Professional Documents
Culture Documents
Amoebiasis is due to invasion of the intestinal wall by the protozoan parasite Entemoeba
histolytica. Amoebic colitis results from ulcerating mucosal lesions caused by the release of
parasite-derived hyaluronidases and proteases. It refers to infection of man by Entamoeba
hystolytica initially involving the colon but which may spread to other soft tissues organs by
contiguity or by hematogenous or lymphatic dissemination most commonly to the liver and
lungs. (William A. Petri, Jr.)
It is a worldwide parasitic disease. It creates many medical and surgical problems. About
15 to 20 per cent of Indians are affected by the parasite. It can be acute and chronic and can have
intestinal and extra-intestinal manifestations. The causative organism is a protozoa which
remains in the large intestine and can be transmitted to other organs like liver, lungs, brain,
spleen and skin etc. It is transmitted through contaminated food, water and infected human
feces. (Rashidul Haque, Scientist and Head of Parasitology Laboratory)
Amoebiasis can occur at any age. There is no gender or racial difference in the
occurrence of the disease. It is a household infection and the human being is responsible for
spreading the disease. Most of the infected people remain asymptomatic (without symptoms) and
are called as healthy carriers. If one person in a family gets infected with the parasite, other
family members are at the great risk of infection. The human carrier can discharge up to 1.5x107
cysts per day. (Vinod K Dhawan, MD, FACP, FRCPC,)
Pathogenic amoeba which produce condition of a great clinical variations; Acute
Amoebic Dysentery stools contain blood and mucus which may give rise to amoebic hepatitis or
liver abscess, Chronic Amoebic Dysentery with recurrent attack of diarrhea or relatively mild
dysentery, Amoebic Colitis characterized by periods of constipation and diarrhea and episodes of
abdominal discomfort frequently stimulating appendicitis (Mehmet Tanyuksel and William A.
Petri, Jr.)
P. P. a nine year old child residing in Purok 4 Barangay Poktoy Surigao Del Norte was
admitted at Surigao Medical Center last November 6, 2018 at exactly 6:06 am with chief
complain of loss bowel movement and fever of 39.1°c with chills for further management.
Patient P. P was diagnosed Intestinal Ameobiasis with Moderate Dehydration.
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The second year students chose the case of Patient P. P to gain more knowledge and
experience in the field of nursing to establish holistic approach to the S.O and to the patient
promoting for optimal health of the patient’s condition. Enhance critical thinking and skills that
can be useful in the future as to provide appropriate nursing care to our clients. Also this output
will be useful for future purposes related to the case Intestinal Amoebiasis with Moderate
Dehydration.
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Review Related Literature
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less commonly, it spreads to other parts of the body, such as the lungs or brain. The symptoms
are in two forms. First, burrowing the intestines and making ulcers, which bleed and cause
anemia or other disease due to added infection. Second, absorbing the food from the host or
letting out toxic substances in the intestines
The important symptoms of amoebiasis are passing of more number of stools is one of
the main symptom in amoebiasis; the presence of mucus is common in stool and can sometimes
also be accompanied with blood; usually symptoms starts with diarrhea and pain in right
hypochondrium.
It could be associated with a low-grade fever too. Sometimes allergic reactions can occur
throughout the body, due to release of toxic substances or dead parasites inside the intestine.
Loss of Weight and stamina is encountered with person suffering from amoebiasis. Others are
foul smelling stool, loss of appetite, stomach cramp and nausea
Risk Factors:
The risk factors are exposure to contaminated water, poor hygiene, lack of proper
sanitation facilities. Traveling to tropical areas with unsanitary conditions, increases the
likelihood of exposure to this disease. Young or elderly people, who have poor immune function;
such individuals are more likely to develop this disease, because their immune systems are
weaker. Consequently, individuals who lack proper nutrition may have weaker immune systems,
and are more likely to develop Infection due to Entamoeba histolytica, when they consume
contaminated food/water.
Complications:
Fulminant or necrotizing colitis - Acute fulminant necrotizing amebic colitis (FNAC) is a rare
complication of intestinal amebiasis that is associated with high mortality and requires prompt
diagnosis and surgical intervention. (Suhani, Ali S, Thomas S, Aggarwal L., Ann Trop Med
Public Health 2013;6:661-3)
Toxic megacolon- Toxic megacolon is the clinical term for an acute toxic colitis with dilatation
of the colon. The dilatation can be either total or segmental. A more contemporary term for toxic
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megacolon is simply toxic colitis, because patients may develop toxicity without megacolon.
(Clin Colon Rectal Surg. 2010 Dec. 23(4):274-84.)
Bowel perforation- Bowel perforations occur when a hole is made in this lining, often as a
result of colon surgery or serious bowel disease. A hole in the colon then allows the contents of
the colon to leak into the usually sterile contents of your abdominal cavity. (Digestive Diseases
and Sciences. 2017. 62(6):1607-1614)
Gastrointestinal bleeding- Gastrointestinal bleeding refers to any bleeding that occurs in the
gastrointestinal tract, which runs from your mouth to your anus. More specifically, the
gastrointestinal tract is divided into the upper gastrointestinal tract and the lower gastrointestinal
tract. The upper gastrointestinal tract is the section between the mouth and the outflow tract of
the stomach. The lower gastrointestinal tract is the section from the outflow tract of the stomach
to the anus, including the small and large bowel. ( Gastrointestinal Bleeding. Scott Moses, MD.
6/1/2008)
Peritonitis- Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of
the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually
caused by infection from bacteria or fungi.
Left untreated, peritonitis can rapidly spread into the blood(sepsis) and to other organs, resulting
in multiple organ failure and death. (Minesh Khatri, MD, 2017)
Prognosis
In uncomplicated disease, the mortality rate is less than 1% but is much higher in complicated
severe disease - eg, fulminant amoebic colitis, chest involvement or cerebral amoebiasis. More
severe illness occurs in children (especially neonates), the immunosuppressed, malnourished,
pregnancy and postpartum. Recurrence is common if amoebae are not completely eradicated.
The bowel heals rapidly and completely; hepatic abscesses usually disappear within 8 months to
2 years. (Dr. Roger Henderson, 2016)
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Prevention
According to Park’s Textbook of Preventive and Social Medicine, 22nd Edition, Amoebiasis,
219-220, amoebiasis can be prevented and controlled both by non-specific and specific
measures.
Non-specific measures are concerned with:
1.Improved water supply– The cysts are not killed by chlorine in amount used for water
disinfection. Water filtration and boiling are more effective than chemical treatment of
water against amoebiasis.
2.Sanitation–Safe disposal of human excreta coupled with the sanitary practice of
washing hands after defecation and always before handling and consuming food.
3.Food safety– Uncooked fruits and vegetables should be washed thoroughly with safe
water, peel fruits, and boil vegetables prior to eating.Measures should also include the
protection of food and drink from flies and cockroaches and the control of these insects.
Carriers, who pass cysts and are involved in handling food, whether at home, at street
stalls, or in catering establishments, should be actively detected and treated since they are
major transmitters of amoebiasis.
4.Health education of the public as well as health personnel at all levels about sanitation
and food hygiene-Elementary hygienic practices should be propagated and constantly
reinforced in schools, health care units, and the home through periodic campaigns using
the mass media.
