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CP on amoebiasis

CP on amoebiasis

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Published by kathy
A case study on amoebiasis
A case study on amoebiasis

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Published by: kathy on Oct 09, 2009
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11/19/2012

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

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

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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.

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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

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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

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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 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 C

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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.

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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

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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.

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GENOGRAM

DEVELOPMENTAL DATA
Theorist Lawrence Kohlberg

Theory Stages of Moral Development: The theory holds that moral reasoning, the basis for ethical behavior, has six identifiable develop mental stages, each more adequate at responding to moral dilemmas than its rg followed the development of moral judgment far beyond the ages studied earlier by Piaget, who also claimed that logic and morality develop through constructive stages. Expanding on Piaget's work, Kohlberg determined that the process of moral

Stage The post-conventional level, also known as the principled level, consists of development. There is a growing realization that individuals are separate entities from society, and that the individual's own perspective may take precedence over society's view. Because of this level's "nature of self behavior of postconventional individuals, especially those at stage 6, can be confused with that of those at the preconventional level. In Stage six (universal ethical principles driven), moral reasoning is based on abstract reasoning using Laws are valid only insofar as they are grounded in justice, and a commitment

Justification Mr. Mamugz is already in stage six of the post conventional level in Evidence of this can be found in something as simple as his reaction to food that was given to him. He definitely knows that food containing oil cannot be for him, yet this is the food that was being served to him for a total of 3 days already. The self-before-others kind of behavior kicks into his psyche as he knows that the food served was not the kind that the doctor ordered. So, as the policy of the hospital remains that the food served cannot be replaced, he still decides station and complain about the issue. In this act, he knows that

stages five and six of moral moral development.

predecessor. Kohlbe before others", the

universal ethical principles. to approach the nurse’s

development was principally concerned with justice, and that it continued throughout the individual's lifetime, a notion that spawned dialogue on the philosophical implications of such research.

to justice carries with it an obligation to disobey unjust laws.

whether he complains or not, the oily food that was served cannot be changed. However, in his morality, he is driven to do something about it because he feels the injustice that has been done to him. The very act of complaining can give justice to his situation simply because something was done about it.

Theorist

Erik Erikson

Theory Erikson's stages of psychosocial development as articulated by Erik Erikson explain eight stagers throug h which a healthily developing human s hould pass from infancy to late adulthood. In each stage the person confronts, and hopefully masters, new challenges. Each stage builds on the successful completion of earlier stages. The challenges of stages not successfully completed may be expected to reappear as problems in the future.

Stage Middle adulthood (40 to 60 years) Psychosocial Crisis: Generativity vs. Stagnation Generativity is the concern of establishing and guiding the next generation. Socially-valued work and disciplines are expressions of generativity. Simply having or wanting children does not in and of itself achieve generativity. Central tasks of Middle adulthood [bold tasks indicate accomplished tasks by Mr. Mamugz]

Justification Mr. Mamugz is probably one of the best examples of successful generativity. First of all, he has successfully achieved a doctorate degree in education. He couldn’t have achieved this if he didn’t get his master’s degree in public administration. Furthermore, this master’s degree could not exist if he didn’t have his college degree in BS-Commerce and being a CPA too. With all of these achievements, Mr. Mamugz is able to achieve even more. His achievements have given him such a strong foundation. All the education that he went through gave him all that he needed to successfully achieve this stage in psychosocial

Express love through more than sexual contacts. Maintain healthy life patterns. Develop a sense of unity with mate. Help growing and grown children to

be responsible adults.

development. Through this, he is very much ready for the next stage in his life, which is Late Adulthood.

Relinquish central role in lives of grown children. 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
Havighurst

The developmentaltask concept occupies middle ground between two opposed theories of education: the theory of freedom—that the child will develop best if left as free as possible, and the theory of constraint—that the child must learn to become a worthy, responsible adult through restraints imposed by his society. A developmental task is midway between an individual need and societal demand. It assumes an active learner interacting with an active social environment

(Ages 30-60) [bolded indicates accomplished]

Mr. Mamugz falls into this category. He is 59 years old. Yet regardless of his age, all of these developmental tasks were accomplished successfully. Towards his two daughters, he was able to be a very good inspiration to their success. As an adult, he is able to be all he can be because of all his experience and knowledge. Even at home, he is able to spend leisure time by taking care of his very own garden. With all of these tasks accomplished, Mr. Mamugz is well and ready for the next stage in his life when he becomes 60 and over.

