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Liceo de Cagayan University

College of Nursing
R.N.P. Blvd., Carmen Cagayan de Oro City

NCM501x
First Semester
In Partial Requirement for NCM501x

Submitted by:

x)x

x
Table of Contents

I. INTRODUCTION ……………………………………………………

II. PATIENT’S PROFILE ………………………………………………

III. DEVELOPMENTAL TASK …………………………………………

IV. HISTORY OF PRESENT ILLNESS ……………………………….

V. ACTUAL PHYSICAL ASSESSMENT …………………………….

VI. DOCTOR’S ORDERS ………………………………………………

VII. LABORATORY RESULTS ………………………………………...

VIII. DRUGS STUDY ……………………………………………………..

IX. ANATOMY AND PHYSIOLOGY ………………………………….

X. PATHOPHYSIOLOGY ……………………………………………..

XI. IDEAL NURSING MANAGEMENT ……………………………….

XII. ACTUAL NURSING MANAGEMENT …………………………….

XIII. HEALTH TEACHINGS ……………………………………………..

XIV. EVALUATION ……………………………………………………….

XV. PROGNOSIS ………………………………………………………..

XVI. BIBLIOGRAPHY ……………………………………………………
I. INTRODUCTION

Amebiasis is an infection caused by the protozoal organism Entamoeba
histolytica and includes amebic colitis and liver abscess. In developed countries,
infection occurs primarily among travelers to endemic regions, recent immigrants
from endemic regions, homosexual males, immunosuppressed persons, and
institutionalized individuals. Transmission usually occurs by food-borne
exposure, particularly when food handlers are shedding cysts or food is
cultivated in feces-contaminated soil, fertilizer, or water. Less common means of
transmission include contaminated water, oral and anal sexual practices, and
direct rectal inoculation through colonic irrigation devices.

In 1875, in St. Petersburg, Russia, Fedor Losch was credited with the
initial documentation of amebae in stool. Losch described the amebae in the
stool as having a "round, pear shaped or irregular form and which are in a state
of almost continuous motion."

In 1890, Sir William Osler reported the first North American case of
amebiasis, when he observed amebae in stool and abscess fluid from a
physician who had previously resided in Panama.

In 1913, in the Philippines, Walker and Sellards documented the cyst form of
E histolytica as the infective form of the parasite; in 1925, Dobell further
described

Internationally: Entamoeba species infect approximately 10% of the world's
population. The prevalence of infection is as high as 50% in areas of Central and
South America, Africa, and Asia.

E histolytica probably is second only to malaria as a protozoal cause of death.
The prevalence of amebic colitis and liver abscess is estimated at 40-50 million
cases annually worldwide, resulting in 40,000-110,000 deaths.
Asymptomatic intestinal infection occurs in 90-99% of infected individuals.
Most infected individuals eliminate the parasite from the gut within 12 months;
however, colonization with E histolytica carries a low but definite risk of
developing into invasive amebiasis.

Amebic liver abscess is one of the common complication, more common in
men than in women, although the sex distribution is equal in children. Amebic
colitis affects both sexes equally. Young children appear to be at higher risk for
fulminant invasive disease, resulting in a higher mortality rate.
II. PATIENT’S PROFILE

Name: ?
Birthdate: ?
Address: ?
Age: 38 years old
Sex: female
Height: 5’ 4”
Weight: 55 kilograms
Civil Status: Married
Allergy: No known food and drug allergy
Chief complaint: LBM, VOMITING AND FEVER
Diagnosis: Acute Infectious Diarrhea with some dehydration, amoebiasis
Physician: ?
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: College Level
Occupation: ?
Income: 4 thousand plus per month
Name of Spouse: ?
Number of Children: 4
Vital signs: (during the first day of assessment)
BP: 90/870 mmHg
Temperature: 36.5 C
Pulse: 96 bpm
Respiration: 24 cpm
III. DEVELOPMENTAL DATA

ERIK ERICKSON (PSYCHOSOCIAL THEORY)

