INTRODUCTION

PIA Press Release

2006/03/30
Small amoebiasis outbreak hits pacific towns in Southern Leyte
by R.G. Cadavos
Southern Leyte (30 March) -- An
epidemic due to amoebiasis affected
Pacific towns here since last
Saturday believed to have came from
the source of water they drank.
A 9-month old boy did not arrive
safe or "dead on arrival" in
Anahawan District Hospital because
of vomiting and diarrhea due to
amoebiasis wherein 63 patients from
(6) Pacific towns already came for
treatment since last Saturday, March
25.
Gov. Rosette Lerias personally
visited the patients last March 28 at
the Anahawan District Hospital. Of
the 63 patients served, 55 were left
admitted at the hospital wherein 24
of them were children and 31 adults..
It was reported that some patients
already went home to continue the
treatment there and others who were
hit by the epidemic did not go to the
hospital, they just asked for
medicines and antibiotics for home
medications.
PIA Infocen Manager Erna Sy
Gorne who accompanied the
governor said that Hospital Chief Dr.
Ernesto Cahoy suspected that the primary
cause of the vomiting and loose bowel
movement of these patients was the drinking
water they drank particularly in the
municipality of Anahawan where officials
saw leaks in the intake tank of the reservoir.
As of press time, Anahawan Mayor Jose
Ma. Miñana already ordered to seal the leaks
and the water treatment will immediately
follow.
Gov. Lerias already sent medicines to
the district hospital through Dr. Cahoy, to
treat the ailing patients from Pacific towns.
Medicines sent were as follows: dextrose,
syringes, antibiotics and other medicines
related to the illness.
The lady governor also instructed the
hospital management that all medicines
given to these patients should be free.
As of this writing, Anahawan District
Hospital record showed patients afflicted
with amoebiasis came from whole of Pacific
towns. Silago town had 2 victims; San Juan-
2; St. Bernard-8; Anahawan-40;
Hinundayan-2 and Hinunangan-1. (PIA-
Maasin)

[article from: http://www.pia.gov.ph/?m=12&fi=p060330.htm&no=49]

1
 Here in the Philippines, there are a lot of places that serve delicious food, at a very

low and affordable price, but are located in areas exposed to a wide variety of germs.

Because of this, Amoebiasis is the usually feared illness that would possibly result from

eating foods that are suspected to be ‘dirty.’

Still, Filipinos are prone to ingesting amoebas because they find it convenient to

drink water straight from the faucet. Even good restaurants do this. What is worse is that

some public water fountains already have defective filtering systems.

It is estimated by the World Health Organization that about 70,000 people die due

to Amoebiasis annually worldwide.

For three days, the group has been able to observe and care for a 59 year old man

suffering from amoebiasis. This case presentation will be about that man, whose name

will be known only as “Mr. Mamugz” He has been chosen for a case presentation

because out of all the cases available during the exposure, he was the only one who was

the most entertaining; Thus, he had the greatest potential of sharing the most information.

2
 OBJECTIVES

General Objectives:

To conduct a thorough and comprehensive study about the Mr. Mamugz’s disease

according to the data that was gathered by conducting a series of interviews and through

the use of data gathered from extensive research.

Specific Objectives:

• To organize our patient’s data for the establishment of good background

information

• To show the family health history as well as the history of past and present illness

for the knowledge of what could be the predisposing factors that might contribute

to the patient's illness

• To present the family’s genogram containing information that will help out in

tracing any hereditary risk factors

• To trace the psychological development of our patient through analysis of different

developmental theories with comparison to the patient’s data

• To give different definitions of the complete diagnosis of our patient for better

understanding of unfamiliar terms

• To present the data from the physical assessment performed on our patient using

the cephalocaudal approach for a good overview of his over-all health

• To discuss the human anatomy and physiology of the systems involved in the

disease process of our patient

• To identify the symptoms, predisposing and precipitating factors that contribute to

the present illness of the patient

3
• To organize a flow chart showing the pathophysiology of amoebiasis for a clear

visualization of how this condition affects a person

• To correlate the different orders of the physicians assigned to our patient with their

rationale for a general knowledge of what consists of the medical management for

amoebiasis.

• To present the different results of our patient’s diagnostic exams together with

comparisons of normal values for the understanding of what changes during the

disease

• To study the different drugs used by our patient to have a better understanding of

its actions and indications

• To analyze the different nursing theories applicable to our patient

• To formulate specific, measurable, attainable, realistic and time-bounded nursing

care plans

• To impart appropriate health teachings specifically for the patient to promote

wellness

• To present an appropriate discharge plan for our patient

• To have an over-all conclusion and recommendation about the case study

4
 PATIENT’S DATA

Patient’s Code name: Mr. Mamugz

Age: 59

Sex: Male

Nationality: Filipino

Religion: Seventh Day Adventist

Civil Status: Single

Occupation: Teacher

Ward: Male Ward

Date of Admission: April 27, 2009

Time of Admission: 10:40am

Vital Signs on Admission:

BP – 180/100 mmHg

RR – 20 cpm

Temp - 37.6 C

PR – 80 bpm

Mode of Arrival: Ambulatory

Admitting Doctor: Dr. Claire Miyake

Admitting Nurse: Francis Sison, R.N.

Admitting Clerk: M, Mira, R.M.

Admitting Diagnosis: LBM and Fever

5
 FAMILY BACKGROUND AND HEALTH HISTORY

Mr. Mamugz, a 59 year old male, was born in Davao City, on November 23,

1950. He is currently residing at Agdao, Davao City. They are 9 in the family including

his parents. He is the 5th child among the 7 children. Our patient was completely

immunized since he received the needed immunizations before he reached 1 year old.

Regarding his educational background, he finished high school at Leyte Normal

University. He finished his course, Bachelor of Science - Commerce major in accounting

in University of Mindanao in the year 1978. He then obtained his Certificate for Public

Accountancy or CPA 8 years after graduating college. In 1990, he pursued his Masteral

degree in Public Administration in UP Diliman. After getting his master’s degree, he then

became a Doctor of education in 2005 at University of Mindanao. Finally he was able to

accomplish his first year in Law in his Alma Mater in the year 2008.

Mr. Mamugz has been married for 28 years with his wife. They have 2 offspring.

Their eldest is 27 years old graduate of Bachelor of Science in English Literature and

their youngest is 22 year old graduate of Bachelor of Science major in English Education.

Lifestyle: Daily Schedule

Mr. Mamugz verbalized that being a teacher entails great responsibilities. He

usually wakes up 4am to take bath and change into working clothes. After that he then

goes to Agdao via motorcycle to have his breakfast. Then he goes to teach at University

of Mindanao using his own car. He shared that he always experiences stress from

students.

6
Lifestyle: Vices

Mr. Mamugz verbalized that he smokes and drinks at the same time, but only does

so occasionally (during parties, birthday celebrations, fiesta and others special occasions).

During these celebrations he would be able to consume 5 sticks of cigarette and finish 3

bottles of beer.

Lifestyle: Diet

Mr. Mamugz usually eats three meals a day. They are restricted from eating pork

but they are allowed to eat seafoods except for the one that do not have scales such as

crabs, eel, squids and etc. Mr Mamugz is fond of drinking kamote tap juice from his own

garden. He shares that he had his garden for a long time, however, a house was built next

to it and the new house’s bathroom was built closest to the garden. A canal for the

bathroom was also built near the garden

During times without special occasions, he would have meals that would consist

of the following kamote tap juice mixed with honey, egg, hotdog and bread for breakfast;

kamote tap juice mixed with honey, and vegetable salad for lunch; kamote tap juice and

fried chicken for dinner.

History of Patient's Past Illness

Mr. Mamugz verbalized that he was hospitalized five years ago at Davao Doctors

Hospital due to loose bowel movements and he was also diagnosed with amoebiasis at

that time.

He verbalized that six months ago he also experienced productive cough and self

medicated with carbocistine.

Mr. Mamugz verbalized that when he was 40 years old, he was diagnosed with

7
hypertension by their University Physician. Whenever he gets hypertensive he will

experience pain at the back of his neck

History of Patient's Present Illness

Mr. Mamugz verbalized that he experienced loose bowel movement three times;

at 10pm of April 26, 2009, and at 1am and 4am of April 27, 2009. He took Loperamide,

the “generic” kind, to treat LBM. Eventually he started taking Diatabs instead of the

generic.

On the same day he experienced fever that made him decide to admit himself at

Ricardo Limso Hospital.

Effects of Illness to the Family

During the interview, Mr. Mamugz was asked regarding the effects of his
illness to his family. They are financially stable; they do not have any problems in terms
of money. However he said that his family is greatly affected because he is the
breadwinner of the family. Even if this condition may be considered minor, having the
breadwinner hospitalized is truly a concern for all the members of the family. Aside from
that Mr. Mamugz is also a very important person to the family as he is the father and
husband.