5.General social and economic development-The implementation of individual and
community preventive measures (e.g., washing of hands, proper excreta disposal) should
be an essential part of these activities.
Specific measures that should be undertaken when possible are-
1.community surveys to monitor the local epidemiological situation with regard to
amoebiasis;
2.improvement of case management, i.e., rapid diagnosis and adequate treatment of
patients with invasive amoebiasis at all levels of the health services, including the
community and health centre levels;
3.surveillance and control of situations that may encourage the further spread of
amoebiasis, e.g., refugee camps, contaminated public water sources.
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Test and Diagnosis:
Hematology is the science or study of blood, blood-forming organs and blood diseases.
In the medical field, hematology includes the treatment of blood disorders and malignancies,
including types of hemophilia, leukemia, lymphoma and sickle-cell anemia. Hematology is a
branch of internal medicine that deals with the physiology, pathology, etiology, diagnosis,
treatment, prognosis and prevention of blood-related disorders. (Ramanan, 2013)
Stool Exam - A stool analysis is a series of tests done on a stool (feces) sample to help diagnose
certain conditions affecting the digestive tract. These conditions can include infection (such as
from parasites,viruses, or bacteria), poor nutrient absorption, or cancer.
For a stool analysis, a stool sample is collected in a clean container and then sent to the
laboratory. Laboratory analysis includes microscopic examination, chemical tests, and
microbiologic tests. The stool will be checked for color, consistency, amount, shape, odor, and
the presence of mucus. The stool may be examined for hidden (occult) blood, fat, meat fibers,
bile, white blood cells, and sugars called reducing substances. The pH of the stool also may be
measured. A stool culture is done to find out if bacteria may be causing an infection (Wolters
Kluwer Health/Lippincott Williams & Wilkins, 2009.)
Microscopy- Microscopic examination of fresh stool smears for trophozoites that contain
ingested red blood cells (RBCs) is commonly done (see the image below). The presence of
intracytoplasmic RBCs in trophozoites is diagnostic of E histolyticainfection, though some
studies have demonstrated the same phenomenon with E dispar.
Culture- Cultures can be performed either with fecal or rectal biopsy specimens or with liver
abscess aspirates. Culture has a success rate of 50-70%, but it is technically difficult. Overall,
culture is less sensitive than microscopy.
Xenic cultivation, first introduced in 1925, is defined as the growth of the parasite in the
presence of an undefined flora. This technique is still in use today, using modified Locke-egg
media. Axenic cultivation, first achieved in 1961, involves growing the parasite in the absence of
any other metabolizing cells. Only a few strains of E dispar have been reported to be viable in
axenic cultures.
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Medication/Treatment:
Several antibiotics are available to treat amebiasis. Treatment must be prescribed by a
physician. You will be treated with only one antibiotic if your E. histolytica infection has not
made you sick. You probably will be treated with two antibiotics (first one and then the other) if
your infection has made you sick. (Centers for Disease Control and Prevention).
Gastrointestinal amoebiasis is treated with ranitidine is for treatment and prevention of
heartburn, acid indigestion, and sour stomach and prophylaxis of GI hemorrhage from stress
ulceration. Ceftriazone is for indicated in patients with neurologic complications, carditis and
arthritis. It is also effective in Gram negative infections; Meningitis, Gonorrhea. It is also for
Bone and joint infections, Lower respiratory tract infections, middle ear infection, PID,
Septicemia and Urinary Tract infections. Metronidazole is for acute infection with susceptible
anaerobic bacteria and acute intestinal amoebiasis. Bacillus Clausii is for acute diarrhea with
duration of ≤14 days due to infection, drugs or poisons and chronic or persistent diarrhea with
duration of >14 days. ( Wolters Kluwer, 2016)
Prevalence
Epidemiology
Worldwide, approximately 50 million cases of invasive E histolytica disease occur each
year, resulting in as many as 100,000 deaths. This represents the tip of the iceberg because only
10%-20% of infected individuals become symptomatic. The incidence of amebiasis is higher in
developing countries.
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Earlier estimates of E histolytica infection, based on examination of stool for ova and
parasites, are inaccurate, because this test cannot differentiate E histolytica from E dispar and E
moshkovskii. In developing countries, the prevalence of E histolytica, as determined by enzyme-
linked immunosorbent assay (ELISA) or polymerase chain reaction (PCR) assay of stool from
asymptomatic persons, ranges from 1% to 21%. On the basis of current techniques, it is
estimated that 500 million people with Entamoeba infection are colonized by E dispar.
The prevalence of Entamoeba infection is as high as 50% in areas of Central and South
America, Africa, and Asia. E histolytica seroprevalence studies in Mexico revealed that more
than 8% of the population were positive. In endemic areas, as many as 25% of patients may be
carrying antibodies to E histolytica as a result of prior infections, which may be largely
asymptomatic. The prevalence of asymptomatic E histolytica infections seem to be region-
dependent; in Brazil, for example, it may be as high as 11%.
In Egypt, 38% of individuals presenting with acute diarrhea to an outpatient clinic were
found to have amebic colitis. A study in Bangladesh indicated that preschool children
experienced 0.09 episodes of E histolytica -associated diarrhea and 0.03 episodes of amebic
dysentery each year. In Hue City, Vietnam, the annual incidence of amebic liver abscess was
reported to be 21 cases per 100,000 inhabitants.
An epidemiologic study in Mexico City reported that 9% of the population was infected
with E histolytica in the 5-year to 10-year period preceding the study. Various factors, such as
poor education, poverty, overcrowding, contaminated water supply, and unsanitary conditions,
contributed to fecal-oral transmission.
Several studies have evaluated the association of amebiasis with AIDS. The impact of
the AIDS pandemic on the prevalence of invasive amebiasis remains controversial. Some reports
suggest that invasive amebiif leasis is not increased among patients with HIV infection; however,
others suggest that amebic liver abscess is an emerging parasite infection in individuals with HIV
infection in disease-endemic areas, as well as in non–disease-endemic areas.
Of 31 patients with amebic liver abscess at Seoul National University Hospital from 1990
to 2005, 10 (32%) were HIV-positive. In a case-control study of persons seeking voluntary
counseling and testing for HIV infection, homosexual activity, fecal-oral contamination, lower
educational achievement, and older age were associated with increased risk of amebiasis.
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CLIENT HEALTH HISTORY
A. Client Profile
P. P. is a 9 year old boy, catholic, Filipino child, born on November 28, 2008. Currently
living with his family at Purok 4 Barangay Poktoy Surigao del Norte, a grade three
elementary pupil at the Clavero Memorial Elementary School. Major reason for seeking
health care is due to a fever of 39.1°c with presents chills and a loss of bowel movement
on the morning of November 6, 2018.
Treatments/Medications:
Prescribed: none
OTC: Cherifer as his vitamins taken everyday
Past Illness/Hospitalization
Diarrhea at 8 months old hospitalized at Surigao Medical Center
Allergies
No known food allergies and drug allergies except on to wild grasses
B. DEVELOPMENTAL HISTORY
Developmental milestone the pt. is Industry vs. Inferiority. Describes that he enjoys his
life being as a child and he wanted to be a policeman in the future. Describes relationship
with his parents and siblings as close and sharing, active in school activities and living
with his parents.