According to Erik Erickson, Mrs. ? belongs to adulthood stage (30-65years)
since she is 38 years old. The central task for her stage is Generative vs.
stagnation. Care is the virtue during this stage and the task is being creative and
productive and establishing the next generation.
Generative vs. stagnation is the stage which is the person is working and
productive and stable with his\her family. If the person until this stage is not yet
stable with his work and the family. The person is stagnated, person feels that he
is hopeless and is not productive.
In our actual patient Mrs. Tion was 38 years old and she was in the generative
vs. stagnation stage. She married a barangay official and had 4 children which
are still studying. She was working in barangay as a clerk with a monthly income
of 4 thousand plus a month as a source of there physiologic needs. Mrs. ? was
productive and her income was enough for her family. Safety sand security was
being met and happily living with her family with love and care. She has the
confident, determination and moral support with all the respect of her family
which strengthening her self-esteem. Mrs. ? now was still in self-actualization in
the Maslows hierarchy of needs. Important nursing intervention is enhancing
patient’s interpersonal relationship and improve social skills as an important tool
in working in a community.

SIGMUND FREUD ( PSYCHOSEXUAL THEORIES )

Based on Sigmund Freud’s theory, Mr. ?belongs to the Genital Stage (13
years and after) since he is 48 years old already in this stage energy is directed
toward attaining a mature sexual relationship. This stage involves a reactivation
of the pre-genital impulses. These impulses are usually displaced and the
individual passes to the genital stage of maturity. An inability to resolve conflicts
can result in sexual problems, such as frigidity, impotence and the inability to
have a satisfactory sexual relationship obviously, Mrs? is a married and has a
good relationship with her husband because I can see it the way Mrs. ? tell us
abut her family. I can see that she is good at decision making and know how to
handle things, but theirs anxiety right now because of his situation so constant
encouragement need to be done.
HISTORY OF PAST AND PRESENT ILLNESS

A case of ? a 48 year old female, married from ? who was diagnosed with
Intestinal Amebiasis with some Dehydration. Patient had her recent amebiasis
when she was just 2 months old and was hospitalized. Two years after her
hospitalization in 1956, she also had a disease namely scabies. Condition started
a day prior to admission as sudden onset of f LBM, soft to watery, mucoid stools
with vomiting and abdominal pain. The patient started to consult at PHS and had
her stool examination and the result showed that she is positive for Amebiasis.
She then started to take metronidazole 1 tab once daily. Signs and symptoms of
amebiasis still persisted and fainted thus the client sought for admission last
December 3, 2006 at 10 o’clock in the evening. Upon admission the patient’s BP
was 90/70 mmHg and a temperature of 36.5 degrees Celsius. Upon physical
examination there was absence of abdominal pain. She was very weak, her eyes
was sunken, her skin was dry and skin turgor was poor. She emphasized that
she used to eat anywhere.

According to the client, she haven’t completed the immunization during
her younger years. And they use to live near the swampy areas.
PHYSICAL ASSESSMENT
VI. DOCTOR’S ORDER

December 5, 2006
11pm

 Please admit to Female Medical  For further medical management
Ward and monitoring

 TPR every four hours  For baseline data of
interventions and close
monitoring of patients vital signs

 For – CBC, Platelet Count,  CBC- includes absolute number
Fecalysis, Urinalysis of percentages of erythrocytes,
leukocytes, platelets,
hemoglobin and hematocrit in
blood sample. Used to evaluate
potential for infection.

 Fecalysis -It is also called stool
culture. it is obtained when
diarrhea is severe and when
known exposure to enteric
pathogens

 Urinalysis- involves examination
of the urine for the overall
characteristics, such as
appearance, pH, specific gravity,
and osmolality, as well as
microscopic evaluation for the
presence of abnormal cells.

 Star venoclysis of D5LR 1 L 1st  A hypertonic solution that that
300cc at fast drip and remaining exerts a higher osmotic
IVF at 40 drops per minute pressure. Indicated as a source
of water, electrolytes, and
calories or as alkalinizing
agents.