Assisting teenage children to become responsible and happy adults. Achieving adult social and civic responsibility. Reaching and maintaining satisfactory performance in one’s occupational career. Developing adult leisure time activities. Relating oneself to one’s spouse as a person. To accept and adjust to the physiological changes of middle age. 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: Age: Sex: Ward: Mr. Mamugz 59 years old Male 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 o

The adventitia is the serous membrane that lines the esophagus. The visceral peritoneum is the serous membrane that lines the stomach, large intestine, and small intestine. The mesentery is an extension of the visceral peritoneum that attaches the small intestine to the rear abdominal wall. The mesocolon is an extension of the visceral peritoneum that attaches the large intestine to the rear of the abdominal wall. 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.

o

o

o

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

Tropical Area

Present

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

Third World Country

Present

Precipitating Factors

Factor Using vegetables growing near a canal as food.

Present of Absent

Justification Mr. Mamugz verbalized that he had a

Present

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

SYMPTOMATOLOGY

Symptom

Present of Absent

Justification This was evident in during Mr. Mamugz’s physical assessment. This was also his chief complaint. Another one of Mr. Mamugz’s chief complaint. His verbalization during physical assessment also confirms this. Not found in Diagnostic Exams Not found in Diagnostic Exams Not found in Diagnostic Exams

Fever

Present

LBM + blood streaked stools

Present

Liver Abscess Brain Abscess Pleural Effusion

Absent Absent Absent

Precipitating Factors Predisposing Factors Tropical Area 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 ingestion of bacteria Using vegetables growing near a canal as food.

penetration and digestion of mucosal lining entrance of trophozoites into vascular system fever

malabsorption of chyme components collection of watery fecal matter in rectum LBM

Diagnostic CBC Tests CXR
fecalysis UA SGPT lipid profile blood chemistry ECG FBS Diagnosis: Amoebiasis Medical Management antiprotozoal antibiotic antipyretic (none)

Surgical Management

Nursing Management increase OFI complete bed rest low salt low fat diet nonfibrous food PO med compliance

Prognosis >good compliance of medications >cooperation during nursing management >adequate financial support >poor compliance of medications >no cooperation during nursing management >inadequate financial support extra intestinal diseases

Good Prognosis

pleural effusion

liver absces s

brain absces 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 2009 E. Durban (HC) medical attention so he is admitted at Limso Hospital Low salt and low fat diet To indicate specific diet for patient

DONE

DONE

Monitor VS

Vital signs are recorded to 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. These entire lab tests are performed to screen for alteration and to serve as a baseline data for future comparison.

DONE

Labs: CBC, Urinalysis, CXR, Lipid Profile, Crea, SGPT, Uric acid, SE, Serum Na+, K+, ECG, FBS (c/o watcher)

DONE

Start venoclysis with PNSS 1L at Serves as a route for IVTT 120cc/o medications and replaces fluid and electrolyte losses due to frequent loose bowel movement Meds: 1. Paracetamol (Alvedon) 500mg - Antipyretic, nonopiod 1 tab TID analgesic; Indicated for fever. 2. Salbutamol + Guaifenesin (Ventolin) 1 tab BID - Bronchodilator; Indicated for Productive Cough?

DONE

DONE

3. Celecoxib 200mg 1 tab OD

- NSAID; Management of acute pain.

Monitor I & O every shift

To determine if the patient’s intake is closely equal to his output Monitor the intake and 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 Referral is done to correct unusualities as soon as possible and to inform the

DONE

Hydration rounds every 6 hours

DONE

Refer for any unusualities

DONE

attending physician of the patient's condition. 1:40 pm - Stool Exam ASAP <3 To analyze the condition of a person's digestive specimen tract in general - Losartan 100mg 1 tab - Antihypertensive; Management for now then OD hypertension. - Incorporate 30 meqs - To return Potassium KCL with present IVF and levels to normal run @ 120cc/o DONE

04/28/09 IVF to follow with PNSS 1L + KCL 30 meqs to run @ 120 cc/o

- PNSS is an isotonic 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.

DONE

6:30 pm

- Start Metronidazole 500mg 1 tab - Anti-infectives; 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. Xenoflox 500mg 1 tab now then 1 Anti-infevtives; Indicated tab every 12 (7-7) for infectious diarrhea and intra-abdominal infections.

DONE

1pm

DONE

04/28/09 150/100 x 2 takes captopril 25mg - To increase the 1 tab for sublingual effectiveness of the drug (anthypertensive) 9:40pm 04/29/09 SE with occult blood 10:45 am 6:40pm IVF to follow: PLR @120 cc/o - To detect blood in the feces. Occult blood usually indicates gastrointestinal bleeding. - Plain Lactated Ringer’s 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.