8
GENOGRAM
 DEVELOPMENTAL DATA
Theorist Theory Stage Justification
Lawrence Stages of Moral The post-conventional Mr. Mamugz is already
Kohlberg
Development: level, also known as the in stage six of the post
principled level, consists of conventional level in
The theory holds stages five and six of moral moral development.
that moral development. There is a Evidence of this can be
reasoning, the basis growing realization that found in something as
for ethical behavior, individuals are separate simple as his reaction to
has six entities from society, and food that was given to
identifiable develop that the individual's own him. He definitely
mental stages, each perspective may take knows that food
more adequate at precedence over society's containing oil cannot be
responding to moral view. Because of this for him, yet this is the
dilemmas than its level's "nature of self food that was being
predecessor. Kohlbe before others", the served to him for a total
rg followed the behavior of post- of 3 days already. The
development of conventional individuals, self-before-others kind
moral judgment far especially those at stage 6, of behavior kicks into
beyond the ages can be confused with that his psyche as he knows
studied earlier of those at the pre- that the food served was
by Piaget, who also conventional level. not the kind that the
claimed that logic doctor ordered. So, as
and morality In Stage six (universal the policy of the hospital
develop through ethical principles driven), remains that the food
constructive moral reasoning is based served cannot be
stages. Expanding on abstract reasoning using replaced, he still decides
on Piaget's work, universal ethical principles. to approach the nurse’s
Kohlberg Laws are valid only insofar station and complain
determined that the as they are grounded in about the issue. In this
process of moral justice, and a commitment act, he knows that
development was to justice carries with it an whether he complains or
principally obligation to disobey not, the oily food that
concerned with unjust laws. was served cannot be
justice, and that it changed. However, in
continued his morality, he is driven
throughout the to do something about it
individual's because he feels the
lifetime, a notion injustice that has been
that spawned done to him. The very
dialogue on the act of complaining can
philosophical give justice to his
implications of such situation simply because
research. something was done
about it.
Theorist Theory Stage Justification
Erik Erikson's stages of Middle adulthood (40 to Mr. Mamugz is probably
Erikson psychosocial 60 years) one of the best examples
development as Psychosocial Crisis: of successful
articulated by Erik Generativity vs. Stagnation generativity. First of all,
Erikson explain he has successfully
eight stagers throug Generativity is the concern achieved a doctorate
h which a healthily of establishing and guiding degree in education. He
developing human s the next generation. couldn’t have achieved
hould pass Socially-valued work and this if he didn’t get his
from infancy to late disciplines are expressions master’s degree in public
adulthood. In each of generativity. Simply administration.
stage the person having or Furthermore, this
confronts, and wanting children does not master’s degree could
hopefully masters, in and of itself achieve not exist if he didn’t
new challenges. generativity. have his college degree
Each stage builds Central tasks of Middle in BS-Commerce and
on the successful adulthood [bold tasks being a CPA too. With
completion of indicate accomplished all of these
earlier stages. The tasks by Mr. Mamugz] achievements, Mr.
challenges of stages  Express love Mamugz is able to
not successfully through more achieve even more. His
completed may be than sexual achievements have given
expected to contacts. him such a strong
reappear  Maintain healthy foundation. All the
as problems in life patterns. education that he went
the future.  Develop a sense of through gave him all that
unity with mate. he needed to
 Help growing and successfully achieve this
grown children to stage in psychosocial
 be responsible development. Through
adults. this, he is very much
 Relinquish central ready for the next stage
role in lives of in his life, which is Late
grown children. Adulthood.
 Accept children's
mates and friends.
 Create a
comfortable home.
 Be proud of
accomplishments
of self and
mate/spouse.
 Reverse roles with
aging parents.
 Achieve mature
civic and social
responsibility.
 Adjust to physical
changes of middle
age.
 Use leisure time
creatively.
 Love for others
Theorist Theory Stage Justification
Robert The developmental- (Ages 30-60) [bolded Mr. Mamugz falls into
Havighurst task concept indicates accomplished] this category. He is 59
occupies middle  Assisting teenage years old. Yet regardless
ground between two children to of his age, all of these
opposed theories of become developmental tasks
education: responsible and were accomplished
the theory of happy adults. successfully. Towards
freedom—that the  Achieving adult his two daughters, he
child will develop social and civic was able to be a very
best if left as free as responsibility. good inspiration to their
possible, and  Reaching and success. As an adult, he
the theory of maintaining is able to be all he can be
constraint—that the satisfactory because of all his
child must learn to performance in experience and
become a worthy, one’s occupational knowledge. Even at
responsible adult career. home, he is able to
through restraints  Developing adult spend leisure time by
imposed by his leisure time taking care of his very
society. A activities. own garden. With all of
developmental task  Relating oneself to these tasks
is midway between one’s spouse as a accomplished, Mr.
an individual need person. Mamugz is well and
and societal  To accept and ready for the next stage
demand. It assumes adjust to the in his life when he
an active learner physiological becomes 60 and over.
interacting with an changes of middle
active social age.
environment  Adjusting to aging
parents.
 DEFINITION OF COMPLETE DIAGNOSIS

Amoebiasis

-protozoal infection of human beings initially involves the colon, but may spread
to soft tissues, most commonly to the liver or lungs, by contiguity or hematogenous or
lymphatic dissemination.

www.nursingcrib.com

-(also known as spelt amebiasis) is an infection caused by the parasite entamoeba

histolytica. It is usually contracted by ingesting water or food contaminated with amoebic
cysts.

http://www.health-disease.org/skin-disorders/amoebiasis.htm

-Amoebias is an inflammation of the intestines caused by a parasite, Entamoeba

histolytica. This microscopic parasite enters the body through contaminated food or
water. The infection is common in areas with poor sanitation or living conditions. This
parasite can live in the intestine without causing symptoms, or it can produce severe
symptoms. It is a very common problem in India.

http://www.doctorndtv.com/topicsh/Amoebiasis.asp
 PHYSICAL ASSESSMENT

Date of Assessment: April 27, 2009 @ 4pm

Patient’s Name: Mr. Mamugz

Age: 59 years old

Sex: Male

Ward: DMC - Med CP

GENERAL SURVEY
Mr. Mamugz was received sitting up on bed awake, conscious and coherent. He
had an ongoing IVF of PNSS 1 liter at 30gtts/min infusing well at his right metacarpal
vein; noted at 680cc level. He weighs 72 kgs and has a height of 5’6”. He has an
endomorphic body structure. Calculation of his BMI reveals that he is overweight
(25.62kg/m2).

VITAL SIGNS
4:00 pm
BP - 150/80 mmHg
PR - 98 bpm
RR - 20 cpm
Temp. – 38.8 ۫ C

VERBALIZATIONS

“Naa pa ba ko’y tambal nga pain reliever? Sakit man gud ang akuang likod.” [pain scale:
6]

“Murag lima ka beses na ko naka libang kaganinang buntag.”

“Dili gahi ang akuang tae… Daghan pud ug tubig.”

“Dili kaayo ko makatulog kay pirminti lang ko momata para maglibang bisan kadlawon
pa na.”

HEAD

Mr. Mamugz’s head is normocephalic. Some hair strands are already grayish in
color, but he still has black strands of hair. All hair strands are equally distributed
throughout his scalp. Lesions, bleeding and bruises were not seen upon inspection.

EYES

Mr. Mamugz’s eyes are symmetrical. The cornea is white and adequately moist.
Both his irises are colored dark brown. His pupils are equally round and reactive to light
and accommodation with a papillary size of 3mm. He verbalizes that he never needed the
use of glasses. His eyebrows were thick and eyelashes were evenly distributed along the
margins of the eyelids. Both eyes move in unison. No signs of redness, jaundice, or
discharges were noted on both eyes. [Due to the lack of a Snellen Chart, an alternative
method to determine visual acuity was used] Mr. Mamugz was able to read a news paper
up close without the aid of eyeglasses. On the other hand, he was able to identify three
different ballpen colors of a student nurse who was standing approximately 7 meters
away only with the aid of eyeglasses; this reveals that Mr. Mamugz has near-sightedness.

EARS

The shapes of Mr. Mamugz’s auricles were symmetrical. No discharges were

noted around and within each external acoustic meatus. Tenderness was not experienced
by Mr. Mamugz when his ears were palpated. There were no lesions, wounds or
discoloration noted upon inspection.

To determine his level of hearing, he was made to sit on his bed and have a
student nurse whisper a phrase behind his head. He was then instructed to repeat this
phrase. He was able to do so in his first try. This reveals that Mr. Mamugz has an
adequate level of hearing.
NOSE

Mr. Mamugz’s nose was symmetrical. Both nostrils were patent and had no
discharges. No nasal flaring was noted. His nasal septum was not deviated from the
midline of his face. Short nasal hairs were present upon inspection. In determining
olfaction, Mr. Mamugz was instructed to be blind folded. Different scents were then
placed under his nose and he was instructed to identify the smells as each scent is tested.
He was able to identify the smell of alcohol, feminine perfume, and food.

MOUTH

Mr. Mamugz’s lips were adequately moist. Generally, his teeth had a yellow color.
His gums and buccal mucosa are pinkish in color. His tongue is moist and is not deviated
from the midline of the mouth. He was able to speak well and was understood well by
every person who interacted with him. His tonsils and uvula show no sign of
inflammation. No bleeding was seen upon inspection. No nausea or vomiting noted.

NECK

Mr. Mamugz did not complain of any pain on his neck. He was also able to tilt,
rotate, flex and extend his neck without any difficulty. Both carotid pulses were palpable
with normal pulse rhythm. There were no lymph nodes that were observed to be swelling
or enlarged. The trachea was in midline. The thyroid gland was not observed to be
enlarged or inflamed.

CHEST AND LUNGS

Expansion and relaxation of Mr. Mamugz’s chest wall was symmetrical and in
unison during respiration. He did not complain of any dyspnea or distress in breathing.
Upon auscultation, his lung fields were clear. He complained of having pain in his back
whenever he coughs.

ABDOMEN

Mr. Mamugz’s abdomen was flabby, globular and non-distended. He had

hyperactive bowel sounds. 21 bowel sounds were counted within one full minute. He
refused to give permission for the student nurse to perform deep palpation on his
abdomen because he knows that he will experience pain. However, he verbalized that he
had experienced 5 episodes of loose bowel movement in the morning before the
assessment.

BACK

Mr. Mamugz’s back was observed to be moist with his sweat. Upon inspection,
his back does not have any lesions, deformities, or signs of altered skin integrity. Light
palpation along Mr. Mamugz’s spine reveals that he does not have scoliosis. During
repositioning, he complains about pain in his lower back, which radiates to his buttocks
until the upper parts of the posterior and lateral areas of his thighs.

GENITO-URINARY

Mr. Mamugz refused to have his genital area assessed. However, he did not
complain of any pain or discomfort in the area. He also verbalized that he did not have
any problems in urinating. His average urine output within 8 hours was 800cc.

UPPER EXTREMITIES

Mr. Mamugz was able to have an adequate range of motion without any pain or
weakness. The grip power of both his hands was strong. His long nails weren’t trimmed
and had presence of dirt under them. His palms were observed to be calloused upon
palpation. Skin pinching reveals that he has good skin turgor. There were no wounds,
deformities and swelling noted on both his arms.

LOWER EXTREMITIES

Mr. Mamugz did not have any complaints regarding walking in general. However,
he did explain that he easily gets tired due to his heavy weight. Still, he was able to
demonstrate strong range of motion and was able to resist the downward force of a
student nurse’s hand towards his knees.
 ANATOMY AND PHYSIOLOGY

Gastrointestinal Tract
[image from: http://www.lessonsonthelake.com/_images//j0438737.jpg]

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral
cavity, where food enters the mouth, continuing through the pharynx, oesophagus, stomach and
intestines to the rectum and anus, where food is expelled. There are various accessory organs that
assist the tract by secreting enzymes to help break down food into its component nutrients. Thus
the salivary glands, liver, pancreas and gall bladder have important functions in the digestive
system. Food is propelled along the length of the GIT by peristaltic movements of the muscular
walls.