 IVF to follow D5NM 1L at 40  This medication is an
drops per minute intravenous (IV) solution used to
supply water, calories, and
electrolytes (e.g., sodium,
chloride) to the body.
 Ranitidine 50mg every 8 hours
IVTT  Is known as an H2 histamine
blocker. It works by reducing the
amount of acid in your stomach.
To prevent hyperacidity thus
preventing ulceration of the
stomach.
 Metronidazole IV 500mg every 8
hours IVT by piggyback to IVF  Used to treat a variety of
(fast drip run for 30 minutes) infections. It works by stopping
the growth of bacteria and
protozoa.
 Refer accordingly
 To immediately manage any
changes in patient’s condition.

December 6,2006

 IVFTF D5NM 1L at SR  This medication is an
intravenous (IV) solution used to
supply water, calories, and
electrolytes (e.g., sodium,
chloride) to the body.

December 7,2006

 IVFTF with D5NM at same rate  This medication is an
intravenous (IV) solution used to
supply water, calories, and
electrolytes (e.g., sodium,
chloride) to the body.

December 8, 2006

 May Go Home  This indicate that the patient is in
good condition and return to its
functional level.

 Home meds: Metronidazole 1  Used to treat a variety of
tab OD for 1 week infections. It works by stopping
the growth of bacteria and
protozoa.
VII. LABORATORY RESULTS

Dx Exam Result Normal Values Significance of
the Result

COMPLETE BLOOD
COUNT

• WBC 4.0 5.0 – 10.0 /L Infection

• Hgb 12.2 12 – 16 gm/dL Normal

• Hct 35.7 35 – 47 Normal

287,000 150 – 450/cumm Normal
• Platelet Count

39 43.4 – 76.2% Decrease
• Segmenters

60 17.4 – 76.2 % Infection
• Lymphocyytes

01 2-3 Infection
• Eosinophil

FECALYSIS

• Character Browm mucoid Light to dark Normal
brown
• E. Histolytica 0-2 (c-1st) Absent
Presence of
protozoa
• Platelet Count 25-30 hpf 150-450/cumm
Normal

• Red Blood Cells 1-4 Absent
Infection

URINALYSIS

• Transparency Slightly cloudy Clear Normal

• Sugar Negative (-) Normal

• SG 1.005 1.015 – 1.030 Depends on the
collection of the
urine

6.5 4.6 – 7.5 Normal
• Reaction

(-) (-) Normal
• Albumin

1-3 Absent Infection
• Platelet count

0-1 Absent Infection
• Red Blood Cells
• Epithelial
Plenty Absent Infection
VIII. DRUG STUDY

Generic Date Classification Dosage Mechanism of Indication Contraindication Side Effects Nursing
Name ordered Action Precaution
(Brand
Name)

Ranitidine Decem Histamine2 50mg Competitively To Contraindicated Headache, Check the IV
hydrochlori ber 5, (H2) IVTT q8 inhibits the prevent with allergy to dizziness, site first before
de 2006 antagonist hrs action of hyperacid ranitidine. insomnia, administering
histamine at ity thus constipation, the drug.
histamine2 preventin diarrhea,
receptors of g nausea and
the parietal ulceration vomiting.
cells of the of the
stomach, stomach
inhibiting
basal gastric
acid secretion.