DONE

DONE

DONE

7pm

Discontinue Ciprofloxacin shift to -Anti-infectives; Tetracycline 250mg 2 caps BID Prevention of after meals exacerbations of bronchitis. - Plain Lactated Ringer’s 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. - For follow-up assessment and evaluation.

DONE

04/29/09 IVF to follow with PLR 1L @ 120cc/o

DONE

04/30/09 - Rounds with Dr. Durban 2:30pm

DONE

04/30/0 9

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

DIANOSTIC EXAMS HEMATOLOGY Date: April 27, 2009 Parameter Hemoglobin Results 177 Units g/L Lower limits Upper limits 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 Chemical: specific Gravity: 1.030 Reaction (pH): acidic (6.0) Microscopic

Physical: Color: Dark Yellow Appearance: cloudy

Albumin: Trace Sugar: negative

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 Test K+, substc Na+, substc SGPT, activity C Crea, substc 3.14 137.5 39.26 77,72 Ref. range 3,5-5,3 135-148 M: 0-41 M: <50 y.o.: less than 115 >50 y.o.: less than 124

Date: April 28, 2009 @ 11:30 am Test Urate, substc Cholesterol Triglycerides HDL LDL Result 0, 23 4, 32 0, 79 0, 84 3,12 Ref. range M: 0, 21 – 0, 42 Up to 5,2 Up to 1,7 More than 0, 91 Less than 3,5 SI units mmol/L mmol/L mmol/L mmol/L mmol/L

NameGeneric

Brand Name

Classification

Mode of Indication Contraindication Action

Dosage

Side Drug effects/ Interaction Adverse reactions

Nursing Responsibilities

m e t r o n i d a z o l e

F l a g y l

Anti- Disrupts Amebecide Hypersensitivity. 500 CNS: Cimetidine Adiminister on empty stomach or may infectiv DNA in the Use cautiously in: mg 1 Seizures, may decrease administer with food or milk to minimize es, and management history in blood tab, dizziness metabolism of GI irritation. antiprot protein of amebic dyscrasias, TID , metronidazole. - Instruct patient to take medication ozoals, synthesis dysentery, History of headache Phenobarbital exactly as directed with evenly spaced antiulce susceptib amebic liver seizures or . and rifampin times between doses, even if feeling better. r agents le abscess and neurologic EENT: increases - Advised patient to not skip doses or organism trichomonias problems and Tearing metabolism double up on missed doses. s. is: treatment severe hepatic (topical and may - Inform patient that medication can cause Therape of peptic impairement. only). decrease metallic taste. utic ulcer disease GI: effectiveness. - Advise patient that frequent mouth effects: caused by Abdomi Metronidazole rinses, good oral hygiene and sugarless 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 c bacteria includin g: Bacteroi des, clostridi um. In addition is active against: Trichom onas vaginalis , entamoe ba histolytic a, giardia lamdia, H. pylori and clostridi um difficile.

. disulfiram. Hemat: Increased risk Leukope of leucopenia nia with Neuro: fluorourousel Peripher or al azathioprine. neuropat hy

NameGeneric

Brand Name

c i p r o f l o x a c i n

C i p r o

Classification

a n t i b i o t i c

Bacteri Complicate Ciprofloxacin50 Cardiovascula When - Advise to contact healthcare cidal d Intrahydrochlorid 0mr: palpitation, Ciprofloxac provider if they experience pain, drugs, Abdominal e is g 1 atrial flutter, in tablets swelling, or inflammation of a meanin Infections contraindica ta ventricular are given tendon, or weakness; discontinue g that (used in ted in b, ectopy, concomita Ciprofloxacin treatment. they kill combinatio persons with ev syncope, ntly with - Advise patient that antibacterial bacteri n with a history of eryhypertension, food, there drugs including Ciprofloxacin tablets a. metronidaz hypersensiti 12 angina is a delay should only be used to treat bacterial These ole) vity to ho pectoris, in the infections. They do not treat viral antibiot caused by Ciprofloxacinurs myocardial absorption infections (e.g., the common cold). – ic drugs Escherichia, any infarction, of the Tell patient not to skip or or inhibit coli, member of cardiopulmon drug, discontinue even if feeling better. 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

Dosage

Mode of Indication Contraindica Action tion

Side effects/ Adverse reactions

Drug Interaction

Nursing Responsibilities

made (enterotoxi pain in each genic extremities, time a strains), injection site cell Campyloba reaction divides, cter jejuni, (Ciprofloxaci interferi Shigella n ng with boydii 1, intravenous) replicati Shigella on dysenteria makes e, Shigella it flexneri or difficult Shigella for sonnei1 bacteri when a to antibacteri multiply al therapy . is indicated.