The primary purpose of the gastrointestinal tract is to break down food into nutrients,
which can be absorbed into the body to provide energy. First food must be ingested into the
mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the
stomach and small intestine where proteins, fats and carbohydrates are chemically broken down
into their basic building blocks. Smaller molecules are then absorbed across the epithelium of the
small intestine and subsequently enter the circulation. The large intestine plays a key role in
reabsorbing excess water. Finally, undigested material and secreted waste products are excreted
from the body via defecation (passing of faeces).
 Cross-section of the small intestine
[image from: http://z.about.com/d/coloncancer/1/0/Y/3/Overview.png]

The digestive tract, from the esophagus to the anus, is characterized by a wall with four
layers, or tunics. Here are the layers, from the inside of the tract to the outside:

• The mucosa is a mucous membrane that lines the inside of the digestive tract from mouth
to anus. Depending upon the section of the digestive tract, it protects the GI tract wall,
secretes substances, and absorbs the end products of digestion. It is composed of three
layers:
o The epithelium is the innermost layer of the mucosa. It is composed of simple
columnar epithelium or stratified squamous epithelium. Also present are goblet
cells that secrete mucus that protects the epithelium from digestion and endocrine
cells that secrete hormones into the blood.
o The lamina propria lies outside the epithelium. It is composed of areolar
connective tissue. Blood vessels and lymphatic vessels present in this layer
provide nutrients to the epithelial layer, distribute hormones produced in the
 epithelium, and absorb end products of digestion from the lumen. The lamina
propria also contains the mucosa-associated lymphoid tissue (MALT), nodules of
lymphatic tissue bearing lymphocytes and macrophages that protect the GI tract
wall from bacteria and other pathogens that may be mixed with food.
o The muscularis mucosae, the outer layer of the mucosa, is a thin layer of smooth
muscle responsible for generating local movements. In the stomach and small
intestine, the smooth muscle generates folds that increase the absorptive surface
area of the mucosa.
• The submucosa lies outside the mucosa. It consists of areolar connective tissue
containing blood vessels, lymphatic vessels, and nerve fibers.
• The muscularis (muscularis externa) is a layer of muscle. In the mouth and pharynx, it
consists of skeletal muscle that aids in swallowing. In the rest of the GI tract, it consists
of smooth muscle (three layers in the stomach, two layers in the small and large
intestines) and associated nerve fibers. The smooth muscle is responsible for movement
of food by peristalsis and mechanical digestion by segmentation. In some regions, the
circular layer of smooth muscle enlarges to form sphincters, circular muscles that control
the opening and closing of the lumen (such as between the stomach and small intestine).
• The serosa is a serous membrane that lines the outside of an organ. The following serosae
are associated with the digestive tract:
o The adventitia is the serous membrane that lines the esophagus.
o The visceral peritoneum is the serous membrane that lines the stomach, large
intestine, and small intestine.
o The mesentery is an extension of the visceral peritoneum that attaches the small
intestine to the rear abdominal wall.
o The mesocolon is an extension of the visceral peritoneum that attaches the large
intestine to the rear of the abdominal wall.
o The parietal peritoneum lines the abdominopelvic cavity (abdominal and pelvic
cavities). The abdominal cavity contains the stomach, small intestine, large
intestine, liver, spleen, and pancreas. The pelvic cavity contains the urinary
bladder, rectum, and internal reproductive organs.
Motility

The gastrointestinal tract generates motility using smooth muscle subunits linked by gap
junctions. These subunits fire spontaneously in either a tonic or a phasic fashion. Tonic
contractions are those contractions that are maintained from several minutes up to hours at a time.
These occur in the sphincters of the tract, as well as in the anterior stomach. The other type of
contractions, called phasic contractions, consist of brief periods of both relaxation and
contraction, occurring in the posterior stomach and the small intestine, and are carried out by the
muscularis externa.

Stimulation

The stimulation for these contractions likely originates in modified smooth muscle cells called
interstitial cells of Cajal. These cells cause spontaneous cycles of slow wave potentials that can
cause action potentials in smooth muscle cells. They are associated with the contractile smooth
muscle via gap junctions. These slow wave potentials must reach a threshold level for the action
potential to occur, whereupon Ca2+ channels on the smooth muscle open and an action potential
occurs. As the contraction is graded based upon how much Ca2+ enters the cell, the longer the
duration of slow wave, the more action potentials occur. This in turn results in greater contraction
force from the smooth muscle. Both amplitude and duration of the slow waves can be modified
based upon the presence of neurotransmitters, hormones or other paracrine signaling. The number
of slow wave potentials per minute varies based upon the location in the digestive tract. This
number ranges from 3 waves/min in the stomach to 12 waves/min in the intestines.

Contraction Patterns

The patterns of gastrointestinal contraction as a whole can be divided into two distinct patterns,
peristalsis and segmentation. Occurring between meals, the migrating motor complex is a series
of peristaltic wave’s cycles in distinct phases starting with relaxation followed by an increasing
level of activity to a peak level of peristaltic activity lasting for 5-15 minutes. This cycle repeats
ever 1.5-2 hours but is interrupted by food ingestion. The role of this process is likely to clean
excess bacteria and food from the digestive system.

Peristalsis

Peristalsis is the second of the three patterns and is one of the patterns that occur during and
shortly after a meal. The contractions occur in wave patterns traveling down short lengths of the
GI tract from one section to the next. The contractions occur directly behind the bolus of food
that is in the system, forcing it toward the anus into the next relaxed section of smooth muscle.
This relaxed section then contracts, generating smooth forward movement of the bolus at between
2-25 cm per second. This contraction pattern depends upon hormones, paracrine signals, and the
autonomic nervous system for proper regulation.

Segmentation

The third contraction pattern is segmentation, which also occurs during and shortly after a meal
within short lengths in segmented or random patterns along the intestine. This process is carried
out by longitudinal muscles relaxing while circular muscles contract at alternating sections
thereby mixing the food. This mixing allows food and digestive enzymes to maintain a uniform
composition, as well as to ensure contact with the epithelium for proper absorption.

Secretion

Every day, seven liters of fluid are secreted by the digestive system. This fluid is composed of
four primary components: ions, digestive enzymes, mucus, and bile. About half of these fluids are
secreted by the salivary glands, pancreas, and liver, which compose the accessory organs and
glands of the digestive system. The rest of the fluid is secreted by the GI epithelial cells.

Ions

The largest component of secreted fluids is ions and water, which are first secreted and then
reabsorbed along the tract. The ions secreted primarily consist of H+, K+, Cl-, HCO3- and Na+.
Water follows the movement of these ions. The GI tract accomplishes this ion pumping using a
system of proteins that are capable of active transport, facilitated diffusion and open channel ion
movement. The arrangement of these proteins on the apical and basolateral sides of the
epithelium determines the net movement of ions and water in the tract.

H+ and Cl- are secreted by the parietal cells into the lumen of the stomach creating acidic
conditions with a low pH of 1. H+ is pumped into the stomach by exchanging it with K+. This
process also requires ATP as a source of energy; however, Cl- then follows the positive charge in
the H+ through an open apical channel protein.

HCO3- secretion occurs to neutralize the acid secretions that make their way into the duodenum
of the small intestine. Most of the HCO3- comes from pancreatic acinar cells in the form of
NaHCO3 in a watery solution. This is the result of the high concentration of both HCO3- and
Na+ present in the duct creating an osmotic gradient to which the water follows.

Digestive Enzymes

The second vital secretion of the GI tract is that of digestive enzymes that are secreted in the
mouth, stomach and intestines. Some of these enzymes are secreted by accessory digestive
organs, while others are secreted by the epithelial cells of the stomach and intestine. While some
of these enzymes remain embedded in the wall of the GI tract, others are secreted in an inactive
proenzyme form. When these proenzymes reach the lumen of the tract, a factor specific to a
particular proenzyme will activate it. A prime example of this is pepsin, which is secreted in the
stomach by chief cells. Pepsin in its secreted form is inactive (pepsinogen). However, once it
reaches the gastic lumen it becomes activated into pepsin by the high H+ concentration,
becoming a enzyme vital to digestion. The release of the enzymes is regulated by neural,
hormonal, or paracrine signals. However, in general, parasympathtic stimulation increases
secretion of all digestive enzmes.

Mucus

Mucus is released in the stomach and intestine, and serves to lubricate and protect the inner
mucosa of the tract. It is composed of a specific family of glycoproteins termed mucins and is
generally very viscous. Mucus is made by two types of specialized cells termed mucus cells in the
stomach and goblet cells in the intestines. Signals for increased mucus release include
parasympathetic innervations, immune system response and enteric nervous system messengers.

Bile
Bile is secreted into the duodenum of the small intestine via the common bile duct. It is produced
in liver cells and stored in the gall bladder until release during a meal. Bile is formed of three
elements: bile salts, bilirubin and cholesterol. Bilirubin is a waste product of the breakdown of
hemoglobin. The cholesterol present is secreted with the feces. The bile salt component is an
active non-enzymatic substance that facilitates fat absorption by helping it to form an emulsion
with water due to its amphoteric nature. These salts are formed in the hepatocytes from bile acids
combined with an amino acid. Other compounds such as the waste products of drug degradation
are also present in the bile.

Regulation

The digestive system has a complex system of motility and secretion regulation which is vital for
proper function. This task is accomplished via a system of long reflexes from the central nervous
system (CNS), short reflexes from the enteric nervous system (ENS) and reflexes from GI
peptides working in harmony with each other.
 ETIOLOGY

Predisposing Factors

Factor Present of Absent Justification

Mr. Mamugz has lived in the Philippines

his whole life. Philippines is a tropical
Tropical Area Present
area. Tropical areas give amoeba a good
climate to proliferate.
Third World Poor sanitary conditions increase the
Present
Country chances of making contact to amoeba.

Precipitating Factors

Factor Present of Absent Justification

Mr. Mamugz verbalized that he had a

Using vegetables
garden growing near a canal and he
growing near a canal Present
uses the vegetables in this garden to
as food.
use food.
 SYMPTOMATOLOGY

Symptom Present of Absent Justification

This was evident in during Mr.

Fever Present Mamugz’s physical assessment. This
was also his chief complaint.

Another one of Mr. Mamugz’s chief

LBM + blood streaked stools Present complaint. His verbalization during
physical assessment also confirms this.