Metronidaz Decem Antiamoebic 500mg Synthetic For the Contraindicated vertigo, Monitor signs
ole IV ber 5, every 8 compound treatment in: blood headache, and symptoms
500mg 2006 hours with direct of dyscrasias, restlessness, of sodium
every 8 IVT by trichomocidal amebiasi active CNS weakness, retention
hours IVT piggyba and s and disease, first fatigue, Administer dru
by ck to amebicidal other trimester of drowsiness g before or
piggyback IVF activity against intraabdo pregnancy. after meals.
to IV amoeba and minal Cautious use in:
other diarrheal infections coexistent
diseases. Also . candidiasis,
exhibits alcoholism,
antibacterial hepatic
activity against diseases.
obligate
anaerobic
bacteria,
gram-negative
anaerobic
bacilli and
clostridia.
Microaerophili
c streptococci
and most
aerobic
bacteria are
resistant.
ANATOMY AND PHYSIOLOGY
VIII. PATHOPHYSIOLOGY

Definition:
Amebiasis
 Is caused by transmission by ingestion of fecally contaminated food or
water, or sexually by anal intercourse.
 It is caused by a protozoan called Entamoeba histolytica.
 It is characterized by diarrhea, vomiting and abdominal pain.

Predisposing Factors
 Age (48 years old)
 History of amebiasis at the age of 2 years old

Precipitating Factors
 Environmental factors (lives near the market)
 Improper water sanitation
 Eating of foods anywhere

Clinical Manifestations
 LBM
 Abdominal pain
 Vomiting
 Sunken eyes
 Poor skin turgor
 Dry skin
 (+) Entamoeba histolytica in stool examination result
Schematic Diagram

Ingestion of protozoa
s
(Entamoeba Histolytica)

S/sx: (+)
Invasion in the entamoeba
intestines histolytica in S/E
result

S/sx: Increase
Release of endotoxins gastric
secretions

Inflammation of S/sx:
the intestines - Abdominal
pain
- Fever

Decreased S/sx:
water absorption Increased
intestinal motility

Passage pf Vomiting
S/sx: LBM watery stools

S/sx:
Dehydration -Sunken eyes
-Poor skin turgor
-Dry skin
-Weak in
appearance
XI. IDEAL NURSING MANAGEMENT

NURSING DIAGNOSIS: Fluid Volume, risk for deficient
Risk factors may include;excessive losses through normal routes (severe
frequent diarrhea, vomiting);hypermetabolic state (inflammation, fever)

INTERVENTIONS:

 Monitor I&O. Note number, character, and amount of
stools; estimate insensible fluid losses, e.g., diaphoresis.
 Measure urine specific gravity; observe for oliguria.
 Assess vital signs (BP, pulse, temperature).
 Observe for excessively dry skin and mucous membranes,
decreased skin turgor, slowed capillary refill.
 Weigh daily.
 Maintain oral restrictions, bedrest; avoid exertion.
 Observe for overt bleeding and test stool daily for occult
blood.
 Note generalized muscle weakness or cardiac
dysrhythmias.
 Administer parenteral fluids, blood transfusions as
indicated.
NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements
May be related to Altered absorption of nutrients, Hypermetabolic state
Medically restricted intake; fear that eating may cause diarrhea

INTERVENTIONS:

 Weigh daily.
 Encourage bedrest and/or limited activity during acute
phase of illness.
 Recommend rest before meals.
 Provide oral hygiene.
 Serve foods in well-ventilated, pleasant surroundings,
with unhurried atmosphere, congenial company.
 Avoid/limit foods that might cause/exacerbate abdominal
cramping, flatulence (e.g., milk products, foods high in
fiber or fat, alcohol, caffeinated beverages, chocolate,
peppermint, tomatoes, orange juice).
 Record intake and changes in symptomatology.
 Promote patient participation in dietary planning as
possible.
 Encourage patient to verbalize feelings concerning
resumption of diet.
NURSING DIAGNOSIS: Pain, acute
May be related to
Hyperperistalsis, prolonged diarrhea, skin/tissue irritation, perirectal excoriation,
fissures, fistulas

INTERVENTIONS:

