does not cry easily.
He recognizes the people around him and play with them. He has one elder
brother and they kept on playing with each other when he was around. He can
cope easily with other person.

H. Sexuality and Reproductive Pattern

 Not applicable to age

I. Coping and Stress Tolerance

Patient SMP copes up to his condition very well. He is not easily irritated
and is even a jolly kid. He is fond of playing with people around him. He reduces
his stress by entertaining himself with the different things around him. He has also
good appetite despite of his condition.

J. Value and Belief Pattern

Their religion is Roman Catholic.

K. Self-Perception and Self-Concept Pattern

Not applicable to age
IX. Course in the Ward

DATE &TIME DATA ACTION RESPONSE / RESULT

Monday-May 9, 2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

sleeping on bed recorded. CR: 130cpm
with his mother RR: 34bpm
on the bedside.
 8:30 am  Provided with bedside care.  Established rapport.
 Nurse-patient interaction,
done.

 11:00 am  The ileostomy  Assisted the mother in

bag of the emptying the ileostomy bag.
patients is  Noted the appearance of the  Beefy red stoma.
about two- stoma.
thirds.  Noted the consistency, and  Fluid condense-like effluent.
odor of the effluent.

 12:00 noon  Vital signs taken and  Temp: 36.5oC

recorded. CR: 135cpm
RR: 30bpm
 Intake and Output was  Intake: Breast feeding and 120 ml
documented. of water
Output: 90 ml ( 1 diaper changed)
Tuesday- May 10,
2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

awake and recorded. CR: 135ccpm
playing with RR: 30bpm
her mother.  Due medications are given.  Ferrous sulfate 150mg/10.6
ml/2ml, PO, OD
Probiotics plus prebiotics 1
sachet, OD
 Provided with bedside care
and done with nurse-patient
interaction.
 9:00 am  Physical assessment done.

 11:00 am  Scheduled time  Assisted the mother in  Fluid condense-like effluent

for ileostomy ileostomy bag emptying.
bag emptying. Noted the appearance of the
stoma.
 12:00 noon  Vital signs taken and  Temp: 36.5oC
recorded. CR: 134 cpm
RR: 30 bpm
 Documented the intake and  Intake: Breast feeding and 60 ml
output. of water
Output: 90 ml (1 diaper change)
Wednesday- May 11,
2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

eating cerelac recorded. CR: 136 cpm
 for breakfast, RR: 30 bpm
with his mother
feeding his son.
 Due medications given.  Ferrous sulfate 150mg/10.6
 Bedside care done, nurse- ml/2ml, PO, OD
patient interaction done. Probiotics plus prebiotics 1
sachet, OD
 9:00 am  CBG monitored.  68 mg/dl

 11:00 am  With beefy red

stoma on the
lower right
quadrant of the
abdomen.
 Scheduled time  Assisted the mother in  Fluid condense-like effluent
for ileostomy ileostomy bag emptying.
bag emptying.

 12:00 noon  Vital signs taken and  Temp: 36.5oC

recorded. CR: 136 cpm
RR: 30 bpm
 Documented the intake and  Intake: Breastfeeding and 60 ml
output. of water
Output: 90 ml ( 1 diaper change)
Thursday-May 12,
2011

 8:00 am  Seen patient  Vital signs taken and  Temp: 36.5oC

sleeping with recorded CR: 136 cpm
his parents on RR: 30 bpm
 the bedside. .

 Bedside care done, with

nurse-patient interaction.

 11:00 am  With beefy red

stoma on the
lower right
quadrant of the
abdomen.
 Scheduled time  Assisted the mother in  Fluid condense-like effluent
for ileostomy ileostomy bag emptying.
bag emptying.
 Scheduled time  Assisted the mother in
for ileostomy providing ileostomy care.
care.
 12:00 noon

 Vital signs taken and  Temp: 36.5oC

recorded. CR: 134 cpm
RR: 30 bpm
 Documented the intake and  Intake: Breastfeeding and 50 ml
output of water
Output: 90 ml ( 1 diaper change)
X. Review of Systems

General
(+) altered sleeping pattern
Integumentary System
(+) pruritus around the skin barrier of ileostomy bag
Gastrointestinal System
Stool from ileostomy bag was yellowish in colour, ~ half of plastic cup as amount and drain
twice a day

XI. Physical Assessment (MAY 10, 2011)

GENERAL APPEARANCE Awake, conscious, active and looks as an

infant (1 yr old).