Liver Abscess Absent Not found in Diagnostic Exams

Brain Abscess Absent Not found in Diagnostic Exams

Pleural Effusion Absent Not found in Diagnostic Exams

 Precipitating Factors
Predisposing Factors
Using vegetables
Tropical Area ingestion of growing near a canal as
bacteria food.
Third world country
amoeba (trophozoite) survives
passing through the stomach and
small intestine

trophozoite undergoes
excystation

production of more
trophozoites

trophozoites migrate to
large intestine

trophozoites reproduce by
undergoing schizomy

trophozoites become
schizont as it increases in
size while its nucleus and
other organelles divide

schizont splits and forms two

merozoites

merozoites develop into

individual trophozoites

trophozoites undergo
encystation

trophozoites become
immature cysts

immature cysts secrete enzymes

that breakdown cell membranes
and proteins
penetration and digestion of malabsorption of chyme
mucosal lining components

entrance of trophozoites into collection of watery

vascular system fecal matter in rectum

fever LBM

Diagnostic
CBC
Tests
CXR

fecalysis

UA

SGPT

lipid profile

blood chemistry

ECG

FBS
Diagnosis: Amoebiasis

Medical Nursing Management

Surgical
Management
Management
increase OFI
antiprotozoal
complete bed rest
antibiotic
(none)
low salt low fat diet
antipyretic
nonfibrous food

PO med compliance
 Prognosis
>good compliance of
>poor compliance of
medications
medications
>cooperation during
>no cooperation during
nursing management
nursing management
>adequate financial
>inadequate financial
support
support

extra intestinal
Good Prognosis
diseases

liver brain
pleural
effusion absces absces
s s

Poor Prognosis

DEATH
 DOCTOR'S ORDER

DATE DOCTOR'S ORDER RATIONALE REMARKS

April 27, Pls. admit under the service of Dr. The patient is in need of DONE
2009 E. Durban (HC) medical attention so he is
admitted at Limso
Hospital

Low salt and low fat diet To indicate specific diet DONE
for patient

Monitor VS Vital signs are recorded to DONE

obtain patients baseline
data and are useful for
further management. A
temperature higher than
normal may indicate the
development of infection.
Pulse & respiration is
taken to watch out for
tachycardia - a sign of
hemorrhage &
dehydration.

Labs: These entire lab tests are DONE

CBC, Urinalysis, CXR, Lipid
Profile, Crea, SGPT, Uric acid,
SE, Serum Na+, K+, ECG, FBS
(c/o watcher)
performed to screen for
alteration and to serve as a
baseline data for future
comparison.
Start venoclysis with PNSS 1L at Serves as a route for IVTT DONE
120cc/o medications and replaces
fluid and electrolyte losses
due to frequent loose
bowel movement

Meds: DONE

1. Paracetamol (Alvedon) 500mg - Antipyretic, nonopiod

1 tab TID analgesic; Indicated for
fever.

- Bronchodilator;
2. Salbutamol + Guaifenesin Indicated for Productive
(Ventolin) 1 tab BID Cough?

3. Celecoxib 200mg 1 tab OD - NSAID; Management of

acute pain.

Monitor I & O every shift To determine if the DONE

patient’s intake is closely
equal to his output

Hydration rounds every 6 hours Monitor the intake and DONE

output of the patient with
an additional task of
instructing them to replace
the loss fluids with exactly
the same amount of water
by ,means of drinking

Refer for any unusualities Referral is done to correct DONE

unusualities as soon as
possible and to inform the
 attending physician of the
patient's condition.

1:40 pm - Stool Exam ASAP <3 To analyze the condition DONE

specimen of a person's digestive
tract in general

- Losartan 100mg 1 tab - Antihypertensive;

now then OD Management for
hypertension.

- Incorporate 30 meqs - To return Potassium

KCL with present IVF and levels to normal
run @ 120cc/o

04/28/09 IVF to follow with PNSS 1L + - PNSS is an isotonic DONE

KCL 30 meqs to run @ 120 cc/o
solution. This is to
provide the patient with
essential electrolytes and
nutrients in the body. It
will also maintain an
access to the circulating
system for the intermittent
administration of
scheduled medications.

6:30 pm - Start Metronidazole 500mg 1 tab - Anti-infectives; DONE

TID PO indicated to
intraabdominal infection,
management of amoebic
dysentery.
- IV to follow: PLR 1L @ 120cc/o
- Is an isotonic with blood
and intended for
intravenous
administration.

1pm Xenoflox 500mg 1 tab now then 1 Anti-infevtives; Indicated DONE

tab every 12 (7-7) for infectious diarrhea and
intra-abdominal
infections.
04/28/09 150/100 x 2 takes captopril 25mg - To increase the DONE
1 tab for sublingual effectiveness of the drug
9:40pm (anthypertensive)

04/29/09 SE with occult blood - To detect blood in the DONE

feces. Occult blood
10:45 am usually indicates
gastrointestinal bleeding.

6:40pm IVF to follow: PLR @120 cc/o - Plain Lactated Ringer’s DONE
Solution (PLR) is an
isotonic solution which is
commonly used to replace
fluid loss resulting from
bleeding, and dehydration
for diarrhea. It will also
maintain an access to the
circulating system for the
intermittent administration
of scheduled medications.

7pm Discontinue Ciprofloxacin shift to -Anti-infectives; DONE

Tetracycline 250mg 2 caps BID Prevention of
after meals exacerbations of
bronchitis.

04/29/09 IVF to follow with PLR 1L @ - Plain Lactated Ringer’s DONE

120cc/o Solution (PLR) is an
isotonic solution which is
commonly used to replace
fluid loss resulting from
bleeding, and dehydration
for diarrhea. It will also
maintain an access to the
circulating system for the
intermittent administration
of scheduled medications.

04/30/09 - Rounds with Dr. Durban - For follow-up DONE

assessment and
2:30pm evaluation.

04/30/0
9
7:30pm
180/10 Captopril 25mg now -Antihypertensive; DONE
indicated for treatment of
0
hypertension
↓
160/10
0
 DIANOSTIC EXAMS

HEMATOLOGY

Date: April 27, 2009

Parameter Results Units Lower limits Upper limits

Hemoglobin 177 g/L 135 180

- To identify the amount of oxygen

carrying protein contained within the
RBC.

Hematocrit 0.49 0.40 0.54

-to identify the percentage of the blood

volume occupied by red blood cells.

-decreased HCT indicates blood loss,

anemia, blood replacement therapy,
and fluid balance, and screens red
blood cells status

RBC 5.92 10ˆ 12/L 5.5 6.5

-to know the amount of RBC in the

blood.

-a decreased count may indicate

anemia, fluid overload, or severe
bleeding

WBC 10.34 10 ˆ 9/L 5 10

-to determine infection or
inflammation in the body and monitor
its responses to specific therapies.

-a leukocyte count is elevated in

infectious diseases of the heart (e.g.,
acute bacterial endocarditis)

-increases because large number of

white cells are necessary to dispose of
the necrotic tissue resulting from the
infarction.

Neutrophil 0.90 0.55 0.65

-active phagocytes; number increases

rapidly during short-term or acute
infections.

- increases in localized tissue death

(ischemia) due to heart attack, burns,
carcinoma.
Lymphocyte 0.05 0.25 0.35

-part of immune system; one group (B

lymphocytes) produces antibodies;
other group (T lymphocytes) involved
in graft rejection, fighting tumors and
viruses, and activating B lymphocytes

- decreased by severe debilitating

illness such as heart failure, renal
failure, and advanced TB

Monocyte 0.05 0.03 0.06

-active phagocytes that become
macrophages in the tissues; long-term
“clean-up team”

-an increase may respond to

corticosteroid, with pus conditions,
hemorrhage.
Eosinophil 0.00 0.02 0.04

-kills parasitic worms; might

pathocyte antigen-antibody complexes
and inactive inflammatory chemicals.
Basophil 0.00 0 0.01

- granules contain histamine

(vasodilator chemical), which is
discharged at sites of inflammation

Platelet count 261 150 350

-is the number of platelets in a given

volume of blood.

-responsible for beginning the process

of coagulation, or forming a clot,
whenever a blood vessel is broken

-both increase and decrease can point

to abnormal conditions of excess
bleeding or clotting.
 URINALYSIS

Date: April 27, 2009 2:17 pm

Macroscopic
Physical: Chemical:
Color: Dark Yellow specific Gravity: 1.030 Albumin: Trace
Appearance: cloudy Reaction (pH): acidic (6.0) Sugar: negative
Microscopic
Cells:
Pus cells: 2-3/Hpf
Erythrocytes/RBC: 0-2/Hpf

FECALYSIS

Date: April 27, 2009 @ 2:02 pm

Macroscopic
Physical:
Color: Yellow
Consistency: Loose
Microscopic
Cells:
Pus cells: 0-1/Hpf
Erythrocytes/RBC: 0-1/Hpf
Yeast Cells: + (1 plus)

FECALYSIS

Date: April 27, 2009 @ 6:34 pm

Macroscopic
Physical:
Color: Light Brown
Consistency: Loose
Microscopic
Cells:
Pus cells: 0-5/Hpf
Erythrocytes/RBC: 0-3/Hpf
Yeast Cells: + (1 plus)

FECALYSIS
Date: April 27, 2009 @ 10:49 pm

Macroscopic
Physical:
Color: Bloody
Consistency: Watery
Microscopic
Cells:
Pus cells: 0-1/Hpf
Erythrocytes/RBC: 0-3/Hpf
Yeast Cells: ++ (2 plus)

FECALYSIS

Date: April 28, 2009 @ 6:09 am

Macroscopic
Physical:
Color: Brown
Consistency: Watery
Microscopic
Cells:
Entamoeba Cyst: 0-1 (E.coli) /Hpf
Pus cells: 0-4/Hpf
Yeast Cells: few

FECALYSISDate: April 29, 2009 @ 4:21 pm

Macroscopic
Physical: Chemical:
Color: Greenish Occult Blood: (-) negative
Consistency: Loose
Microscopic
Cells:
Entamoeba Cyst: 0-1/Hpf
Entamoeba Trophozoite: 0-1/Hpf
Pus Cells: 0-1/Hpf
Erythrocyte/RBC: 0-3/Hpf
Yeast Cells: few