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D. NUTRITONAL METABOLIC PATTERN
SO stated that the patient’s usual meals are canned goods and he doesn’t like to eat any
kind of vegetables. Before that he was admitted, he would take his breakfast 7 in the
morning with a cup of milk, have lunch during noon, will have a dinner mostly 8 in the
evening and drinks up to five glasses of water per day. As of his current situation, patient
losses his appetite and will only have a banana as his meal. Patient can consume almost
two liters of water per day.
E. ELIMINATION PATTERN
Bowel habits: 2 times a day brown, soft and form stool.
Bladder habits: Voids 5-6 times per day, clear yellow urine. Doesn’t have current
problems like dysuria, hematuria, incontinence but sometimes experience nocturia mostly
when excessive activities during the day.
G. SEXUALITY-REPRODUCTION PATTERN
A child becoming more aware of his body, possibly developing secondary sex
characteristics. He is independently starts wanting privacy when going to toilet or
shower. Curious about sexuality and play with the same age.
H. SLEEP-REST PATTERN
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Goes to bed at 8 pm. Doesn’t have any difficulty falling asleep or sleeping. Feels well
rested when he rises at 6 in the morning. Never uses sleep medications.
I. SENSORY-PERCEPTUAL PATTERN
Vision: Doesn’t have any difficulty in his vision
Hearing: Doesn’t have any difficulty in hearing
Smell: Doesn’t have difficulty with smell, pain, postnasal drip, sneezing and nosebleed
Touch: no difficulty in touching
Taste: no difficulty tasting foods
J. COGNITIVE PATTERN
Speech clear without slur or stutter and follows verbal cues. He can recall past weekly
events. Learn best by studying at school then reviewing it to their house. Makes major
decision jointly with his parents.
K. ROLE-RELATIONSHIP PATTERN
Client is the second child and only son in his family. Has a good relationship with his
siblings and parents. No conflict in any person in their community.
L. SELF-PERCEPTION-SELF-CONCEPT PATTERN
Describe his self as a friendly and happy person and likes outdoor activities such as
playing basketball with his friends at their Barangay gymnasium. He stated that his
condition is now getting well and recovered.
M. COPING-STRESS TOLERANCE
The major stressors in his life are the house hold chores and the bullies at school. He
copes up with his stress through playing basketball and computer games.
N. VALUE-BELIEF PATTERN
A Roman Catholic child and attended mass every Sunday with his family. He believes
that Jesus Christ is our savior and prayer is the only communication through God.
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PHYSICAL EXAMINATION
Properly groomed, alert and cooperative. Sitting comfortably on bed conscious, oriented,
with sunken eyeballs, febrile, appears fatigue, thin and has dry skin. Hooked with an IVF of D5
0.3 NaCl 500cc @ 20gtt/min at left cephalic vein and infiltration noted. Abrasion wounds
located at both anterior tibia with pus.. Ht: 4’5 ft, Wt: 48 lbs, Apical pulse: 85, Resp: 16, Temp:
38 C.
Alert and awake with eyes open and looking at the examiner; client responds
appropriately. Oriented to time and place and also oriented to people around. Able to recall when
and who visits a while ago for immediate memory. Can recall his name. Attentive and able to
memorize, think, read, reason and pay attention. Takes incoming information and move it into
the bank of knowledge.
Skin
Skin is brown, warm and dry to touch. Poor skin turgor noted. Abrasion wound located at
both anterior tibia with pus upon inspection. No edema. No scalp lesions or flaking.
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Eyes
Eyeballs are sunken. Eyebrows sparse with equal distribution. No scaliness noted. Lids
brown, without edema, or lesions noted. Sclera without increased vascularity or lesions noted.
Palpebral and bulbar conjunctiva pale without lesions noted. Irises uniformly black. Pupils are
equally round and react to light and accommodation (PERRLA).
Auricle without deformity, lumps or lesions. Auricles and mastoid processes non-tender.
Auricle aligned with outer canthus of eye about 10 degree from vertical. Pinna recoils after it is
folded.
Whisper test: Client identifies words clearly. Nose is symmetrical and straight upon palpation.
Nares patent. No tenderness, masses, and displacement of bone cartilages. No redness, swelling,
and abnormal discharge on the nasal mucosa.
Lips are pale and dry to touch, cracked lips. Intact teeth and no teeth anomalies upon
inspection. Tonsils appear to be normal. No swelling on uvula.
Neck
Neck symmetrical without masses and scars. Lymph nodes are non-palpable. Trachea is
in center placement in midline of neck.
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Arms are equal in size and symmetry bilaterally; brown; warm and dry to touch without
edema, bruising, or lesions noted. No lesions and bruising on hands. Three flexion creases
present in palm. Fingernails are finely cut, clean and clear. No clubbing.
Posterior and Lateral Chest
Posterior lateral diameter is 1:2 ratio. Respiration rate is 16 cpm. Symmetrical expansion
on posterior thorax.
Anterior Chest
Chest symmetry is equal. Anterior lateral diameter is 1:2 ratio. Shape and position of
sternum is level with ribs. Position of trachea is in midline. No pain or tenderness in the anterior
thorax. Symmetrical expansion on anterior thorax.
Breasts (Male)
Skin is the same color as the abdomen/back. No swelling, ulcerations, or nodules noted.
Flat disk of undeveloped breast tissue under nipple noted.
Heart
Apical pulse rate is 85 bpm. No gallops or murmurs, or rubs.
Abdomen
Vomits and visceral pain noted in the umbilical region with the pain scale rate of 7 out of
10. Abdomen is uniform in color upon inspection. No rashes or lesions. No evidence of
enlargement of liver and spleen upon inspection and palpation. Navel is protruding. Hyperactive
sounds were heard due to GI disturbance.
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Genitalia (Male)
No bulging or masses in inguinal area. No discharge. No pubic hair. Not yet circumcise
Muscoloskeletal and Neurologic examination
Muscle strength 4/5. No edema noted at both lower extremities. Active resistive range of
motion against some resistance noted. No deviations, inflammations, or bony deformities. Moves
upper and lower extremities freely against gravity and against resistance. Pt. is alert and awake
with eyes open and looking at the examiner; client responds appropriately. Oriented to time and
place and also oriented to people around. Able to recall when and who visits a while ago for
immediate memory. Can recall his name. Attentive and able to memorize, think, read, reason and
pay attention. Takes incoming information and move it into the bank of knowledge.
Cereberal and motor function: Alternates finger to nose with eyes closed; occasionally tends to
hit opposite side of nose. Rapidly opposes fingers to thumb bilaterally without difficulty.
Alternates pronation and supination of hands rapidly without difficulty. Heel to shin intact
bilaterally. Walks steady. No involuntary movements noted.
Sensory status: Superficial light- and deep-touch sensation intact on arms, legs, neck, chest, and
back. Position sense of toes and fingers intact bilaterally.
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Cranial Nerve Assessment
Cranial Nerve Name Result
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XI Spinal Accessory Patient can move his neck
REVIEW OF SYSTEMS
General Survey
The usual weight of the client is 26kg upon hospitalization, after 3 days of hospitalization
the patient’s weight decreased from 26kg to 24kg. A sunken eyeball, febrile, appears fatigue, thin
and dry skin noted upon assessment.
Integumentary System
Skin is brown, warm and dry to touch. Poor skin turgor noted. Abrasion wound located at the
both anterior tibia with pus. No edema. Healthy black hair and evenly distributed on the scalp.