 CEPHALOCAUDAL EXAMINATION

Findings Reference Value

Height : 69 cm Height : 71 -81 cm
Anthropometric Weight : 8.5 kg Weight : 8.6-12.2kg
measurement Weight Percentile Rank: 9% Weight percentile Rank : 5%-95%
Height Percentile Rank: <5% Height percentile Rank : 5%-95%

Head circumference : 46 cm Chest Circumference generally < 2

Chest Circumference : 44 cm cm than Head circumference.
Abdomen circumference : 45
cm Abdomen circumference :
protuberant abdomen

Initial Vital Signs Heart rate : 130 bpm Heart rate : 120-160 bpm
Respiratory rate : 34 cpm Respiratory rate : 20-40 cpm
Temperature : 36.5 C Temperature : 36.5-37.5C
 Organ/ Techniques of Findings Reference findings
system physical
examination
Head (Facial Inspection  (-) lesions  (-) lesions
features )  (-) areas of deformity  (-) areas of deformity
 Symmetric facial  Symmetric facial
features features

Palpation  (-) palpable masses or  (-) palpable masses or

lesions lesions
 (+) temporal pulse  (+) temporal pulse

Hair Inspection  Evenly distributed  Evenly distributed

black hair black hair
 (-) infestations  (-) infestations
 normal texture  normal texture

Eyes Inspection  Eyebrows  Eyebrows

symmetrically aligned symmetrically aligned
 Eyelashes equally  Eyelashes equally
distributed distributed
 (+) Sunken eyes  (-) Sunken eyes
 Anecteric sclera  Anecteric sclera
 White sclera  White sclera
 Pinkish Conjunctivae  Pinkish Conjunctivae
 Dark brown iris  Black iris
 (+) PERRLA (2-3  (+) PERRLA (2-3 mm
mm diameter of iris diameter of iris)
 (-) discharge  (-) discharge

 Symmetrically  Symmetrically aligned

aligned  Intact tymphanic
Ears Inspection  Intact tymphanic membrane
membrane  (-) masses
 (-) masses  (-) discharge
 (-) discharge  (-) lesions
 (-) lesions

 Pinna immediately  Pinna immediately

recoil after it is folded recoil after it is folded
Palpation
 Pink nasal mucosa  Pink nasal mucosa
 (-) nose flaring  (-) nose flaring
Nose Inspection  Teeth (+) central and  Teeth (+) central and
lateral incisor on lateral incisor on upper
upper and lower and lower
Mouth and Inspection  Gums and Mucosa  Gums and Mucosa
Throat (-) swelling (-) swelling
(-) bleeding (-) bleeding
(-) infection (-) infection
(-) white patches (-) white patches
 Gums are pink  Gums are pink
 normal Pharynx and  normal Pharynx and
Tonsillar Fossa Tonsillar Fossa
 Pink and moist oral  Pink and moist oral
mucosa mucosa
 (-) swelling and  (-) swelling and
lesions lesions
 (-) lips are pinkish  (+) lips are pinkish and
and moist moist
 Tongue is pink, moist  Tongue is pink, moist
and at midline and at midline position
position  (-) lesions
 (-) lesions

 Supple  Supple
 (-) vein engorgement  (-) vein engorgement

Neck Inspection  Thyroid: non-palpable  Thyroid: non-palpable

lymph nodes lymph nodes
(-) postauricular (-) postauricular
Palpation (-) occipital (-) occipital
(-) superficial cervical (-) superficial cervical
(-) posterior cervical (-) posterior cervical
(-) tonsilar (-) tonsilar
(-) anterior cervical (-) anterior cervical
(-) supraclavicular (-) supraclavicular
(-) preaucular (-) preaucular
(-) submental (-) submental
(-) submaxillary (-) submaxillary
 (-) masses or lesions  (-) masses or lesions
present present
 Suprasternal Notch:  Suprasternal Notch:
 (-) pulsation  (-) pulsation

