I.

Describe the Scenario

A. Case Scenario

On the day of March 10, 2012, a 12-year-old boy was admitted in an

emergency with acute periumbilical abdominal pain that was not referred to
other sites, vomiting and constipation for 3 days. Upon having a physical
examination, it was revealed that the boy had a pallor and appeared poorly
nourished. His vital signs include a temperature of 37.5°C, and blood
pressure of 100/60 mmHg. Moreover, his pulse has a regular rate of 120 beats
per minute, and upon checking the respiratory rate, it was 35 per minute.

A respiratory examination revealed that there were no added sounds

but had a slight effort in having the bilateral air entry, as for cardiovascular
examination it was revealed that normal S1 and S2 was heard with no murmur,
and there were no neurological deficits upon checking the central nervous
system. But during the abdominal examination, it was discovered that the boy
is experiencing abdominal tenderness and rigidity in the central and mid-
abdomen. There was no organomegaly and auscultation revealed a silent
abdomen or minimal peristalsis.

During the time of abdominal ultrasonography, it was demonstrated that

there were parallel paired lines like “railway tracks” in the intestinal lumen that
were suggestive of worms. Moreover, upon knowing the background of the
boy, it was revealed that he came from an unprivileged family. His father was
a farmer and all the family who helped the father, are usually spending all the
day working in the fields. They usually consume vegetables they have
gathered from the field without it having been washed. It was also revealed
that the boy had a history of pica. It was suspected that an Ascaris
lumbricoides infection was the reason behind it as the patient’s mother said
that there was an incident that a one big worm was seen coming out from the
child’s ear before rushing to the hospital. Moreover, it was reported that there
were recurrent attacks of vague abdominal pain, and some attacks of diarrhea.
And the boy was preparing for an operation.

B. Introduction

According to Willis (2017), Ascariasis is evident worldwide but

concentrated in tropical and subtropical areas, mostly living in impoverished
rural regions of the developing world. An estimation of more than 1 billion
people is infected, making the Ascariasis the world’s most prevalent intestinal
helminth infection. In our country, the Philippines, a study by Cabrera (1998)
shows that about 74% of the children remained negative for Ascaris eggs during
one year, but 26% got infected. During the rainfall season, the cases and
infections of Ascariasis reappeared that took three months back of the
transmission. But what causes this disease? This disease is known as a
parasitic infection wherein a certain Ascaris lumbricoides, a parasitic nematode,
live in the small intestine of the human body.

C. Mode of Transmission

According to scientific findings, the mode of transmission of such

infection is fecal-oral. It is which the fingers are contaminated by contact with
soil or feces. Alongside, the Ascaris Eggs present in soil will retain their
infectious properties for several months, estimating to 2 months after ingestion,
and will survive in cold weather (5 – 10C) for up to 5 – 7 years. Besides, another
way of transmission is by food, especially those which are taken raw and are
infected by insects or fertilizers. As for the case of the 12-year-old boy, he may
have gotten it by eating unwashed foods and his history of pica (an eating
disorder in which a person eats things not usually considered food).
 D. Clinical Manifestations

The school-age children are prone and morbid for Ascaris lumbricoides
as they can be induced because of the age-related severity patterns. Also, their
intestinal lumen is said to be narrower than the adults. Furthermore, when
Ascaris larvae grow and develop, various stage-specific antigens are studied.
It was found out that multiple tissues are invaded, which, therefore, the effects
of infection are different upon the procedure of larval migration and
development. Indeed, some of the conditions are asymptomatic or not showing
signs of the symptoms. Then, in terms of the manifestations of ascariasis, it can
be distinguished into acute and chronic symptoms. The human hosts tend to
experience acute lung inflammation, difficulty in breathing, and fever due to
larval migration through the pulmonary tissue. Having abdominal distension
and pain, nausea, and diarrhea can also characterize adult worm infection and
chronic ascariasis. With the given case scenario, the boy has had abdominal
pain, vomiting, and constipation for three days already.

II. Identify the Key Problems

1. Massive infection may lead to abdominal cramps that may

cause intestinal obstruction.