No scalp lesions or flaking. No hair noted on axilla, or on chest, back or face. Fingernails are
finely cut, clean and clear. No clubbing.
Eyes: Eyeballs are sunken. Eyebrows sparse with equal distribution. No scaliness noted. Lids
brown, without edema, or lesions noted. Sclera without increased vascularity or lesions noted.
Palpebral and bulbar conjunctiva pale without lesions noted. Irises uniformly black. Pupils are
round and react to light and accommodation.
Ears: Auricle without deformity, lumps or lesions. Auricles and mastoid processes non-tender.
Auricle aligned with outer canthus of eye about 10 degree from vertical. Pinna recoils after it is
folded.
Whisper test: Client identifies words clearly.
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Nose: Nose is symmetrical and straight upon palpation. Nares patent. No tenderness, masses, and
displacement of bone cartilages. No redness, swelling, and abnormal discharge on the nasal
mucosa.
Gastrointestinal System
Visceral pain in the umbilical region with the pain scale rate of 7 out of 10. Abdomen is uniform
in color upon inspection. No rashes or lesions. No evidence of enlargement of liver and spleen
upon inspection and palpation. Navel is protruding. Hyperactive bowel sounds with the count of
10 were heard due to GI disturbance. Vomits, diarrhea for 2 days, and stools had soft mucoid
with blood streaks.
Muscoloskeletal System
Muscle strength 3/5. No edema noted at both lower extremities. Active resistive range of motion
against some resistance noted. No deviations, inflammations, or bony deformities. Moves upper
and lower extremities freely against gravity and against resistance. The child cannot be able to
perform ADLS.
Neurologic System
Alert and awake with eyes open and looking at the examiner; client responds appropriately.
Oriented to time and place and also oriented to people around. Able to recall when and who visits
a while ago for immediate memory. Can recall his name. Attentive and able to memorize, think,
read, reason and pay attention. Takes incoming information and move it into the bank of
knowledge. Alternates finger to nose with eyes closed; occasionally tends to hit opposite side of
nose. Rapidly opposes fingers to thumb bilaterally without difficulty. Alternates pronation and
supination of hands rapidly without difficulty. Heel to shin intact bilaterally. Walks steady. No
involuntary movements noted. Superficial light and deep-touch sensation intact on arms, legs,
neck, chest, and back. Position sense of toes and fingers intact bilaterally.
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Urinary Systems
Patient has no history of any urinary tract infection. No pain in urination. No discharge.
Hematologic
Patient had leukocytosis (High WBC) and thrombocytosis (High platelet count), and decreased
iodized calcium upon admission (November 6, 2018). Positive anemia and blood streak in stool.
No bruising.
WHITE 11.1 4.5-10 10^9/L Increased Infection
BLOOD
CELLS
PLATELET 545 150-450 10^9/L Increased Thrombocyto
COUNT sis
Endocrine
Diaphoresis was present. No polyuria. Child has loss of appetite
Psychiatric
No signs of depression, memory change, or suicide attempts.
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LABORATORY RESULTS
HEMATOLOGY
COMPLETE BLOOD COUNT
November 6, 2018
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MCH 26.2 29 ± 2 pg Decrease Anemia
PLATELET 545 150-450 10^9/L Increased Thrombocytosis
COUNT
RDW 13.9 11.6-14.6 % Normal
WHITE BLOOD 11.1 4.5-10 10^9/L Increased Infection
CELLS
ANALYSIS:
The result of the exam with the platelet count 545 caused by several conditions, including
anemia, inflammation and infection in the GI tract. Elevated white blood cell counts of 11.1 are
infections and inflammation. Lymphocyte count decreased to 7.4 that may indicate
lymphocytopenia. Segmenters and mid cells increased that respond to a bacterial infection.
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HEMATOLOGY
November 7, 2018
ANALYSIS:
Lymphocyte count increased from previous day 7.4 to 11.9 but still below normal that
may indicate lymphocytopenia. Segmenters and mid cells increased that respond to a bacterial
infection.
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BLOOD CHEMISTRY
NOVEMBER 7, 2018
Analysis
The result shows decreased sodium counts of 134.4, for the amount of fluid contains is less or
the sodium in the body may be diluted because often the body retains more fluid than sodium,
which means the sodium is diluted. The patient is having diarrhea that causes its potassium level
decreased to 3.30 lost in the digestive tract. Iodized calcium decreased to 0.97 because of
abnormal level in the blood protein malabsorption of calcium, vitamin d, phosphorous and
magnesium deficiency.
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URINALYSIS
NOVEMBER 6, 2018
Analysis
Urinalysis shown normal urine color amber and slightly hazy a decrease urine specific
gravity it is less precise than urine osmolality and reflects both the quantity and the nature of
particles. Therefore, protein, Glucose, and intravenous contrast agent specific gravity than
osmolality. Urine is a good medium for growth of bacteria that’s why urine ideally performed on
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fresh specimen preferably the first voiding. If left standing at room temperature urine become
alkaline because of contamination of urea-splitting bacteria.
STOOL EXAM
November 6, 2018
Analysis:
Stool exam show a brownish in color which it contains a pigment called bilirubin, which
forms when red blood cells break down. Soft mucoid with blood streak indicates of blood
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entering the lower portion of the GI tract or passing rapidly through it. WBC decreased because
of infection and has a few bacteria in the stool of the patient.
TYPHOID TEST
November 7, 2018
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Anatomy and Physiology
Mouth The mucosal layer of the mouth is composed of stratified squamous epithelial cells. These
cells slough off during normal food chewing and are easily replaced. The mouth functions to
break down food into smaller parts.
Tongue ‐ a muscle that is covered by taste buds. It also assists with the process of chewing, and
helps to maneuver food to a position where it can be swallowed easily.
Salivary glands ‐ these glands produce saliva, which moistens food to assist with swallowing.
The salivary glands also begin the process of chemical digestion through the secretion of the
enzyme, salivary amylase, which begins the process of breaking down carbohydrates. Lingual
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lipase in saliva is responsible to begin digestion of fats. Ptyalin and salivary amylase begin the
digestion of starch and maltose. Additionally, the saliva is composed of mucous to facilitate
swallowing and Immunoglobulin A (IgA) which consists of antibodies that fight bacteria and
viruses.
Teeth ‐ teeth mechanically break food down into smaller particles for easier swallowing and
ingestion Pharynx ‐ allows the passage of both food and air (Scanlon, 2011).
Esophagus The esophagus is the “food tube” that allows the passage of the food bolus from the
mouth to the stomach. It plays no part in the digestive process.
The esophagus only produces mucus, which acts to:
• Facilitates the passage of food
• Lubricate and protect the esophagus
At the lower end of the esophagus is the gastroesophageal or cardiac sphincter. This sphincter
prevents reflux of gastric contents into the esophagus. Increased gastrin secretion and certain
drugs that increase parasympathetic activity influence the patency of this sphincter. Cigarettes
and alcohol decrease the sphincter’s tone and increase the potential for reflux here as
well. Blood supply to the esophagus comes via the left gastric artery (Scanlon, 2011).
Stomach
The uppermost regions of the stomach are the cardiac region and the fundus, which lead into the
body of the stomach. The antrum is the lower segment of the stomach, leading into the most
distal part of the stomach, known as the pylorus. At the base of the pylorus is the pyloric
sphincter, which allows the passage of chyme into the small intestine.