hallucinations, however, the first sign of a skin rash or other manic is not allergic reaction. reaction, substantial - Instruct patient that peripheral irritability, ly affected. neuropathies have been associated tremor, Concurrent with Ciprofloxacin use. If symptoms ataxia, administra of peripheral neuropathy including convulsive tion of pain, burning, tingling, numbness seizures, antacids and/or weakness develop, they lethargy, containing should discontinue treatment and drowsiness, magnesiu contact their physicians. weakness, m - Advise patient that Ciprofloxacin malaise, hydroxide may cause dizziness and anorexia, or lightheadedness; therefore, patients phobia, aluminum should know how they react to this depersonaliza hydroxide drug before engaging in activities tion, may requiring mental alertness or depression, reduce the coordination. 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

Classific-ation

Mode of Action

tionIndica-

Contraindication

Dosage

Side effects/ Adverse reactions

Drug Interaction

Nursing Responsibilities

c a p t o p r i l

C a p o t e n

A n t i h y p e r t e n s i v e

Captopril is an Hype Contraindicated in 25 - Renal: About - Agents ACE inhibitor rtensi patients who are mg 1 one of 100 Having - Patients should be advised to which on: hypersensitive to tab patients Vasodilator immediately report any signs or prevents the capto this product or developed Activity: symptoms suggesting angioedema (e.g., conversion of pril any other proteinuria Data on the swelling of face, eyes, lips, tongue, Ang.I to tablet angiotensin- Hematologic: effect of larynx and extremities; difficulty in Ang.II s, converting Neutropenia/agr concomitant swallowing or breathing; hoarseness) resulting in USP enzyme inhibitor anulocytosis has use of other and to discontinue therapy peripheral is (e.g., a patient occurred. Cases vasodilators - Patients should be told to report vasodilatation indic who has of anemia, in patients promptly any indication of infection and reducing ated experienced thrombocytopen receiving (e.g., sore throat, fever), which may be a peripheral for angioedema ia, and CAPOTEN; sign of neutropenia, or of progressive resistance and the during therapy pancytopenia nitroglycerin edema which might be related to after load and treat with any other have been or other proteinuria and nephrotic syndrome the reduction ment ACE inhibitor). reported. nitrates (as - Patient should be cautioned that 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 potassium retention. It also reduces the angiotensinmediated vasopressin release resulting in protection from volume overload with reduction of pre - load. The above action is of value in control of heart failure. The inhibition of ACE, promotes accumulation of bradykinin with its vasodilator properties

fever, arthralgia, having depletion such as vomiting or diarrhea and vasodilator may also lead to a fall in blood pressure; eosinophilia, activity patients should be advised to consult occurred in should, if with the physician. about 4 to 7 possible, be - Patients should be advised not to use (depending on discontinued potassium-sparing diuretics, potassium renal status and before supplements or potassium-containing dose) of 100 starting salt substitutes without consulting their patients, usually Capoten. physician during the first - Agents - Patients should be informed that four weeks of Increasing CAPOTEN should be taken one hour therapy. It is Serum before meals. usually Potassium; maculopapular, Potassiumand rarely sparing urticarial. The diuretics rash is usually such as mild and spironolacto disappears ne, within a few triamterene, days of dosage or amiloride, reduction, short- or potassium term treatment supplements with an should be antihista-minic given only agent, and/or for discontinuing documented therapy; hypokalemia remission may occur even if captopril is

continued. Flushing or pallor.

NameGeneric

Brand Name

Classification

Mode of Action

Indication Contraindicati
on

Dosage

Side effects/ Adverse reactions

Drug Interaction

Nursing Responsibilities

t e t r a c y c l i n e

S u m y c i n

Tetracy It works Tetracycli cline is by ne's an inhibiting primary antibiot action of use is for ic with theprokary the a broad otic 30s treatment spectru ribosome, of acne m, that by binding vulgaris is, it is the 16S and active rRNA rosacea. against thereby It is firstmany blocking line differen the therapy for t aminoacyl-Rocky bacteria tRNA. Mountain . However, Spotted bacterial Fever strains can (Rickettsia acquire ), Q Fever

250 This medication Tetracycline mg 2 may cause stomach should not be caps, upset, diarrhea, taken at the same BID nausea, headache or time as aluminum, vomiting. If these magnesium, or symptoms persist or calcium-based worsen, notify your antacids [for doctor. Very example, unlikely, but report aluminum with promptly: stomach magnesium pain, yellowing eyeshydroxide-oral or skin, vision (Mylanta, problems, mental Maalox), calcium changes. carbonate (Tums, Tetracyclines Rolaids)]; iron increase sensitivity supplements;bism to sunlight.Use of uth subsalicylate this medication for (Pepto-Bismol), prolonged or and dairy

resistance (Coxiella) against Psittacosis tetracyclin and e and its Lymphogr derivates anuloma by venereum encoding a (Chalydia) resistance , and to operon. erradicate nasal carriage of meningoco cci

repeated periods may result in a secondary infection like sore throat while taking this medication. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing.