CLINICAL CHEMISTRY
Date: April 27, 2009 @ 12:57 pm

Result Ref. range

Test
K+, substc 3.14 3,5-5,3
Na+, substc 137.5 135-148
SGPT, activity C 39.26 M: 0-41
Crea, substc 77,72 M: <50 y.o.: less than
115

>50 y.o.: less than 124

Date: April 28, 2009 @ 11:30 am

Test Result Ref. range SI units

Urate, substc 0, 23 M: 0, 21 – 0, 42 mmol/L
Cholesterol 4, 32 Up to 5,2 mmol/L
Triglycerides 0, 79 Up to 1,7 mmol/L
HDL 0, 84 More than 0, 91 mmol/L
LDL 3,12 Less than 3,5 mmol/L
NameGeneric

Brand Name

Dosage
Classific-
Mode of Indication Contraindication Side Drug Nursing Responsibilities

ation
Action effects/ Interaction
Adverse
reactions

m F Anti- Disrupts Amebecide Hypersensitivity. 500 CNS: Cimetidine Adiminister on empty stomach or may
e l infectiv DNA in the Use cautiously in: mg 1 Seizures, may decrease administer with food or milk to minimize
t a es, and management history in blood tab, dizziness metabolism of GI irritation.
r g antiprot protein of amebic dyscrasias, TID , metronidazole. - Instruct patient to take medication
o y ozoals, synthesis dysentery, History of headache Phenobarbital exactly as directed with evenly spaced
n l antiulce susceptib amebic liver seizures or . and rifampin times between doses, even if feeling better.
i r agents le abscess and neurologic EENT: increases - Advised patient to not skip doses or
d organism trichomonias problems and Tearing metabolism double up on missed doses.
a s. is: treatment severe hepatic (topical and may - Inform patient that medication can cause
z Therape of peptic impairement. only). decrease metallic taste.
o utic ulcer disease GI: effectiveness. - Advise patient that frequent mouth
l effects: caused by Abdomi Metronidazole rinses, good oral hygiene and sugarless
e Bacterici Helicobacter nal pain, increases the gum or candy may minimize dry mouth.
dal, pylori. anorexia, effects of - Inform patient that medication may cause
trichomo nausea, phenytoin, urine to turn dark.
nacidal diarrhea, lithium, and - Advise patient to consult health care
or dry warfarin. professional if no improvement in a few
amebicid mouth, Disulfiram- days or if signs and symptoms of
al action. furry like reaction superinfection (black furry overgrowth on
Spectru tongue, may occur tongue or foul-smelling stools) develop
m: Most glossitis, with alcohol
notable unpleasa ingestion. May
for nt taste cause acute
avtivity and psychosis and
against vomiting confusion with
anaerobi . disulfiram.
c Hemat: Increased risk
bacteria Leukope of leucopenia
includin nia with
g: Neuro: fluorourousel
Bacteroi Peripher or
des, al azathioprine.
clostridi neuropat
um. In hy
addition
is active
against:
Trichom
onas
vaginalis
,
entamoe
ba
histolytic
a, giardia
lamdia,
H. pylori
and
clostridi
um
difficile.
 Mode of Indication Contraindica Side effects/ Drug Nursing Responsibilities
NameGeneric

Brand Name

Classific-

Dosage
ation
Action tion Adverse Interaction
reactions

c C a Bacteri Complicate Ciprofloxacin50 Cardiovascula When - Advise to contact healthcare

i i n cidal d Intra- hydrochlorid 0mr: palpitation, Ciprofloxac provider if they experience pain,
p p t drugs, Abdominal e is g 1 atrial flutter, in tablets swelling, or inflammation of a
r r i meanin Infections contraindica ta ventricular are given tendon, or weakness; discontinue
o o b g that (used in ted in b, ectopy, concomita Ciprofloxacin treatment.
f i they kill combinatio persons with ev syncope, ntly with - Advise patient that antibacterial
l o bacteri n with a history of eryhypertension, food, there drugs including Ciprofloxacin tablets
o t a. metronidaz hypersensiti 12 angina is a delay should only be used to treat bacterial
x i These ole) vity to ho pectoris, in the infections. They do not treat viral
a c antibiot caused by Ciprofloxacinurs myocardial absorption infections (e.g., the common cold). –
c ic drugs Escherichia, any infarction, of the Tell patient not to skip or or
i inhibit coli, member of cardiopulmon drug, discontinue even if feeling better.
n the Pseudomo the ary arrest, resulting in - Ciprofloxacin may be taken with or
bacteri nas quinolone cerebral peak without meals and to drink fluids
al DNA aeruginosa class of thrombosis, concentrati liberally. As with other quinolones,
gyrase , Proteus antimicrobia phlebitis, ons that concurrent administration of
enzyme mirabilis, l agents, or tachycardia, occur Ciprofloxacin with
which is Klebsiella any of the migraine, closer to 2 magnesium/aluminum antacids, or
necessa pneumonia product hypotension hours after sucralfate, didanosine
ry for e, or components. - Central dosing chewable/buffered tablets or
DNA Bacteroide Body as a Nervous rather than pediatric powder, other highly
replicati s fragilis. Whole: System: 1 hour. buffered drugs or with other
on. Infectious headache, restlessness, The overall products containing calcium, iron or -
Since a Diarrhea abdominal dizziness, absorption Tell that Ciprofloxacin may be
copy of caused by pain/discomf lightheadedne of associated with hypersensitivity
DNA Escherichiaort, foot ss, insomnia, Ciprofloxac reactions, even following a single
must becoli pain, pain, nightmares, in tablets, dose, and to discontinue the drug at
made (enterotoxi pain in hallucinations, however, the first sign of a skin rash or other
each genic extremities, manic is not allergic reaction.
time a strains), injection site reaction, substantial - Instruct patient that peripheral
cell Campyloba reaction irritability, ly affected. neuropathies have been associated
divides, cter jejuni, (Ciprofloxaci tremor, Concurrent with Ciprofloxacin use. If symptoms
interferi Shigella n ataxia, administra of peripheral neuropathy including
ng with boydii 1, intravenous) convulsive tion of pain, burning, tingling, numbness
replicati Shigella seizures, antacids and/or weakness develop, they
on dysenteria lethargy, containing should discontinue treatment and
makes e, Shigella drowsiness, magnesiu contact their physicians.
it flexneri or weakness, m - Advise patient that Ciprofloxacin
difficult Shigella malaise, hydroxide may cause dizziness and
for sonnei1 anorexia, or lightheadedness; therefore, patients
bacteri when phobia, aluminum should know how they react to this
a to antibacteri depersonaliza hydroxide drug before engaging in activities
multiply al therapy tion, may requiring mental alertness or
. is depression, reduce the coordination.
indicated. paresthesia, bioavailabil - Tell patient that convulsions have
abnormal gait, ity of been reported in patients receiving
grand mal Ciprofloxac Ciprofloxacin.
convulsion in by as
- much as
Gastrointestin 90%.Patien
al: painful oral ts should
mucosa, oral be
candidiasis, advised:
dysphagia,
intestinal
perforation,
gastrointestin
al bleeding,
cholestatic
jaundice,
hepatitis

Metabolic/Nutr
itional:
amylase
increase,
lipase
increase
-
Skin/Hypersen
sitivity:
allergic
reaction,
pruritus,
urticaria,
photosensitivi
ty/phototoxicit
y reaction,
flushing,
fever, chills,
angioedema,
edema of the
face, neck,
lips,
conjunctivae
or hands,
cutaneous
candidiasis,
hyperpigment
ation,
erythema
nodosum,
sweating
Generic Name

Brand Name

Dosage
Classific-ation

tionIndica-
Mode of Contraindication Side effects/ Drug Nursing Responsibilities
Action Adverse Interaction
reactions

c C A Captopril is an Hype Contraindicated in 25 - Renal: About - Agents

a a n ACE inhibitor rtensi patients who are mg 1 one of 100 Having - Patients should be advised to
p p t which on: hypersensitive to tab patients Vasodilator immediately report any signs or
t o i prevents the capto this product or developed Activity: symptoms suggesting angioedema (e.g.,
o t h conversion of pril any other proteinuria Data on the swelling of face, eyes, lips, tongue,
p e y Ang.I to tablet angiotensin- - Hematologic: effect of larynx and extremities; difficulty in
r n p Ang.II s, converting Neutropenia/agr concomitant swallowing or breathing; hoarseness)
i e resulting in USP enzyme inhibitor anulocytosis has use of other and to discontinue therapy
l r peripheral is (e.g., a patient occurred. Cases vasodilators - Patients should be told to report
t vasodilatation indic who has of anemia, in patients promptly any indication of infection
e and reducing ated experienced thrombocytopen receiving (e.g., sore throat, fever), which may be a
n peripheral for angioedema ia, and CAPOTEN; sign of neutropenia, or of progressive
s resistance and the during therapy pancytopenia nitroglycerin edema which might be related to
i after load and treat with any other have been or other proteinuria and nephrotic syndrome
v the reduction ment ACE inhibitor). reported. nitrates (as - Patient should be cautioned that
e of aldosterone of - Dermatologic: used for excessive perspiration and dehydration
secretion hype Rash, often with management may lead to an excessive fall in blood
promoting rtensi pruritus, and ofangina) or pressure because of reduction in fluid
sodium on. sometimes with other drugs volume. Other causes of volume
excretion and fever, arthralgia, having depletion such as vomiting or diarrhea
potassium and vasodilator may also lead to a fall in blood pressure;
retention. It eosinophilia, activity patients should be advised to consult
also reduces occurred in should, if with the physician.
the about 4 to 7 possible, be - Patients should be advised not to use
angiotensin- (depending on discontinued potassium-sparing diuretics, potassium
mediated renal status and before supplements or potassium-containing
vasopressin dose) of 100 starting salt substitutes without consulting their
release patients, usually Capoten. physician
resulting in during the first - Agents - Patients should be informed that
protection four weeks of Increasing CAPOTEN should be taken one hour
from volume therapy. It is Serum before meals.
overload with usually Potassium;
reduction of maculopapular, Potassium-
pre - load. The and rarely sparing
above action is urticarial. The diuretics
of value in rash is usually such as
control of mild and spironolacto
heart failure. disappears ne,
The inhibition within a few triamterene,
of ACE, days of dosage or amiloride,
promotes reduction, short- or potassium
accumulation term treatment supplements
of bradykinin with an should be
with its antihista-minic given only
vasodilator agent, and/or for
properties discontinuing documented
therapy; hypokalemia
remission may
occur even if
captopril is
 continued.
Flushing or
pallor.
NameGeneric