Thorax and Inspection  (+) symmetrical  (+) symmetrical

Lungs expansion with expansion with
 respiration respiration

Palpation  (+) Tactile fremitus  (+) Tactile fremitus

Percussion  (+) resonant sound  (+) resonant sound

Auscultation  (+) normal vesicular  (+) normal vesicular

breathing sounds breathing sounds
 (-) added or  (-) added or
adventitious sound adventitious sound
Heart Inspection  (+) not visible PMI  (+) not visible PMI

Palpation  (+) regular rhythm  (+) regular rhythm

 Precordium:  Precordium:
(-) parasternal (-) parasternal
impulse impulse
(-) thrills (-) thrills
 PMI- palpable in 5th  PMI- palpable in 5th
ICS, apical area ICS, apical area

Auscultation  S1- heard best at  S1- heard best at apex,

apex, normal intensity normal intensity
 S2- heard best at  S2- heard best at base,
base,  Extra Sounds- (+) S3,
 Extra Sounds- (+) S3, S4
S4  (-)murmurs
 (-)murmurs
Abdomen Inspection  (+) protuberant  (+) protuberant
 (-) scars, striae  (-) scars, striae
 (+) Ileostomy on  (-) Intact on Right
Right lower Quadrant lower Quadrant
(+) beefy red  Ileostomy should:
(+) moist (+) beefy red
(+) redness around (+) moist
the skin barrier (-) redness around the
skin barrier

Auscultation  (+) pinging sounds

(bowel sounds) 5-10  (+) pinging sounds 5-
secs. 10 secs.
Palpation  (-) bruit  (-) bruit

 Umbilicus  Umbilicus
Facial ring ~2cm Facial ring ~2cm
 (-) hernia (-) hernia
 Right & left Kidney:  Right & left Kidney:
(+) palpable as size as (+) palpable as size as
walnut walnut
Extremities Inspection  Upper extremities:  Upper extremities:

(-) pallor (-) pallor

(+) slightly cyanosis (-) cyanosis
(-) rashes (-) rashes
(+) 3 major creases on (+) 3 major creases on
the palms the palms
(+) pink nails (+) pink nails

Palpation (+) hard masses on the (-) masses

right antecubital area
and carpal region
Palms normal in texture Palms normal in texture
(-) nails are hard and (+) smooth and convex
clubbing
(-) warm to touch (-) warm to touch
(-) slightly moist (-) slightly moist
(+) skin pinch goes back (+) skin pinch goes back
rapidly rapidly
Radial pulse normal and Radial pulse normal and
symmetric symmetric
(+) capillary refill (+) capillary refill

 Lower Extremities
Inspection (bilaterally):
(-) pallor
(-) cyanosis (-) pallor
(-) rashes (-) cyanosis
(-) edema (-) rashes
(+) nails are convex (-) edema
(-) nails cyanosis and (+) nails are convex
Clubbing (-) nails cyanosis and
clubbing
Pulse of Dorsalis pedis
and Posterior tibia was Pulse of Dorsalis pedis
Palpation normal and symmetric and Posterior tibia was
(-) palpable popliteal normal and symmetric
nodes (-) palpable popliteal
(+) capillary refill nodes
within 2 secs. (-) cold (+) capillary refill within
and clammy extremities 2 secs. (-) cold and
 clammy extremities
Genitalia Inspection  Penis:  Penis:
(+) Uncircumcised (+) Uncircumcised
(-) lesions and normal for his age
deformities (-) lesions and
deformities

 Urethral meatus:  Urethral meatus:

(-) discharge (-) discharge
(+) slit like and (+) slit like and
centered at penis tip centered at penis tip

Inspection and  Scrotum & testes :  Scrotum & testes :

palpation (+) normal size for his (+) normal size for his
age age
(+) left testes was (+) left testes was
slightly lower slightly lower than right
than right
 Inguinal area:  Inguinal area:
(-) bulging (-) bulging
(-) palpable Femoral (-) palpable Femoral
Lymph nodes Lymph nodes

XII. Diagnosis

Acute Gastroenteritis with some signs of dehydration