products. These agents bind tetracycline in the intestine and reduce its absorption into the body. Tetracycline may enhance the activity of the blood thinner, warfarin (Coumadin), and result in excessive "thinning" of the blood, necessitating a 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

Classification

Mode of Action

Indication Contraindication

Dosage

Side effects/ Adverse reactions

Drug Interaction

Nursing Responsibilities

c e l e c o x i b

C e l e b r e x

Celecox Celecoxib Acute PainContraindicated ib is a blocks the in patients who nonster enzyme are oidal that makes hypersensitive antiinfl prostaglan to any ammato dins component of ry drug (cyclooxyg this product. (NSAI enase 2), D) that resulting is used in lower to treat concentrati arthritis ons of , pain, prostaglan menstru dins. As a al consequen cramps, ce, and inflammati colonic on and its polyps. accompan ying pain, fever,

200 Headache, - Concomitant use of mg 1 abdominal pain, celecoxib with aspirin tab, dyspepsia, or other NSAIDs may OD diarrhea, nausea,increase the flatulence, and occurrence of insomnia. Other stomach and intestinal side effects ulcers. include fainting, - Fluconazole kidney failure, (Diflucan) increases heart failure, the concentration of aggravation of celecoxib in the body hypertension, by preventing the chest pain, elimination of ringing in the celecoxib in the liver. ears, deafness, - Celecoxib increases stomach and the concentration of intestinal ulcers, lithium (Eskalith) in bleeding, the blood by 17% and blurred vision, may promote lithium anxiety, toxicity. photosensitivity, - Persons taking the

swelling and tenderness are reduced. Celecoxib differs from other NSAIDs in that it causes less inflammati on and ulceration of the stomach and intestine (at least with shortterm use) and does not interfere with the clotting of blood

weight gain, water retention, flu-like symptoms, drowsiness and weakness.

anticoagulant (blood thinner) warfarin (Coumadin) should have their blood tested when initiating or changing celecoxib treatment, particularly in the first few days, for any changes in the effects of the anticoagulant.

NameGeneric

Brand Name

Classification

Mode of Action

Indic Contraindication ation

Dosage

Side effects/ Drug Interaction Adverse reactions

Nursing Responsibilities

L o s a r t a n

L i f e x a r

Losarta Losartan is a n an selective, angiote competitive nsin II Angiotensin II receptor receptor type 1 antagon (AT1) ist drug receptor used antagonist, mainly reducing the to treat end organ high responses to blood angiotensin II. pressur Losartan e administration (hypert results in a ension). decrease in total peripheral resistance (afterload) and cardiac venous return (preload) All of the physiological effects of angiotensin II, including stimulation of release of aldosterone, are antagonized in the presence of losartan. Reduction in blood pressure occurs independently

H y p e r t e n s i o n

Contraindicated in 100 Dizziness, Digoxin, patients who are mg 1 lightheadedness, fluconazole, Do not take any new hypersensitive to tab blurred vision, or lithium, certain medication during therapy any component of a stuffy nose as non-steroidal anti- unless approved by prescriber. this product. your body adjusts inflammatory - Do not use potassium to the medication. drugs (e.g., supplement or salt substitutes If any of these indomethacin), without consulting prescriber. effects persist or potassium-sparing - Take exactly as directed and worsen, notify "water pills" do not discontinue without your doctor or (diuretics such as consulting prescriber. pharmacist amiloride, Preferable to take on an empty promptly. spironolactone, stomach, 1 hour before or 2 Fainting, triamterene), hours after meals. decreased sexual "water pills" - May cause dizziness, ability. Tell your (diuretics such as fainting, or lightheadedness doctor furosemide), (use caution when driving or immediately if potassium engaging in tasks that require any of these supplements (e.g., alertness until response to drug highly unlikely potassium is known); postural but very serious chloride) or salt hypotension (use caution when side effects occur: substitutes, rising from lying or sitting change in the rifampin. position or climbing stairs); amount of urine, diarrhea (boiled milk, stomach/abdomin buttermilk, or yogurt may al pain, severe help). nausea, yellowing - Observe for symptomatic eyes or skin, dark hypotension and tachycardia urine, unusual especially in patients with fatigue, muscle CHF; hyponatremia, high-dose pain. An allergic diuretics, or severe volume reaction to this depletion drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash,