The stomach functions to store, churn, and puree food into a substance known as chyme:
• Digestion of fats and starches begin in the mouth with the action of salivary enzymes, and
continues in the stomach.
• Protein digestion begins in the stomach.
• There is some digestion of water, alcohol, and glucose in the stomach. Additionally, gastric
acid is produced in the stomach which destroys most bacteria that is ingested with food.
29
Gastric juices are secreted by the cells of the stomach, contributing to chemical digestion. The
food ends up in semi‐ liquid form that is called chyme.
The stomach functions to store, churn, and puree food into chyme:
Digestion of fats and starches begin in the mouth with the action of salivary enzymes, and
continues in the stomach. Protein digestion begins in the stomach. There is some digestion of
water, alcohol, and glucose in the stomach. Additionally, hydrochloric (or gastric) acid is
produced in the stomach, which destroys most bacteria that is ingested with food. Food usually
remains in the stomach for three to four hours for the process of breakdown (Krumhardt &
Alcamo, 2010).
Gastric Cells
There are several types of cells in the stomach that serve both protective and digestive
functions:
• Goblet cells: Are typically mucus secreting cells. Their role in the stomach is protective in
nature.
• Parietal cells: Secrete hydrochloric acid which lowers the pH of the stomach to destroy
bacteria, viruses, and other organisms. The hydrochloric acid also changes pepsinogen into
pepsin and intrinsic factor. These two substances aid in vitamin B12 absorption.
• Chief cells: Secrete pepsinogen, which helps to change ingested proteins into amino acids.
• G cells: Located in the antrum of the stomach, which is lined by mucosa that does not
produce acid. The G cells secrete the hormone, gastrin. Gastrin secretion is stimulated by
stomach distention, presence of protein in the stomach, vagal stimulation, elevated blood
levels of calcium and epinephrine, and decreased acidity. Gastrin helps the gastric mucosa
grow and repair itself. It stimulates the secretion of hydrochloric acid by the parietal cells and
pepsin by the chief cells. Many drugs that prevent the formation of gastric ulcers work in this
30
area of the stomach. Gastrin also increases the flow of bile and decreases gastric emptying
(Krumhardt & Alcamo, 2010).
31
Small Intestine
The small intestine extends from the pylorus to the ileocecal valve. The small intestine is
composed of the duodenum, jejunum, and ileum. The ligament of Treitz divides the duodenum
from the jejunum. Upper gastrointestinal bleeding occurs above this ligament and lower
gastrointestinal bleeding occurs below this ligament.
The primary function of the small intestine is the absorption of vitamins and nutrients, including
electrolytes, iron, carbohydrates, proteins, and fats. Most digestion of nutrients happens here.
The small intestine also absorbs approximately 8,000 milliliters (mL) of water per day (Barron,
2010). Three thousand milliliters of digestive enzymes are secreted in the small intestine daily.
Intestinal Hormones
The mucosa in the intestines also contains hormones. These include (Barron, 2010):
Enterogastrone: Found in the duodenal mucosa. Inhibits gastric acid secretion and gastric
motility. Gastric inhibitory polypeptide (GIP): Found in the duodenal and jejunal mucosa.
Inhibits gastric acid secretion, pepsin secretion, and gastric motility.
32
secretion. Cholecystokinin (CCK): Found in the jejunal mucosa. Stimulates contraction of the
gallbladder and secretion of pancreatic enzymes, and inhibits gastric motility.
Vasoactive intestinal peptide (VIP): Found in intestinal mucosa. Similar effects as secretin,
stimulates production of intestinal secretions that decrease chyme acidity, and inhibits gastric
secretion. Somatostatin: Found in the intestines. Inhibits secretion of gastric acid, saliva, pepsin,
intrinsic factor, and pancreatic enzymes. Inhibits gastric motility, gallbladder contraction,
intestinal motility, and blood flow to the liver and intestine. Also inhibits secretion of insulin and
growth hormone.
Large Intestine
The large intestine extends from the terminal ileum at the ileocecal valve to the rectum. At the
terminal ileum, the large intestine becomes the ascending colon, the transverse colon, and then
the descending colon. Following the descending colon is the sigmoid colon and the rectum
(Scanlon, 2011). The main function of the large intestine is water absorption. Typically, the large
intestine absorbs about one and one‐ half liters of water per day. It can, however, absorb up to six
liters. The large intestine also absorbs potassium, sodium, and chloride. It produces mucous
which lubricates the intestinal wall and holds the produced feces together for elimination. The
superior and inferior mesenteric arteries and the hypogastric arteries supply the blood supply to
the large intestine. Innervation of the intestine is the same as for the stomach (Scanlon, 2011)
Gallbladder
33
The gallbladder is a pear‐shaped, sac‐like organ attached to the liver that serves as a storage
facility for bile. It can hold and concentrate approximately 50 mL of bile. The cystic duct
connects the gallbladder to the common bile duct, which terminates at the Sphincter of Oddi in
the duodenum of the small intestine. When a large or fatty meal is consumed, nerve and chemical
signals (release of the enzyme CCK) cause the gallbladder to contract. This contraction releases
bile into the digestive system. The gallbladder receives blood from the cystic and hepatic artery
and is innervated by the splanchnic nerve and the right branch of the vagus nerve (Scanlon,
2011).
Bile & Bile Pigments
Bile has three major components:
• Water
• Bile salts
• Bile pigments Bile salts absorb and emulsify fats and fat‐soluble vitamins (A, D, E, &
K). Bile pigments are composed primarily of bilirubin, cholesterol, and
phospholipids. Bilirubin is the by‐product of hemolysis (Scanlon, 2011).
Direct‐Bilirubin ‐ Conjugated or direct bilirubin: This is bilirubin that has been taken up by the
liver cells and conjugated to form the water‐soluble bilirubin diglucuronide. Most conjugated
bilirubin ends up in bile. Total bilirubin is the indirect plus the direct bilirubin. When total
bilirubin is elevated and the cause is unknown, direct and indirect bilirubin should be measured
(Krumhardt & Alcamo, 2010)
Liver
34
The liver is a very large organ located in the upper right abdomen. There are right, left, and
caudate lobes of the liver. Each of these lobes is further sub‐divided into eight segments. These
segments can be resected during surgery if diseased or traumatized. The functional unit of the
liver is the lobule or the acinus. Blood supply to the liver arises from both the portal vein and
hepatic artery. Nearly one‐quarter of our cardiac output is delivered through the liver per minute,
most of which travels through the portal vein. The blood is filtered through the Kupffer cells of
the liver, which destroy debris and unwanted organisms (Scanlon, 2011).
Although there are literally hundreds of functions of the liver, the main functions can be
categorized into five groups:
1. Conjugation of bilirubin
• Bilirubin is typically formed from the destruction of red blood cells. Conjugation or
conversion to the water‐soluble form of bilirubin occurs in the liver. The kidneys can
excrete this form of bilirubin.
• Patients with liver dysfunction are often jaundiced due to the accumulation of bilirubin
in the body.
2. Synthesis and deactivation of clotting factors
• Produces all Vitamin K dependant clotting factors including II, VI, VII, IX, and
X.