Brand Name

Dosage
Classific-

Mode of Indication Contraindicati Side effects/ Drug Interaction Nursing Responsibilities

ation

Action on Adverse reactions

t S Tetracy It works Tetracycli 250 This medication Tetracycline

e u cline is by ne's mg 2 may cause stomach should not be
t m an inhibiting primary caps, upset, diarrhea, taken at the same
r y antibiot action of use is for BID nausea, headache or time as aluminum,
a c ic with theprokary the vomiting. If these magnesium, or
c i a broad otic 30s treatment symptoms persist or calcium-based
y n spectru ribosome, of acne worsen, notify your antacids [for
c m, that by binding vulgaris doctor. Very example,
l is, it is the 16S and unlikely, but report aluminum with
i active rRNA rosacea. promptly: stomach magnesium
n against thereby It is first- pain, yellowing eyeshydroxide-oral
e many blocking line or skin, vision (Mylanta,
differen the therapy for problems, mental Maalox), calcium
t aminoacyl-Rocky changes. carbonate (Tums,
bacteria tRNA. Mountain Tetracyclines Rolaids)]; iron
. However, Spotted increase sensitivity supplements;bism
bacterial Fever to sunlight.Use of uth subsalicylate
strains can (Rickettsia this medication for (Pepto-Bismol),
acquire ), Q Fever prolonged or and dairy
resistance (Coxiella) repeated periods products. These
against Psittacosis may result in a agents bind
tetracyclin and secondary infection tetracycline in the
e and its Lymphogr like sore throat intestine and
derivates anuloma while taking this reduce its
by venereum medication. In the absorption into the
encoding a (Chalydia) unlikely event you body.
resistance , and to have an allergic Tetracycline may
operon. erradicate reaction to this enhance the
nasal drug, seek activity of the
carriage of immediate medical blood thinner,
meningoco attention. warfarin
cci Symptoms of an (Coumadin), and
allergic reaction result in excessive
include: rash, "thinning" of the
itching, swelling, blood,
dizziness, trouble necessitating a
breathing. reduction in the
dose of warfarin.
Phenytoin
(Dilantin),
carbamazepine
(Tegretol), and
barbiturates (such
as phenobarbital)
may enhance the
elimination of
tetracycline.
Tetracycline may
reduce the
effectiveness of
oral
contraceptives.
NameGeneric

Brand Name

Dosage
Classific-

Mode of Indication Contraindication Side effects/ Drug Interaction Nursing Responsibilities

ation

Action Adverse
reactions

c C Celecox Celecoxib Acute PainContraindicated 200 Headache, - Concomitant use of

e e ib is a blocks the in patients who mg 1 abdominal pain, celecoxib with aspirin
l l nonster enzyme are tab, dyspepsia, or other NSAIDs may
e e oidal that makes hypersensitive OD diarrhea, nausea,increase the
c b antiinfl prostaglan to any flatulence, and occurrence of
o r ammato dins component of insomnia. Other stomach and intestinal
x e ry drug (cyclooxyg this product. side effects ulcers.
i x (NSAI enase 2), include fainting, - Fluconazole
b D) that resulting kidney failure, (Diflucan) increases
is used in lower heart failure, the concentration of
to treat concentrati aggravation of celecoxib in the body
arthritis ons of hypertension, by preventing the
, pain, prostaglan chest pain, elimination of
menstru dins. As a ringing in the celecoxib in the liver.
al consequen ears, deafness, - Celecoxib increases
cramps, ce, stomach and the concentration of
and inflammati intestinal ulcers, lithium (Eskalith) in
colonic on and its bleeding, the blood by 17% and
polyps. accompan blurred vision, may promote lithium
ying pain, anxiety, toxicity.
fever, photosensitivity, - Persons taking the
swelling weight gain, anticoagulant (blood
and water retention, thinner) warfarin
tenderness flu-like (Coumadin) should
are symptoms, have their blood
reduced. drowsiness and tested when initiating
Celecoxib weakness. or changing celecoxib
differs treatment, particularly
from other in the first few days,
NSAIDs in for any changes in the
that it effects of the
causes less anticoagulant.
inflammati
on and
ulceration
of the
stomach
and
intestine
(at least
with short-
term use)
and does
not
interfere
with the
clotting of
blood
NameGeneric

Brand Name

Dosage
Classific-
Mode of Indic Contraindication Side effects/ Drug Interaction Nursing Responsibilities

ation
Action ation Adverse reactions

L Losarta Losartan is a H Contraindicated in 100 Dizziness, Digoxin,

o L n an selective, y patients who are mg 1 lightheadedness, fluconazole, Do not take any new
s i angiote competitive p hypersensitive to tab blurred vision, or lithium, certain medication during therapy
a f nsin II Angiotensin II e any component of a stuffy nose as non-steroidal anti- unless approved by prescriber.
r e receptor receptor type 1 r this product. your body adjusts inflammatory - Do not use potassium
t x antagon (AT1) t to the medication. drugs (e.g., supplement or salt substitutes
a a ist drug receptor e If any of these indomethacin), without consulting prescriber.
n r used antagonist, n effects persist or potassium-sparing - Take exactly as directed and
mainly reducing the s worsen, notify "water pills" do not discontinue without
to treat end organ i your doctor or (diuretics such as consulting prescriber.
high responses to o pharmacist amiloride, Preferable to take on an empty
blood angiotensin II. n promptly. spironolactone, stomach, 1 hour before or 2
pressur Losartan Fainting, triamterene), hours after meals.
e administration decreased sexual "water pills" - May cause dizziness,
(hypert results in a ability. Tell your (diuretics such as fainting, or lightheadedness
ension). decrease in doctor furosemide), (use caution when driving or
total immediately if potassium engaging in tasks that require
peripheral any of these supplements (e.g., alertness until response to drug
resistance highly unlikely potassium is known); postural
(afterload) and but very serious chloride) or salt hypotension (use caution when
cardiac venous side effects occur: substitutes, rising from lying or sitting
return change in the rifampin. position or climbing stairs);
(preload) All amount of urine, diarrhea (boiled milk,
of the stomach/abdomin buttermilk, or yogurt may
physiological al pain, severe help).
effects of nausea, yellowing - Observe for symptomatic
angiotensin II, eyes or skin, dark hypotension and tachycardia
including urine, unusual especially in patients with
stimulation of fatigue, muscle CHF; hyponatremia, high-dose
release of pain. An allergic diuretics, or severe volume
aldosterone, reaction to this depletion
are drug is unlikely,
antagonized in but seek
the presence immediate
of losartan. medical attention
Reduction in if it occurs.
blood pressure Symptoms of an
occurs allergic reaction
independently include: rash,
NameGeneric

Brand Name

Dosage
Classific-

Mode of Indication Contraindica Side effects/ Drug Interaction Nursing Responsibilities

ation

Action tion Adverse reactions

p B Analges Inhibits Paracetamol is a Paracetamol 500 In rare cases - May need to

a i ic (pain cyclooxyg suitable substitute should not mg 1 hypersensitivity adjust your
r o reliever enase for aspirin, be used in tab, reactions, usual dose of
a g ) and (COX),an especially in hypersensiti every predominantly anticoagulants
c e antipyre enzyme patients where vity to the 4 skin allergy (eg warfarin) if
e s tic responsibl excessive gastric preparation hours (itching and rash), you take
t i (fever e for the acid secretion or and in may appear. paracetamol
a c reducer production prolongation of severe liver Long-term regularly. Check
m ). of bleeding time may diseases. treatment with with your
o prostaglan be a concern. high doses may anticoagulation
l dins, While cause a toxic clinic.
which are paracetamol has hepatitis with Otherwise there
important analgesic and following initial are no serious
mediators antipyretic symptoms: interactions
of properties nausea, vomiting, between
inflammati comparable to sweating, and paracetamol and
on, pain those of aspirin, discomfort. other drugs.
and fever. its anti- Occasionally a
inflammatory gastrointestinal
effects are weak. discomfort may be
seen.
NameGeneric

Brand Name

Dosage
Classific-

Mode of Indication Contraindication Side Drug Interaction Nursing Responsibilities

ation

Action effects/
Adverse
reactions

s V Bronch Salbutamo -Relief of Patients with a -Tremor Beta-blockers: Beta- - Ensure the patient has no
a e odilator l produces severe hypersensitivity to Palpitation adrenergic blocking allergy to it, and there are no
l n bronchodil bronchospasm any of the Tachycardidrugs, especially the contra-indications with other
b t ation associated ingredients and in a noncardioselective medications or conditions.
u o through with acute patients with Headache ones, may effectively - Once administered the nurse
t l stimulationexacerbations tachyarrhythmias. Peripheral antagonize the action of should observe for any
a i of beta2- of chronic Vasodilata salbutamol, and reactions the patient has to the
m n adrenergic bronchitis and ion therefore, salbutamol medication, and take
o receptors bronchial Feelng of and nonselective beta- appropriate observations of
l in asthma Tension blocking drugs, such as the patient.
bronchial - Treatment of propranolol, should not
smooth status usually be prescribed
muscle, asthmaticus together.
thereby - In patients
causing refractory to
relaxation salbutamol
of respiratory
bronchial solution
muscle
fibres.
 NURSING THEORIES

Theorist Theory Application to the

Patient
Faye Glenn Abdellah's theory of nursing stated that This theory is very applicable in
Abdellah it was the “determination of the nature the way care was given to Mr.
and extent of nursing problem Mamugz. During Mr. Mamugz’s
presented by the individual patients or stay in the hospital, he exhibited
families receiving nursing care”. She symptoms that fall under
says a nursing problem presented by a Abdellah’s 21 nursing problems.
client is a condition faced by the client To name a few, his diarrhea
or client's family that the nurse, connected to #8 – “To facilitate
through the performance of the maintenance of fluid and
professional functions, can assist them electrolyte balance,” and his
to meet. Abdellah's use of term complaining behavior towards his
“nursing problems” is more consistent food matched with #12 – “To
with nursing functions or nursing goals identify and accept positive and
than with those client-centered negative expressions, feelings and
problems. The apparent contradiction reactions.” With these problems in
can be explained by her desire to move mind, Abdellah’s theory was able
away from the disease-centered to aid the student nurses in
orientation. In her attempt to bring prioritizing the interventions
nursing practice into its proper given.
relationship with restorative and
preventive measures for meeting total
client needs, her model seems to swing As the theory emphasizes the
the pendulum to the opposite pole, client-centered approach, the
from the disease orientation to nursing student nurses were able to focus
orientation, while leaving the client in caring for Mr. Mamugz in his
somewhere in the middle. physical, biological and socio-
psychological needs.
 Theorist Theory Application to the Patient