NameGeneric

Brand Name

Classification

Mode of Action

Indication

Contraindica tion

Dosage

Side effects/ Drug Interaction Adverse reactions

Nursing Responsibilities

p a r a c e t a m o l

B i o g e s i c

Analges Inhibits Paracetamol is a Paracetamol ic (pain cyclooxyg suitable substitute should not reliever enase for aspirin, be used in ) and (COX),an especially in hypersensiti antipyre enzyme patients where vity to the tic responsibl excessive gastric preparation (fever e for the acid secretion or and in reducer production prolongation of severe liver ). of bleeding time may diseases. prostaglan be a concern. dins, While which are paracetamol has important analgesic and mediators antipyretic of properties inflammati comparable to on, pain those of aspirin, and fever. its antiinflammatory effects are weak.

500 In rare cases - May need to mg 1 hypersensitivity adjust your tab, reactions, usual dose of every predominantly anticoagulants 4 skin allergy (eg warfarin) if hours (itching and rash), you take may appear. paracetamol Long-term regularly. Check treatment with with your high doses may anticoagulation cause a toxic clinic. hepatitis with Otherwise there following initial are no serious symptoms: interactions nausea, vomiting, between sweating, and paracetamol and discomfort. other drugs. Occasionally a gastrointestinal discomfort may be seen.

NameGeneric

Brand Name

Classification

Mode of Action

Indication

Contraindication

Dosage

Side Drug Interaction effects/ Adverse reactions

Nursing Responsibilities

s a l b u t a m o l

V Bronch Salbutamo -Relief of Patients with a e odilator l produces severe hypersensitivity to n bronchodil bronchospasm any of the t ation associated ingredients and in o through with acute patients with l stimulationexacerbations tachyarrhythmias. i of beta2- of chronic n adrenergic bronchitis and receptors bronchial in asthma bronchial - Treatment of smooth status muscle, asthmaticus thereby - In patients causing refractory to relaxation salbutamol of respiratory bronchial solution muscle fibres.

-Tremor Beta-blockers: Beta- Ensure the patient has no Palpitation adrenergic blocking allergy to it, and there are no Tachycardidrugs, especially the contra-indications with other a noncardioselective medications or conditions. Headache ones, may effectively - Once administered the nurse Peripheral antagonize the action of should observe for any Vasodilata salbutamol, and reactions the patient has to the ion therefore, salbutamol medication, and take Feelng of and nonselective beta- appropriate observations of Tension blocking drugs, such as the patient. propranolol, should not usually be prescribed together.

NURSING THEORIES Theorist Theory Application to the Patient the way care was given to Mr. Mamugz. During Mr. Mamugz’s stay in the hospital, he exhibited symptoms that fall under Abdellah’s 21 nursing problems. To name a few, his diarrhea connected to #8 – “To facilitate the maintenance of fluid and electrolyte balance,” and his complaining behavior towards his food matched with #12 – “To negative expressions, feelings and reactions.” With these problems in to aid the student nurses in prioritizing the interventions given.

Faye Glenn Abdellah's theory of nursing stated that This theory is very applicable in Abdellah it was the “determination of the nature and extent of nursing problem presented by the individual patients or families receiving nursing care”. She says a nursing problem presented by a client is a condition faced by the client or client's family that the nurse, through the performance of professional functions, can assist them to meet. Abdellah's use of term “nursing problems” is more consistent than with those client-centered problems. The apparent contradiction away from the disease-centered orientation. In her attempt to bring nursing practice into its proper 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, from the disease orientation to nursing orientation, while leaving the client somewhere in the middle. client-centered approach, the student nurses were able to focus in caring for Mr. Mamugz in his physical, biological and sociopsychological needs.

with nursing functions or nursing goals identify and accept positive and

can be explained by her desire to move mind, Abdellah’s theory was able

Theorist Lydia Hall

Theory Core, Care and Cure Theory

Application to the Patient

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 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. with conscious selection 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 developing problems through Mamugz was able to cooperate in all 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 Ida

Theory

Application to the Patient Student nurse is finding out the problem and meeting the patient's

Jean Theory: Nursing Process Theory

Orlando

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 / Time August 27, 2009 4:00 pm

Cues Subjective: > “Naa pa ba ko’y tambal nga pain reliever? Sakit man gud ang akuang likod.” [pain scale: 6] >”Dugay dugay na pud ning back pain nako.” > “Katong 40 years old pa ko nagsakit ang akong tangkurog, nagpa-BP ko sa university physician. Unya, ingon niya sa ako, hypertensive daw ko.” Objective: > Grimacing > Age: 59 y.o. > Hypertensive Vital Signs: BP - 150/80 mmHg PR - 98 bpm RR - 20 cpm Temp. – 38.8ºC