• Removes activated clotting factors and produces heparin which prevents too much
clot formation in the body.
• Patients with nutritional problems have abnormal clotting mechanisms and may
develop thrombocytopenia.
3. Detoxification of hormones, ammonia, and drugs
• Converts many fat‐soluble drugs and substances into a water‐soluble form that can be
excreted from the body in the urine.
• Patients with liver dysfunction may manifest inability to excrete certain drugs,
ammonia, and hormones.
4. Phagocytosis
35
• Seventy percent of the body’s total macrophages are in the liver in the form of
Kupffer Cells.
• Patients with liver dysfunction have a poor immune response. 5. Carbohydrate,
protein, and fat metabolism
• Maintains normal serum glucose levels by carbohydrate synthesis, metabolism, and
transport.
• The liver allows the body to use essential nutrients effectively, even if the nutrients
are artificially supplied through partial parental nutrition (PPN) or total parental nutrition
(TPN). So, giving a patient with liver failure TPN or PPN may not correct their
nutritional deficits.
• Patients with liver dysfunction have extreme nutritional deficits. (Scanlon, 2011)
Pancreas
The pancreas is both an endocrine and exocrine gland. The endocrine functions include
the production of:
• Insulin
• Glucagon
• Somatostatin (see also the RN.com course on Endocrine Anatomy and Physiology)
The exocrine function of the pancreas is mainly digestive in nature, and involves the
secretion of pancreatic enzymes and bicarbonate.
The major digestive enzymes secreted by the pancreas are:
• Trypsin
• Lipase
• Amylase
These enzymes help digest carbohydrates, proteins, and fats. They are normally secreted
into the duodenum in their inactive form. Once in the duodenum they are converted to
their active form and begin the digestive process. Bicarbonate is necessary to neutralize
these and other enzymes located in the duodenum. Bicarbonate is secreted by the
exocrine pancreas to prevent duodenal ulceration and irritation (Scanlon, 2011).
36
Blood Supply & Innervation of the Pancreas Blood supply to the pancreas occurs via the
hepatic and cystic artery. The pancreas is innervated by the splanchnic nerve and right
branch of the vagus nerve. Vagal (parasympathetic) stimulation results in the secretion
of pancreatic enzymes. These secretions travel through the main pancreatic exocrine duct,
the Duct of Wirsung. This duct terminates next to the common bile duct at the Sphincter
of Oddi (Scanlon, 2011).
Biliary Ducts
While not organs themselves, the ducts of the biliary tract are very important in the
proper functioning of the gastrointestinal system and body as a whole. In the liver, bile
is collected in the bile calculi, which eventually become the left and right hepatic ducts,
which exit the liver as the common hepatic duct. The cystic duct allows stored bile to be
released from the gallbladder. The cystic duct and the common hepatic duct meet to form
the common bile duct, which eventually terminates in the duodenum, next to the Duct of
Wirsung (from the pancreas) at the Sphincter of Oddi (Krumhardt & Alcamo,
2010). Obstruction or damage to any of these ducts may result in the improper drainage
of bile and pancreatic enzymes. Complications can include hepatitis, liver failure,
pancreatitis, cholangitis, cholecystitis, and others (Scanlon, 2011)
37
PATHOPHYSIOLOGY
If left untreated
If infection is severe
Peritonitis
Sepsis
Death
LEGEND:
= Disease Process
= Client Manifestation
= Clinical Manifestation
= Treatment/management
= If Left Untreated
= Death
39
PATHOPHYSIOLOGY:
The predisposing factor of patient P.P are the age, weak immune system and the location
of their residency at Brgy. Poktoy Surigao Del Norte. The precipitating factors are the ingestion
of contaminated food and drinks, unsanitary food handling, poor environment sanitation and
socioeconomic status.
When cyst is swallowed, it passes through the stomach unharmed and shows no activity
while in an acidic environment. When it reaches the alkaline medium of the intestine, the
metacyst begins to move within the cyst wall, which rapidly weakens, tears and start of
inflammation with client manifestation of diarrhea, abdominal pain and hyperthermia. Treatment
for hydration is IVFD o.3 NaCL 500ml, paracetamol, ranitidine and erceflora.
When cyst has opportunity of the organism to colonize and developed in the lower GI
tract it will have clinical manifestation of decreasing integrity of the intestinal wall.
When the invasion of pathogen is detected the sympathetic and parasympathetic
responses and stimulate client manifestation of vomiting, diarrhea and dehydration with
treatment of IVFD5 o.3 NaCI 500ml and erceflora. The clinical manifestation is the decreased of
absorption.
As the progress of invasion grows the platelet, WBC, segmenters, mid cells increased
while lymphocyte decreased with client manifestation of anemia, infection, thrombocytosis,
lymphocytopenia and neutrophilia with management of taking ceftriaxone, zinc sulfate and
metronidiazole.
If left untreated, peritonitis can rapidly spread into the blood(sepsis) and to other organs,
resulting in multiple organ failure and death.
40
Drug Study No. 1
Generic name:
Paracetamol
Brand name:
BIOGESIC
Dosage:
500 mg/tab 1 tab
Route:
Oral
Frequency:
q 4°
Classification
Analgesic ( Non-opioid)
Antipyretic
Mechanism of action
Paracetamol may cause analgesia by inhibiting CNS prostaglandin synthesis. The mechanism of
morphine is believed to involve decreased permeability of the cell membrane to sodium, which
results in diminished transmission of pain impulses therefore analgesia.
Indications
To relieve mild to moderate pain due to things such as headache, muscle and joint pain, backache
and period pains. It is also used to bring down a high temperature. For this reason, paracetamol
can be given to children after vaccinations to prevent post-immunization pyrexia (high
temperature). Paracetamol is often included in cough, cold and flu remedies
41
Contraindications
Hypersensitivity to acetaminophen or phenacetin; use with alcohol
Adverse effect
Hematologic:
Hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia.
Hepatic:
Liver damage, jaundice
Metabolic:
Hypoglycemia
Skin:
Rash, urticuria
Nursing Responsibility
Assess patient’s fever or pain: type of pain, location, intensity, duration, temperature, and
diaphoresis.
Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.
Teach patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever,
sore throat.
Tell patient to notify prescriber for pain/ fever lasting for more than 3 days.
42
Drug Study No. 2
Generic:
Ranitidine
Brand:
ZANTAC
Classification:
Anti-ulcer
Dosage:
50mg/tab 1 tab
Route:
Oral
Frequency:
OD
Mechanism of Action:
Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells,
resulting in inhibition of gastric acid secretion has some antibacterial action against H. pylori
Indications
Treatment and prevention of heartburn, acid indigestion, and sour stomach
Prophylaxis of GI hemorrhage from stress ulceration
Contraindications
Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be
avoided in patients with known intolerance
43
Nursing Intervention
Instruct patient not to take new medication w/o consulting physician
Instruct patient to take as directed and do not increase dose
Allow 1 hour between any other antacid and ranitidine
Avoid excessive alcohol
Assess patient for epigastric or abdominal pain and frank or occult blood in the stool,
emesis, or gastric aspirate
Nurse should know that it may cause false-positive results for urine protein; test with
sulfosalicylic acid
Inform patient that it may cause drowsiness or dizziness
Inform patient that increased fluid and fiber intake may minimize constipation
Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness;
rash; confusion; or hallucinations to health care professional promptly
Inform patient that medication may temporarily cause stools and tongue to appear gray
black
Instruct patients to monitor for and report occurrence of drug-induced adverse reaction
44
Drug Study No. 3
Genenric name:
Ceftriazone
Brand Name:
FORGRAM
Dosage:
450mg/vial
Route:
IVTT
Frequency:
q 12 hours
Classification
3rd generation cephalosporin
Mechanism of Action
Works by inhibiting the mucopeptide synthesis in the bacterial cell wall. The beta-lactam moiety
of Ceftriaxone binds to carboxypeptidases, endopeptidases, and transpeptidases in the bacterial
cytoplasmicmembrane. These enzymes are involved in cell-wall synthesis and cell division. By
binding to these enzymes, Ceftriaxone results in the formation of of defective cell walls and cell
death.