Lydia Hall Core, Care and Cure Theory

Hall's theory emphasizes the Care is the sole function of nurses,
importance of individuals as unique, During our exposure the student
capable of growth and learning, and nurse assigned to Mr. Mamugz was
requiring a total person approach. able to accomplished the task
Her definition of health can be assigned to him such as tepid sponge
inferred to a state of self-awareness bath, giving P.O. medicines, taking
with conscious selection of vital signs, monitor intake and
behaviors that are optimal for that output and providing comfort as
individual. Hall stresses the need to part of the task assigned to him.
help the person explore the meaning Core involves the cooperation of the
of his or her behavior to identify and patient for his recovery. Mr.
overcome problems through Mamugz was able to cooperate in all
developing self-identity and the nursing interventions (above)
maturity. The concept of society or performed for him.
environment is dealt with in relation
to the individual. Hall's theory of Cure is the willingness of the patient
nursing involves three interlocking to comply all treatment regimen.
circles, each one of it represents one According to the student nurse
aspect of nursing. The same aspect assigned to Mr. mamugz that day,
represents intimate bodily care of Mr. mamugz showed eagerness
the patient. The core aspect deals towards getting himself better and
with the innermost feeling and examples are that he complained
motivations of the patient and family about the food given to him that it
through the medical aspects of care. should not have contained oil
because he is aware that the ordered
diet is low salt and low fat diet.
 Theorist Theory Application to the
Patient

Ida Jean Theory: Nursing Process Theory Student nurse is

Orlando finding out the problem

and meeting the patient's
Orlando’s theory was developed in the immediate needs.
late 1950s from observations she recorded
The student nurse
between a nurse and patient. Despite her efforts
assigned to Mr. Mamugz
she was able to categorize the records as “good”
was able to assess the
or “bad” nursing. It then dawned on her that
patient well therefore he
both formulations of “good” and “bad” nursing
is able to come up a
were contained in the records. From these
good plan of care for
observations she formulated the deliberative
identified problems such
nursing process. The role of the nurse is to find
as fever, hypertension
out and meet the patient’s immediate needs for
and pain. The student
help. The patient’s presenting behavior maybe a
nurse was able to meet
plea for help, however, the help needed may not
the patient's immediate
be what it appears to be. Therefore, nurses need
need.
to use their perception, thoughts about the
perception or the feelings engendered from their
thoughts to explore with patients the meaning of
their behavior. This process helps the nurse
finds out the nature of the distress and what help
the patient needs. Orlando ’s theory remains one
of the most effective practice theories available.
The use of her theory keeps the nurses to focus
on their patients. The strength of the theory is
that it is clear, concise and easy to use. While
providing the overall framework for nursing, the
use of her theory does not exclude nurses from
using other theories while caring for the patient.
 Date / Cues Needs Nursing Diagnosis Objective of Nursing Intervention Evaluation
Time w/ Rationale Care w/ Rationale
August 27, Subjective: C Chronic Pain r/t muscle Within 7 hours 1. Encourage to get adequate rest and sleep Goal met:
2009 > “Naa pa ba O strain secondary to span of care, my ® Pain is minimized when relaxed or asleep
ko’y tambal nga G hypertension and old age patient will August 27, 2009
4:00 pm pain reliever? N experience relief 2. Teach how to do deep breathing exercises 9:00 pm
Sakit man gud I R: Muscle strength from pain as ® Helps relax the body
ang akuang T deteriorates with age and can evidenced by > Patient was able to
likod.” [pain I cause pain with prolonged decreased 3. Assist in guided imagery verbalize a pain level
scale: 6] V use; this is worsened by grimacing and ® To help divert attention of 2.
>”Dugay dugay E hypertension as the verbalization of
na pud ning back - increased blood pressure decreased pain 4. Establish and enumerate preferred attention- >Patient was not
pain nako.” P directly affects the affected with the use of a diverting activities observed to be
> “Katong 40 E muscles. pain scale. ® To decrease pain levels by diverting attention grimacing
years old pa ko R away from pain stimulus by putting more focus
nagsakit ang C on a non-painful stimulus
akong tangkurog, E Source: Marilynn E.
nagpa-BP ko sa P Doenges, APRN, BC, et. al. 5. Encourage to participate in massage therapy
university T Nurse’s Pocket Guide, 10th ® To decrease pain by decreasing muscle tension
physician. Unya, U ed. © 2006. F.A. Davis
ingon niya sa A Company, Philadelphia, 6. Encourage to have an exercise program
ako, hypertensive L Pennsylvania ® To help in strengthening muscles
daw ko.”
P 7. Reposition in bed as preferred
A ® To help in relaxation of muscles
Objective: T
> Grimacing T 8. Apply warm compress to affected areas
> Age: 59 y.o. E ® To vasodilate blood vessels thus helping in
> Hypertensive R getting rid of any lactic acid accumulation.
N
Vital Signs: 9. Administer analgesics as prescribed
® To relieve pain
BP - 150/80
mmHg 10. Administer antihypertensive drugs as
PR - 98 bpm prescribed
RR - 20 cpm ® To decreases blood pressure; helps in lowering
Temp. – 38.8ºC pain levels
 Date / Cues Needs Nursing Diagnosis Objective of Nursing Intervention Evaluation
Time w/ Rationale Care w/ Rationale
August 27, Subjective: N Hyperthermia related to Within 7 hours 1. Encourage increase in oral fluid intake Goal met:
2009 (none) U release of endogenous span of care, my ® To decrease the body temperature by
Objective: T pyrogens secondary to patient will be excretion in urination and will prevent August 27, 2009
4:00 pm > Skin warm to R underlying disease free from fever as dehydration 9:00 pm
touch I evidenced by a 2. Instruct temporary removal of clothing and top
> Sweating T R: An underlying disease, temperature sheets - After 6 hours,
> Chills I such as an infection, triggers reading of lower ® To prevent the insulation of body heat temperature was
O the inflammatory response than 37.5ºC 3. Apply tepid sponge bath 37.4ºC
Vital Signs: N of the body thus increasing ® To lower body temperature by process of
A the body’s temperature due absorption and evaporation
BP - 150/80 L to the release of endogenous 4. Turn to sides frequently
mmHg - pyrogens. ® To prevent insulation of the body heat at the
PR - 98 bpm M back
RR - 20 cpm E
Temp. – 38.8ºC T Source: Marilynn E. 5. Instruct to call the attention of nurse once
A Doenges, APRN, BC, et. al. chills develop
B Nurse’s Pocket Guide, 10th ® For immediate interventions to be applied
O ed. © 2006. F.A. Davis
L Company, Philadelphia, 6. Teach watcher how to do tepid sponge bath
I Pennsylvania ® For continuous care
C
7. Encourage watcher to occasionally fan patient
P ® To cool down the body temperature
A
T 8. Get laboratory results from laboratory
T technician
E ® To determine if there is an evident cause of the
R fever (e.g. infection)
N
9. Administer paracetamol as ordered
® To lower the body temperature

10. Administer antibiotics as ordered

® To eliminate the underlying bacteria that cause
the inflammatory response.
 Date / Cues Needs Nursing Diagnosis Objective of Nursing Intervention Evaluation
Time w/ Rationale Care w/ Rationale
August 27, Subjective: E Diarrhea related to Within 3 days 1. Reduce intake of solid foods Goal partially met:
2009 >“Murag lima ka L malabsorption in intestines span of care, my ® To allow for reduced intestinal workload
beses na ko naka I secondary to amoebiasis patient will April 30, 2009
4:00 pm libang M reestablish and 2. Limit foods that contain caffeine and high 4:00pm
kaganinang I R: Amoebas secrete maintain normal amounts of fiber
buntag.” N enzymes that digest chyme; pattern of bowel ® To prevent aggravation of condition > Patient verbalized
>“Dili gahi ang A digested chyme does not get functioning as that he has had bowel
akuang tae… T digested by small intestine evidenced by 3. Assist in walking towards bathroom during movements with
Daghan pud ug I and this gets excreted from passing of episodes of loose bowel movement formed stools already
tubig.” O the body unformed. formed stools and ® To prevent rushing, accidents and injury but he still has an
N decreased average of 5 episodes
Objective: number of loose 4. Encourage to increase oral fluid intake of bowel movements
> Hyperactive P Source: Marilynn E. bowel ® To replace lost fluids and prevent dehydration during daytime.
bowel sounds: 21 A Doenges, APRN, BC, et. al. movements
sounds in one T Nurse’s Pocket Guide, 10th 5. Provide for changes in dietary intake
minute. T ed. © 2006. F.A. Davis ® To avoid foods that precipitate diarrhea
E Company, Philadelphia,
Vital Signs: R Pennsylvania 6. Promote use of relaxation techniques
N ® To reduce stress and anxiety which can
BP - 150/80 precipitate bowel movement
mmHg
PR - 98 bpm 7. Provide a bed pan as necessary
RR - 20 cpm ® To provide quick access
Temp. – 38.8ºC
8. Teach patient that episodes of diarrhea may
last longer than usual
® To avoid going back and forth from bed to
bathroom in a short period of time