Needs C O G N I T I V E P E R C E P T U A L P A T T E R N

Nursing Diagnosis w/ Rationale Chronic Pain r/t muscle strain secondary to hypertension and old age

Objective of Care Within 7 hours span of care, my patient will experience relief R: Muscle strength from pain as deteriorates with age and can evidenced by cause pain with prolonged decreased use; this is worsened by grimacing and hypertension as the verbalization of increased blood pressure decreased pain directly affects the affected with the use of a muscles. pain scale. Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania

Nursing Intervention w/ Rationale 1. Encourage to get adequate rest and sleep ® Pain is minimized when relaxed or asleep 2. Teach how to do deep breathing exercises ® Helps relax the body 3. Assist in guided imagery ® To help divert attention

Evaluation Goal met: August 27, 2009 9:00 pm > Patient was able to verbalize a pain level of 2.

4. Establish and enumerate preferred attention- >Patient was not diverting activities observed to be ® To decrease pain levels by diverting attention grimacing away from pain stimulus by putting more focus on a non-painful stimulus 5. Encourage to participate in massage therapy ® To decrease pain by decreasing muscle tension 6. Encourage to have an exercise program ® To help in strengthening muscles 7. Reposition in bed as preferred ® To help in relaxation of muscles 8. Apply warm compress to affected areas ® To vasodilate blood vessels thus helping in getting rid of any lactic acid accumulation. 9. Administer analgesics as prescribed ® To relieve pain 10. Administer antihypertensive drugs as prescribed ® To decreases blood pressure; helps in lowering pain levels

Date / Time August 27, 2009 4:00 pm

Cues Subjective: (none) Objective: > Skin warm to touch > Sweating > Chills Vital Signs: BP - 150/80 mmHg PR - 98 bpm RR - 20 cpm Temp. – 38.8ºC

Needs N U T R I T I O N A L M E T A B O L I C P A T T E R N

Nursing Diagnosis w/ Rationale Hyperthermia related to release of endogenous pyrogens secondary to underlying disease

Objective of Nursing Intervention Evaluation Care w/ Rationale Within 7 hours 1. Encourage increase in oral fluid intake Goal met: span of care, my ® To decrease the body temperature by patient will be excretion in urination and will prevent August 27, 2009 free from fever as dehydration 9:00 pm evidenced by a 2. Instruct temporary removal of clothing and top R: An underlying disease, temperature sheets - After 6 hours, such as an infection, triggers reading of lower ® To prevent the insulation of body heat temperature was the inflammatory response than 37.5ºC 3. Apply tepid sponge bath 37.4ºC of the body thus increasing ® To lower body temperature by process of the body’s temperature due absorption and evaporation to the release of endogenous 4. Turn to sides frequently pyrogens. ® To prevent insulation of the body heat at the back Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania 5. Instruct to call the attention of nurse once chills develop ® For immediate interventions to be applied 6. Teach watcher how to do tepid sponge bath ® For continuous care 7. Encourage watcher to occasionally fan patient ® To cool down the body temperature 8. Get laboratory results from laboratory technician ® To determine if there is an evident cause of the fever (e.g. infection) 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 / Time August 27, 2009 4:00 pm

Cues Subjective: >“Murag lima ka beses na ko naka libang kaganinang buntag.” >“Dili gahi ang akuang tae… Daghan pud ug tubig.” Objective: > Hyperactive bowel sounds: 21 sounds in one minute. Vital Signs: BP - 150/80 mmHg PR - 98 bpm RR - 20 cpm Temp. – 38.8ºC

Needs E L I M I N A T I O N P A T T E R N

Nursing Diagnosis Objective of Nursing Intervention w/ Rationale Care w/ Rationale Diarrhea related to Within 3 days 1. Reduce intake of solid foods malabsorption in intestines span of care, my ® To allow for reduced intestinal workload secondary to amoebiasis patient will reestablish and 2. Limit foods that contain caffeine and high R: Amoebas secrete maintain normal amounts of fiber enzymes that digest chyme; pattern of bowel ® To prevent aggravation of condition digested chyme does not get functioning as digested by small intestine evidenced by 3. Assist in walking towards bathroom during and this gets excreted from passing of episodes of loose bowel movement the body unformed. formed stools and ® To prevent rushing, accidents and injury decreased number of loose 4. Encourage to increase oral fluid intake Source: Marilynn E. bowel ® To replace lost fluids and prevent dehydration Doenges, APRN, BC, et. al. movements Nurse’s Pocket Guide, 10th 5. Provide for changes in dietary intake ed. © 2006. F.A. Davis ® To avoid foods that precipitate diarrhea Company, Philadelphia, Pennsylvania 6. Promote use of relaxation techniques ® To reduce stress and anxiety which can precipitate bowel movement 7. Provide a bed pan as necessary ® To provide quick access 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

Evaluation Goal partially met: April 30, 2009 4:00pm > Patient verbalized that he has had bowel movements with formed stools already but he still has an average of 5 episodes of bowel movements during daytime.