Indication
Indicated in patients with neurologic complications, carditis and arthritis. It is also effective in
Gram negative infections; Meningitis, Gonorrhea. It is also for Bone and joint infections, Lower
respiratory tract infections, middle ear infection, PID, Septicemia and Urinary Tract infections.
45
Contraindications
Hypersensitive to cephalosporins, penicillins and related antibiotics.
Side Effect
• Pain
• Induration
• Phlebitis
• Rash
• Diarrhea
• Thrombocytosis
• Leucopenia
• Respiratory super infections
Nursing Consideration
46
Drug Study No. 4
Generic Name
Metronidazole
Brand Name
FLAGYL
Actual Dose
125mg/5mL,
2.5mL/bottle
Route:
Oral
Frequency:
q 8 hours
Classification
Antibiotic
Antibacterial
Amebicide
Antiprotozoal
Mechanism of action
Inhibits growth of amoebae by binding to DNA, resulting in loss of helical structure, strand
breakage, inhibition of nucleic acid synthesis and cell death.
47
Therapeutic Effects:
Hinders growth of selected organisms, including most anaerobic bacteria and protozoa
Drug Half Life
Indication
Acute infection with susceptible anaerobic bacteria
Acute intestinal amoebiasis
Contraindication
Active organic disease of the CNS
Drug Allergy
Blood dyscrasia
hypersensitivity
hypersensitivity to parabens
first trimester of pregnancy
Precautions
>history of blood dyscrasias; seizures or neurologic problems
>severe hepatic impairment
>pregnancy, lactation and children
Drug interactions
>cimetidine
>phenobarbital
>warfarin
>disulfiram
>fluorouracil
Side effects
Headache,
Nausea,
48
dry mouth,
vomiting,
diarrhea
Adverse Reactions
CNS: seizures, dizziness, headache
EENT: Tearing(topical only)
GI: abdominal pain, anorexia, nausea and vomiting, diarrhea, dry mouth, glossitis
Derm: rashes, urticarial, mild dryness, skin irritation
Hemat: leukopenia
Local: Phlebitis at Iv site
Neuro: peripheral neuropathy
Misc: superinfection
Nursing Responsibilities
Observe the 10 Rs before giving the drug.
Instruct to take drug with food or milk to decrease GI upset
Inform that drug may turn urine brown, don’t be alarmed
Before
>assess pts. Infection
>watch carefully for edema because it may cause sodium retention
>assess skin for severity areas of local adverse reactions
>record number and character of stools
>assess pt’s and family’s knowledge of drug therapy
During
>give drug with meals to minimize GI distress
>to treat trichomoniasis, give drug for 7days instead of 2-g single dose
>use only after T.vaginalis has been confirmed by wet smear
>tablets may be crushed for pt’s. with difficult swallowing
49
>do not use aluminium needles or hubs, color will turn orange/rust
After
>tell pt. that metallic taste and dark or red brown urine may occur
>instruct pt. to take oral form with meals to minimize reactions
>instruct to complete full course of therapy
>tell pt. not to use alcohol or drugs that contain alcohol.
>may cause dizziness/ light headedness
50
Drug Study No. 5
Generic Name:
Bacillus Clausii
Brand Name:
ERCEFLORA
Dosage
1 respule of 2 billion/5ml suspension
Route:
Oral
Frequency:
q 12 hours
Classification:
Antidiarrheals
.
Mechanism of Action
Contributes to the recovery of the intestinal microbial flora altered during the course of
microbial disorders of diverse origin.
Produces various vitamins, particularly group B vitamins thus contributing to correction
of vitamin disorders caused by antibiotics & chemotherapeutic agents.
Promotes normalization of intestinal flora.
Indication:
Acute diarrhea with duration of ≤14 days due to infection, drugs or poisons.
51
Chronic or persistent diarrhea with duration of >14 days.
Contraindication
Not for use in immune compromised patients (cancer patients on chemotherapy, patients taking
immune suppressant meds)
Side/Adverse Effect
No known side/adverse effects
Nursing Consideration
Shake drug well before administration.
Monitor patient for any unusual effects from drug.
Administer drug within 30 minutes after opening container.
Dilute drug with sweetened milk, orange juice or tea.
Administer drug orally.
BEFORE
Shake drug well before administration.
Allows equal distribution of the drug in the fluid it is in.
DURING:
Monitor patient for any unusual effects from drug.
Monitoring allows detection of possible side effects of the drug since there
has been no known side effect of the drug.
AFTER:
Administer drug within 30 minutes after opening container.
To avoid contamination of the drug. Dilute drug with sweetened milk, orange
juice or tea.
To allow easy administration of the drug. Administer drug orally.
Proper administration allows better effects of the drug and prevent possible
complications
52
Drug Study No. 6
Generic name:
Zinc Sulfate
Brand name:
ZINCATE
Classification:
Mineral and electrolyte replacements/supplements
Dosage
10ml/bottle suspension
Route
Oral
Frequency
OD
Mechanism of Action
Serves as a cofactor for many enzymatic reactions. Required for normal growth and tissue repair,
wound healing and sense of taste and smell.
Indication
Dietary supplementation; supplement to IV solutions given for TPN; treatment or prevention of
zinc deficiencies. Ophthalmic solution used as mild astringent for relief of eye
irritation.Treatment of acrodermatitis enteropathica and delayed wound healing associated with
zinc deficiency; treatment of acne, rheumatoid arthritis, Wilson's disease.
53
Contraindication
Direct injection of undiluted solution into peripheral vein.
Adverse effects
Abdominal pain, dyspepsia, nausea, vomiting, diarrhea, gastric irritation, gastritis.
Prolonged use may cause copper deficiency (e.g. sideroblastic anemia, neutropenia)
Nursing responsibility
• Tell patient to contact health care provider if nausea, severe vomiting, dehydration, or
restlessness occurs.
• Identify food sources of zinc (e.g., seafood, organ meats, wheat germ).
• Inform patient that sense of taste and smell, skin hydration, and wound healing should
improve.
54
NURSING CAREPLAN #1
Assessment
Subjective: “ Sige ako kalibang nan basa na tae” as verbalized by the
patient.
Objective:
Body malaise
Sunken eyeballs
Poor skin turgor noted
Fatigue
Loose bowel movement stool had soft mucoid with blood streak
10 times defecate
Decrease urine specific gravity(1.015)
Encouraged fluid intake and monitoring of daily To detect early signs of dehydration.
fluid intake and output.