 Encourage patient to report pain.
 Assess reports of abdominal cramping or pain, noting
location, duration, intensity (0–10 scale). Investigate and
 report changes in pain characteristicsNote nonverbal cues, e.g.,
restlessness, reluctance to
move, abdominal guarding, withdrawal, and depression.
Investigate discrepancies between verbal and nonverbal
cues.
 Review factors that aggravate or alleviate pain.
 Encourage patient to assume position of comfort, e.g.,
knees flexed.
 Provide comfort measures (e.g., back rub, reposition) and
diversional activities.
 Cleanse rectal area with mild soap and water/wipes after
each stool and provide skin care, e.g., A&D ointment,
 Sween ointment, karaya gel, Desitin, petroleum jelly.
 Provide sitz bath as appropriate.
 Observe for ischiorectal and perianal fistulas.
 Observe/record abdominal distension, increased
temperature, decreased BP.
 Implement prescribed dietary modifications, e.g.,
commence with liquids and increase to solid foods as
tolerated.
 Administer medications as indicated, e.g.:
Analgesics
ACTUAL NURSING MANAGEMENT

“S”
• “Basa pa gyapon akung tae” , as verbalized by the client

“O”
• dry and pale skin
• weak
• watery stool

“A”
• Fluid volume deficit related to vomiting and watery stools

“P”
• At the end of the shift (8hrs.} the pt. will be able to maintain fluid
volume at a functional level as evidenced by a balanced intake &
output record.

“I”
• Maintained bed rest to prevent vomiting and straining at stool.
• Monitored pt’s intake and output. This provides guidelines for fluid
replacement.
• Provided clear/ bland diet and avoid dark-colored, caffeinated and
carbonated beverages. Caffeine and carbonated beverages stimulates
hydrochloric acid production..
• Administered fluids/ volume expanders as prescribed to replace lost
fluids.
• Administered medications as indicated such as famotidine to reduce
gastric acid production & irritation.

“E”
• Goal partially met. The pt was able to receive adequate fluids
throughout the shift but still claims to have defecated watery stools in a
minimum amount. But other than that, the patient was able to maintain
normal vital signs.

“S”
• “Sakit akong tiyan usahay”, as verbalized by the patient.

“O”
• facial grimace
• moderate pain

“A”
• Pain related to irritation of the gastric mucosa

“P”
• At the end of 30 minutes, the patient will verbalize relief of pain and
demonstrates relaxed body posture.

“I”
• Encouraged pt. to verbalize concerns. Reduction of anxiety can
promote relaxation/comfort.
• Encouraged use of relaxation techniques (deep breathing). Help pt. to
rest more effectively and refocuses attention thereby reducing pain
and discomfort.
• Administered medication as indicated analgesics. Relieves pain,
enhances comfort and promote rest.
• We let the patient applied local massage gently to affected areas.\
helps reduce muscle tension.

“E”
• Goal met. The patient was able verbalize relief of pain and demonstrated a
relaxed body posture and is able to sleep or rest.

“S”
• “Cge lagi ko ug libang-linang:, as verbalized by the pt.

“O”
• dry and pale skin
• weak
• watery stool

“A”
• Diarrhea related to
“P”
• At the end of the shift (8hrs.}pt. will verbalized the relief of diarrhea

“I”
• Monitored vital signs; persistent diarrhea may be a sign of bleeding..
• Restrict foods and fluids that promote diarrhea: raw vegetables,
fruits, whole grain cereals, and carbonated drinks.
• Administered fluids/ volume expanders as prescribed to replace lost
fluids.
• Monitored pt’s intake and output. This provides guidelines for fluid
replacement.
• Increased fluid intake of 2500-3000 mL/day. To assist in improving
stool consistency and helps maintain hydration.

“E”
• Goal was partially met. Patients diarrhea reduces it was no longer
like yesterday. Pt. verbalizes that he was improving of getting well.

“S”
• “Gamay raman ang akong gakan-on kay usahay mawala akong
gana sa pag-kaon”, as verbalized by the patient.
• “Niniwang ko karon” as verbalized by the patient.

“O”
• weight=
• dry and pale skin
• vomitus

“A”
• Altered nutrition less than body requirements related to altered absorption of
nutrients.

“P”
• At the end of two days, the patient will be able to attain an optimum
level of nutrition as evidenced by an increase in appetite and
willingness to eat.