9. Administer antidiarrheal drugs as ordered

® To decrease episodes of diarrhea

10. Administer antibiotics as ordered

® To rid body of underlying cause of diarrhea
 Date / Cues Needs Nursing Diagnosis Objective of Nursing Intervention Evaluation
Time w/ Rationale Care w/ Rationale
August 27, Subjective: S Disturbed sleep pattern Within 3 days span 1. Arrange care to provide for uninterrupted Goal met:
2009 L related to loose bowel of care, my patient periods of rest
>“Dili kaayo ko E movement secondary to will reestablish and ® To maximize hours of sleep April 30, 2009
4:00 pm makatulog kay E amoebiasis maintain normal 2. Restrict intake of food or drinks that contain 4:00pm
pirminti lang ko P sleeping pattern as caffeine especially before bedtime
momata para - R: Amoebas secrete evidenced by ® To prevent prolonged periods of being awake > Patient verbalized
maglibang bisan R enzymes that digest reports of 3. Limit oral fluid intake before bedtime that he was able to
kadlawon pa na.” E chyme; digested chyme improvement in ® To prevent occurence of nocturia sleep 8 hours straight
S does not get digested by sleep pattern and 4. Encourage to designate activities to be done for the past 3 days
Objective: T small intestine and this feeling rested only during the day
needs to be excreted from ® To prevent increased stress levels during bed
>Sleeping during P the body no matter what time
the afternoon A time of day it is. 5. Recommend not to take naps during the
>Awake during the T afternoon
evening T ® To prevent prolonged hours of being awake
E Source: Marilynn E. 6. Suggest to accomplish as many tasks as
Vital Signs: R Doenges, APRN, BC, et. possible during the daytime
N al. Nurse’s Pocket Guide, ® To prevent sleeplessness due to an
BP - 150/80 10th ed. © 2006. F.A. unaccomplished task
mmHg Davis Company, 7. Encourage to ambulate during daytime
PR - 98 bpm Philadelphia, ® To avoid increased energy levels during
RR - 20 cpm Pennsylvania bedtime that will keep patient awake
Temp. – 38.8ºC
8. Recommend bedtime snack
® To avoid sleep interference from
hunger/hypoglycemia

9. Administer antibiotics as ordered

® To rid body of underlying cause of loose
bowel movements

10. Administer analgesic as ordered [if possible,

before bed time.
® To relieve discomfort and take maximum
advantage of sedative effect
 Date / Cues Needs Nursing Diagnosis Objective of Nursing Intervention Evaluation
Time w/ Rationale Care w/ Rationale
August 27, Subjective: N Risk for deficient fluid Within 3 days 1. Weigh patient daily Goal met:
2009 >“Murag lima ka U volume related to loose span of care, my ® To assess changes in weight which can
beses na ko naka T bowel movement secondary patient will be determine extent of any fluid loss April 30, 2009
4:00 pm libang R to amoebiasis free from 4:00pm
kaganinang I dehydration as 2. Encourage to increase oral fluid intake
buntag.” T R: Amoeba disrupts evidenced by ® To reduce risk of hypovolemia and >Patient did not have
>“Dili gahi ang I absorption of water in large good skin turgor, dehydration poor skin turgor and
akuang tae… O intestine which results to non-sunken eyes sunken eyes.
Daghan pud ug N passing of watery stools. and maintained 3. Regulate IVF as ordered
tubig.” A weight. ® To supplement water intake via intravenous
L route
Objective: - Source: Marilynn E.
> Good skin M Doenges, APRN, BC, et. al. 4. Monitor intake and output
turgor E Nurse’s Pocket Guide, 10th ® To ensure accurate knowledge of fluid status
T ed. © 2006. F.A. Davis
Vital Signs: A Company, Philadelphia, 5. Assess skin turgor and mucous membranes
B Pennsylvania regularly
BP - 150/80 O ® To be able to identify if early signs of deficient
mmHg L fluid volume are manifesting
PR - 98 bpm I
RR - 20 cpm C 6. Advise to include food that contain high
Temp. – 38.8ºC amounts of water in daily meals (e.g. soup,
P watermelon, etc)
A ® To maximize hydration of body
T
T 7. Control humidity and ambient air if possible
E ® To reduce high fever and elevated metabolic
R rate
N
8. Teach patient signs of dehydration and advise
to notify health care personnel as soon as they
may manifest
® To ensure timely interventions to be performed
appropriately
9. Keep patient well thermoregulated
® To avoid excessive sweating

10. Administer antidiarrheals as ordered.

® To treat the underlying cause {amoebiasis)
 MEDICATION
• Instruct the patient and family to follow the home medications as prescribed by

the physician.

R: Treatment regimen is important to have faster recovery.

• Explain each purpose of the medication

R: Knowledge about what medications will make the client become aware of what he is

taking and for the family to participate more in the client’s treatment.

• Instruct client not to take over-the-counter drugs without doctor’s knowledge.

R: Non-prescribed drugs may have an antagonistic effect or synergistic effect in any

drug therapy.

• Explain the side effects or adverse reactions of each medication. Instruct the client

and family to watch out for it and to report it immediately as soon as possible to

the physician.

R: Explaining the side effects will let the client and family identify what harmful effects

to expect and for them to distinguish the adverse reaction to medication for them to report

it to their physician immediately.

• Inculcate to the client to comply all the medications prescribed at the ordered

dosage, route and at the ordered time.

R: Taking the drugs at the ordered dose, route and time limits the chance for toxicity and

ensure its effectiveness.

• Advice client to take medications with food if not contraindicated or to take

medicine one hour before meals or one hour after meals.

R: Some medications are irritating to the gastric mucosa.

 • Let patient complete the whole course of the drug therapy.

R: This can help the patient alleviate the problem and be able to experience the full

therapeutic effect of the medication.

EXERCISE

• Encourage early ambulation.

R: Walking is good exercise and could promote circulation, hence, proper healing.

• Promote exercise to the client especially ROM.

R: This will promote good physical health.

• Instruct client to avoid strenuous activities for at least a week or a month until

fully recovered.

R: Activities that require great muscle strength should be avoided to prevent injury and

muscle strain.

• Advise patient to have adequate rest and sleep.

R: To gain back the lost strength and be able to return to its normal state thus allow ample

time for healing.

• Practice deep breathing exercise.

R: This will help alleviate any pain or discomfort that patient will encounter

TREATMENT
 • Explain the need of treatment after discharge and must take it seriously so as to

prevent such complications to the patient

R: To make the client and family aware that the treatment does not only end at hospital but

needs to be continued at home to make the client responsible towards medication.

• Explain to the family the condition of the patient and give them factual

information about the illness.

R: To have better understanding of the patient’s condition and to be able to know what

intervention they should give that could not alter the effect of the therapy.

HYGIENE

• Encourage having proper hygiene like taking a bath, meticulous hand washing,

and brushing of teeth every after meal.

R: Hygiene promotes comfort and cleanliness to the patient. It also increases the sense of

wellness, which is very much needed in the therapeutic process.

• Encourage patient to continue hygienic measures practiced at present such as

changing clothes everyday and changing of underwear as often as necessary,

keeping the nails neatly trimmed, maintaining own supplies/items for personal

necessities.

R: Keeping all practiced measures is necessary in consistent maintenance of proper hygiene.

Owning personal accessories for hygiene purposes keep client away from contamination and

infectious diseases.

• Provide a calm, clean, and accepting environment.

 R: Calm, clean and non threatening environment may lessen the occurrence of

possible infection and would be a good place for healing.

OUTPATIENT ORDER

• Inform the patient that follow-up check-up is important to have continuous

monitoring and care even after attainment of the course medical therapy.

R: Through constant visits as out patient, the physician would still monitor the progress of

the therapeutic intervention availed by the patient.

• Advice the client and the family to carry out follow-up diagnostic examinations

R: This is to evaluate the therapeutic response of the patient to the treatment.

• Instruct the family to report any unusual signs and symptoms experienced by the

patient.

R: This will help detect early signs and symptoms of recurrence of the disease.

DIET

• Encourage client to eat a variety of nutritious foods like fruits and vegetables once

instructed by the physician.

R: To maintain and promote a healthy body.

• Instruct client to take vitamins as ordered.

R: To boost the body’s defense mechanism.

• Encourage patient to increase oral fluid intake.

R: This hydrates the body for normal functioning and maintain acid-base balance.

• Advise client not to skip meals and have a regular eating pattern/schedule.

R: Regular interval of meals is the basic principle of a good dietary plan.

• Tell patient not to eat foods contraindicated by the physician.

R: To prevent the occurrence of complications.

• Instruct patient to avoid drinking liquors and smoking

R: To also avoid illness to be triggered.

Prognosis

Poor Fair Good

Category Justification
(1) (2) (3)
1. Duration of It has been only 5 days since he has

Illness been having diarrhea.
Mr. Mamugz, 59 years old, is nearly a
2. Onset of geriatric patient. Getting sick with
Illness  amoebiasis poses a big threat to his
health.

3. Predisposing Location predisposes Mr. Mamugz to


Factors getting Amoebiasis

Practicing good cleaning of vegetables

4. Precipitating
 would have been the key to avoid
Factors
getting amoebiasis.
5. Willingness
to take the  Mr. Mamugz is very willing to take
medications or his medications. He knows the good
compliance to effects of the drug and intravenous
treatment therapy.
regimen
Mr. Mamugz’s garden is near a canal
which can flood. Unless he moves his
6. environment  garden elsewhere, it will mostly be
unclean and will always be suspected
of carrying amoeba.

The most number of family members

7. family that were present in the ward was 3.

support This number included every member
of his family.
 4 + 0 + 9 = 13
13/7 = 1.85

4x1 = 0x2 =
Calculations 3x3 = 9 Ranges:
4 0
1.0 – 1.5 = Poor
1.5 – 2.5 Fair
2.5 – 3.0 = Good

Mr. Mamugz has a FAIR prognosis.

His condition has only been short term and is very treatable and even curable. He is also

eager to get healthy again. Through this, our prognosis has come up to the fair category.
 RECOMMENDATION

To the Student Nurses:

We have also evaluated ourselves and have agreed that we have to heed the

recommendations of our clinical instructor. Patient care is our ultimate goal and

continuous monitoring and application of nursing interventions is compulsory for the

patient’s recovery. Data gathering skills should also be honed for accurate presentation of

cases.

To the Patient and his family:

Religious taking of medicine was promoted as well as good general and oral

hygiene. Good family support can boost the morale of the patient and continuous holistic

care will improve his over-all health. He must also accept his condition and be aware of

it, so that he could discipline himself and follow the necessary interventions given.

To the Ateneo de Davao University – College of Nursing

The group is proud to belong to such a prestigious school. We recommend that

the Ateneo de Davao University’s College of Nursing keep up, or improve their

inculcation of morals and values to their student nurses. Aside from that, continuous

teaching and evaluating our skills will lead us to aim a higher standard of education.
To the readers:

The group recommends that you, the reader, broaden your knowledge and

continue reading other sources and not base anything on this case presentation alone. A

variety of sources make a good over-all understanding of a subject.

Steps can be taken to lower the chance to develop and to delay the possible

outcome of Amoebiasis. That’s why we recommend that everybody must take care of

themselves in preparing or eating foods. They must also establish new patterns of eating,

drinking, and lifestyle in order to prevent diseases from occurring.