Estimate or measure traumatic or procedural fluid These factors are used to determine degree of
losses and note possible routes of insensible fluid volume depletion and method of fluid
55
losses. Determine customary and current weight. replacement.
Note change in usual mentation, behavior and These signs indicate sufficient dehydration to
functional abilities ( e.g.;confusion, falling, loss of cause poor cerebral perfusion or can reflect the
ability to carry out usual activities, lethargy ,and effects of electrolyte imbalance. In a hypovolemic
dizziness. shock state, mentation changes rapidly and client
may present in coma.
DEPENDENT
IVF Therapy D5 0.3 NaCl To hydrate and replace the fluid loss
Administer medications (Erceflora, To limit gastric/intestinal losses; to treat
Metronidazole, Ceftriaxone) bacteria.
Evaluation: Goal was met. Client was able to maintain adequate fluid volume as evidence by
good skin turgor and balance intake and output.
56
NURSING CAREPLAN #2
Assessment
Subjective: “ Sakit karajao ako tijan” as verbalized by the patient with the pain scale of
from 0-10, pain can be rated as 7. Search sa characteristic sa pain location
Objective:
Diaphoresis
Facial expression of pain ( e.g., grimace, eyes lack luster)
DEPENDENT
Evaluation: Goal met. The patient reported pain is relieved and controlled with the pain scale of
from 0-10 is 5.
57
NURSING CAREPLAN #3
Assessment:
Subjective: “Nag niwang siya maayo maam kaysa adtong niagi nga adlaw” as
verbalized by the SO
( Independent )
Use flavoring agents to determine enhance Suggest severity of effect in fluid and
food satisfaction and stimulate appetite. electrolyte balance and nutritional status.
Encourage clients to choose foods, have family To promote comfort and enhance intake.
members to bring food that seen appealing(
58
which are not contraindicated)
Promote pleasant relaxing environment To reduce gastric acidity and improve nutrient
including socialization when possible to intake.
enhance food intake.
Prevent/minimize unpleasant odors. To reduce the occurrence of vomiting
Auscultated bowel sounds. Hyperactive bowel sounds due to GI
disturbance.
Collavborative
Refer to dietician from modification of diet ( To gradually stimulate appetite for fast
General liquids ) recovery.
Evaluation: Goal partially met at the end of 2 hours of nursing intervention the patient will be
able to verbalize food preference which are not contraindicated to underlying disease to promote
good appetite and reduced the occurrence of vomiting but failed to improve appetite from poor to
fair.
59
NURSING CAREPLAN #4
Assessment
Subjective: “Arang ka init sa lawas ug tag takigan ako anak’ as verbalized
by the SO
Objective:
Warm and flushed skin
Chattering teeth noted
Chills noted
Vital Signs
Elevated temperature (38 degree Celsius)
Vomits 3 times a day
Planning: After 2 hours of rendering of nursing intervention, patient will be able to maintain
body temperature within normal range and be free of convulsion activity.
Nursing intervention Rationale
INDEPENDENT
Adjust and monitor environmental factors like Room temperature may be accustomed to near
room temperature and bed linens as indicated. normal body temperature and blankets and linens
may be adjusted as indicated to regulate
temperature of the patient
Eliminate excess clothing and covers Exposing skin to room air decreases warmth and
increases evaporative cooling.
Raise the side rails at all times This is to ensure patient’s safety even without the
60
presence of seizure activity.
Educate patient and family members about the Providing health teachings to the patient and
signs and symptoms of hypothermia and help in family aids in coping with disease condition and
identifying factors related to occurrence of fever; could help prevent further complications of
discuss importance of increased fluid intake to hypothermia.
avoid dehydration.
Provide additional cooling mechanisms This measures help promote cooling and lower
commensurate with significance of fever and core temperature.
related manifestations:
• Noninvasive: cooling mattress cold packs
applied to major blood vessels
DEPENDENT
IVF Therapy (D5 0.3 NaCl) Hydrate and replace fluid loss
Evaluation:
Goal is met, the patient was able to maintain body temperature of within the normal range 36.5
degree Celsius and free from convulsion activity.
61
NURSING CAREPLAN #5
Assessment
Auscultate breath sounds, assess rate and depth of Certain electrolyte imbalances such as
respirations and ease of respiratory effort, observe hypokalemia, can cause or exacerbate respiratory
color of nailbeds and mucous membranes, and insufficiency.
note pulse oximetry or blood gas measurement, as
indicated.
Review the clients food intake These condition point to electrolyte imbalances
62
Assess fluid intake and output Many factors such as ability to drink, affect an
individual’s fluid balance, disrupting electrolyte
transport, function and excretion.
Note the presence of medical conditions that may Hyponatremia ay be associated such as metabolic
impact sodium level acidosis and intestinal conditions.
Evaluation: Goal met,the patient is free of complication resulting from electrolyte imbalance
63
DISCHARGE PLAN
MEDICATIONS:
Inform the S.O about the possible side effects of the medications.
Inform the S.O about the importance of compliance to prescribed medications and
consequences.
ENVIRONMENT
Wash hands with soap after going to the toilet and before eating or preparing food.
Avoid contact with soil
Avoid sharing towels with infected persons
TREATMENT
Treat intestinal amoebiasis with metronidazole 250mg/tab one tab three times a day for 10 days it
kills trophozoites of Entamoeba histolytica in intestines and tissue.
HEALTH TEACHINGS
Activities
Bed rest upon arrival at home from the hospital.
Light exercise every morning.
Eventually the patient can return to its normal activities of daily living.
Hygiene
Cut and keep your nails clean
Proper handwashing is necessary
Take care of drinking water - either option for mineral water or water boiled for 20
minutes.
64
OPD- FOLLOW-UP:
Return again after a week for follow up check-up at OPD November 14, 2018.
DIETARY MANAGEMENT:
Diet as tolerated but encouraged to have clear liquids such as water, juice and tea to
rehydrate.
Oral rehydration or electrolyte solutions may help.
Drinking small amounts at frequent intervals is better accepted in cases of nausea.
Light soups, toast, rice and eggs are good foods; eat foods high in fiber and
carbohydrates.
SPIRITUAL
Continue religious practices.
Always pray for fast recovery.
65
APPENDICES
IVF CHART
66
Vital Signs
67
I AND O SHEET
CFAC
68
GENOGRAM
LEGENDS:
69
DEFINITION OF TERMS
AMOEBIASIS
- Is an infection of small intestine, which is caused by an protozoan called Entamoeba
histolytica. It is simply called as Amoebic dysentery. This is usually contracted by ingesting
water or food contamination by amoebic cysts.(Dr. Nagata, 2009)
Toxic megacolon
- Toxic megacolon is the clinical term for an acute toxic colitis with dilatation of the colon. The
dilatation can be either total or segmental. A more contemporary term for toxic megacolon is
simply toxic colitis, because patients may develop toxicity without megacolon. (Clin Colon
Rectal Surg. 2010 Dec. 23(4):274-84.)
Bowel perforation
- Bowel perforations occur when a hole is made in this lining, often as a result of colon surgery
or serious bowel disease. A hole in the colon then allows the contents of the colon to leak into the
usually sterile contents of your abdominal cavity. (Digestive Diseases and Sciences. 2017.
62(6):1607-1614)
Peritonitis
- Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the
abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused
by infection from bacteria or fungi.
70