“I”
• Encouraged bedrest and limited activity during illness. Decreasing
metabolic needs and in presenting caloric depletion and conserves
energy.
• Recommended rest before meals. Quiets peristalsis and increases
available energy for eating.
• Provided oral hygiene {gurgle water or brushing teeth}. A clean
mouth can enhance the taste of food.
• Resumeed diet as indicated, e.g. clear liquids, bland, low residue
and high protein and calorie.

“E”
• Goal partially met. The patient was able to show willingness to eat
even though he claimed that he doesn’t have the appetite to eat.

“S”
• Luya paman akong lawas”, as verbalized by the patient.

“O”
• Weak
• ambulates with assistance
“A”
• Activity intolerance related to a decrease in energy due to lack of
appetite

“P”
• At the end of the shift the patient will be able to increase his activity level
and perform activities of daily living.

“I”
• Provided adequate rest periods to preserve energy.
• Facilitated range of motion activities both passive and active to
increase muscle strength.
• Assisted the patient in performing his activities of daily living.
• Instructed patient how to do unfamiliar activities and alternate ways
of doing familiar activities to promote independence.
• Give vitamins as prescribed to facilitate trapped energy within the
cells.

“E”
• Goal partially met. Adequate rest and exercises were provided and
the patient was able to perform her activities of daily living but only to
a minimum level.
DISCHARGE PLANS (HEALTH TEACHINGS)

Medication • It is important to comply regularly its medication as
prescribed by his attending physician and to comply the
entire therapeutic regimen. And explain to the patient the
side effects of the medications so that he will be aware of
its effects.
Exercise • To bring her body back to normal functioning Mrs. Lydia
Tion was advised to do the range of motion exercise
• Active is adviced to enhance recovery.
• Deep breathing exercise with pursued lips.
• Have a regular exercise like walking early in the morning.
Treatment • The patient was instructed to avoid over work for the
following days and must have adequate bed rest
• Boiling the water she drink
• Environmental sanitation to prevent contamination of food
• Water must be boiled
• Proper hand washing
• Lifestyle modification, sensation of smoking and alcohol
consumption.
Out-patient • We Reminded her that she must come back to the
hospital (OPD) one week after, for the follow-up check-up
Diet • Mrs. Lydia Tion was advised to have a low fat and low
cholesterol diet. Eat food that is not too oily. More
emphasize on nutritious foods like fruits and vegetables.
Increase fluid intake 8-10 glasses/day.
• We instructed her to maintain her diet, to eat green leafy
and yellow vegetables that are abundant in their place.
EVALUATION
PROGNOSIS
XV. BIBLIOGRAPHY

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the Interventions, 4th ed. F.A. Davi’s Company Philadelphia USA.

Doenges, M., & Moorhouse M.F Nurse’s Pocket Guide: Nursing diagnosis With
the Interventions, 8th ed. F.A. Davi’s Company Philadelphia USA.

Deglin, J.H & Harvard Vallerand A.H Davi’s Drug guide for Nurses, 8th edition
F.A, Davi’s Company, Philadelphia USA.

Mosby’s Medical and Nursing Dictionary, 2nd ed. The C.V, Mosby Company.
11830 Westline Industrial St. Louis Missouri 63146.

Karch, Amy, 2005, Nursing Drug Guide, Lippincott Williams & Wilkins
Philadelphia, USA

Smeltzer & Bare, medical Surgical Nursing, 10th ed. Vol. 1, Lippincott Williams &
Wilkins, Philadelphia, USA pp.856-857, 581-582

Port, Carol Hattson, concepts of Altered Health Status, 6th ed, lippincott &
Williams, Philadelphia USA, pp.464-465, 583,0634-635

Cotran, et.al, 1999, Pathologic Basis of Disease, 6th ed: WB Saunders
Company, Usa, pp 514, 750-751

Tortora, Grabinski, 2003, Principles of Anatomy and Physiology 10th ed., John
Wiley & Sons