Date / Time August 27, 2009 4:00 pm

Cues Subjective: >“Dili kaayo ko makatulog kay pirminti lang ko momata para maglibang bisan kadlawon pa na.” Objective: >Sleeping during the afternoon >Awake during the evening Vital Signs: BP - 150/80 mmHg PR - 98 bpm RR - 20 cpm Temp. – 38.8ºC

Needs S L E E P R E S T P A T T E R N

Nursing Diagnosis w/ Rationale Disturbed sleep pattern related to loose bowel movement secondary to amoebiasis R: Amoebas secrete enzymes that digest chyme; digested chyme does not get digested by small intestine and this needs to be excreted from the body no matter what time of day it is. Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania

Objective of Care Within 3 days span of care, my patient will reestablish and maintain normal sleeping pattern as evidenced by reports of improvement in sleep pattern and feeling rested

Nursing Intervention w/ Rationale 1. Arrange care to provide for uninterrupted periods of rest ® To maximize hours of sleep 2. Restrict intake of food or drinks that contain caffeine especially before bedtime ® To prevent prolonged periods of being awake 3. Limit oral fluid intake before bedtime ® To prevent occurence of nocturia 4. Encourage to designate activities to be done only during the day ® To prevent increased stress levels during bed time 5. Recommend not to take naps during the afternoon ® To prevent prolonged hours of being awake 6. Suggest to accomplish as many tasks as possible during the daytime ® To prevent sleeplessness due to an unaccomplished task 7. Encourage to ambulate during daytime ® To avoid increased energy levels during bedtime that will keep patient awake 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

Evaluation Goal met: April 30, 2009 4:00pm > Patient verbalized that he was able to sleep 8 hours straight for the past 3 days

Date / Time August 27, 2009 4:00 pm

Cues Subjective: >“Murag lima ka beses na ko naka libang kaganinang buntag.” >“Dili gahi ang akuang tae… Daghan pud ug tubig.” Objective: > Good skin turgor Vital Signs: BP - 150/80 mmHg PR - 98 bpm RR - 20 cpm Temp. – 38.8ºC

Needs N U T R I T I O N A L M E T A B O L I C P A T T E R N

Nursing Diagnosis w/ Rationale Risk for deficient fluid volume related to loose bowel movement secondary to amoebiasis

Objective of Care Within 3 days span of care, my patient will be free from dehydration as R: Amoeba disrupts evidenced by absorption of water in large good skin turgor, intestine which results to non-sunken eyes passing of watery stools. and maintained weight. Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania

Nursing Intervention w/ Rationale 1. Weigh patient daily ® To assess changes in weight which can determine extent of any fluid loss 2. Encourage to increase oral fluid intake ® To reduce risk of hypovolemia and dehydration 3. Regulate IVF as ordered ® To supplement water intake via intravenous route 4. Monitor intake and output ® To ensure accurate knowledge of fluid status 5. Assess skin turgor and mucous membranes regularly ® To be able to identify if early signs of deficient fluid volume are manifesting 6. Advise to include food that contain high amounts of water in daily meals (e.g. soup, watermelon, etc) ® To maximize hydration of body 7. Control humidity and ambient air if possible ® To reduce high fever and elevated metabolic rate 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

Evaluation Goal met: April 30, 2009 4:00pm >Patient did not have poor skin turgor and sunken eyes.

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 the therapeutic intervention availed by the patient.

progress of

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

Category 1. Duration of Illness 2. Onset of Illness

Poor (1)

Fair (2)

Good (3)

Justification It has been only 5 days since he has been having diarrhea. Mr. Mamugz, 59 years old, is nearly a geriatric patient. Getting sick with amoebiasis poses a big threat to his health.

3. Predisposing Factors 4. Precipitating Factors 5. Willingness to take the medications or compliance to treatment regimen

Location predisposes Mr. Mamugz to getting Amoebiasis Practicing good cleaning of vegetables

would have been the key to avoid getting amoebiasis.

Mr. Mamugz is very willing to take his medications. He knows the good effects of the drug and intravenous therapy. 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 support

that were present in the ward was 3. This number included every member of his family.

4 + 0 + 9 = 13 13/7 = 1.85 Calculations 4x1 = 4 0x2 = 0 3x3 = 9 Ranges: 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.

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