Intestinal obstruction is a constant complication in children having heavy

worm loads in endemic areas that constitute 5% to 35% of all cases of bowel
obstruction in the regions. It is said to be an aggregated mass of worms blocking
the bowel lumen, especially in the terminal ileum that causes it. The obstruction
is generally partial; however, when prolonged, it can become complete. A long-
termed obstruction may be intensified by intussusception, volvulus,
hemorrhagic infarction of the bowel, and perforation.
2. Even in moderate infections, it can also lead to malnutrition
in children.

Ascariasis may contribute to protein-energy malnutrition. From specific

calculations in an experimental study in humans, it has been estimated that in
children with heavy worm load (13 to 40 worms), approximately 4g of protein
are lost per day from a daily diet containing 35 to 50g of protein. Ascaris
infections also may contribute to vitamin A and C deficiency in children in
endemic areas.

3. Ascariasis as a cause of hepatic abscess.

A patient with hepatic abscess is often presented with right upper

quadrant pain, high fever, tender enlarged liver with intercostal tenderness, and
edema of the right chest wall. Ultrasonography reveals an echo-poor lesion in
the right lobe or left lobe (or both), and ultrasound-guided aspiration reveals pus,
which yields to the evaluation of Ascaris lumbricoides.

4. A patient may develop cholestatic jaundice which is

caused by a biliary tract obstruction.

Biliary obstruction is delineated to be the affliction of the bile flow from

the liver going to the small intestine caused by a blockage of the biliary duct
system. This obstruction strikes a massive portion of the population around the
world with significant morbidity and mortality. The most common origin of biliary
obstruction is gallstones, which causes common bile duct obstruction,
manifesting when a person feels pain, nausea, vomiting, and jaundice caused
by adult ascariasis.
 5. Ascariasis worms to cause acute pancreatitis.

A patient with acute pancreatitis may show symptoms of epigastric pain

referred to the back, vomiting, and raised serum amylase and alkaline
phosphatase. Ultrasonography can reveal the enlarged pancreas or
pseudocyst. A small portion of patients with severe Ascaris infection and
hemorrhagic pancreatitis may die. And as for all other patients, they can regain
strength faster with palliative treatment or extraction by the mouth of worms
invading the ampullary orifice of the duodenum.

III. Uncovering the Possible Solutions

A. Prevention and Treatment

To prevent this infection, one must consider following specific

preventive measures. It includes handwashing techniques before handling
food. Besides, it is vital to wash, peel, or cook all raw vegetables and fruits
before eating, particularly those grown in soil and fertilized with manure.
Moreover, proper health education is a gateway for people to be aware of
preventing such infections. It helps them obey health principles to alter their
behavior upon reducing the transmission of pathogens. Health education
should also be given in childhood, especially at school. In societies with a high
prevalence of Ascariasis, to deal with it as quickly as possible, education
should be provided in addition to broadcasting in mass media, from home to
home and person to person.

Truly, there are numerous drug medications to treat Ascariasis,

including Anthelmintic medications. It is a drug that removes parasitic worms
from the body. Some examples of these medications are albendazole,
mebendazole, and ivermectin. Regarding its dosage, it is said to have the
same for children and adults. The drug, Albendazole should be taken with
food. On the other hand, Ivermectin should be taken on an empty stomach
with water. The process of immobilizing the parasite and the death of the
helminth takes a long time. There is a slow process of a parasite being
immobilized and the death of the helminth. Furthermore, it may take up to
three days to completely disappear the worms from the gastrointestinal tract.
Its efficacy is variable, which depends on the worm load, strain, and the transit
time of preexisting diarrhea and gastrointestinal.

B. Nursing Management and Rehabilitation

Nurses have the roles and responsibilities in assisting the patient

throughout their medical journey. With that, it is essential to consider
assessment to come up with an accurate nursing diagnosis. Certainly, it will
help medical professionals to aid and give the appropriate care and treatment
that the patients need. An assessment of the patient may include:

History - It is important for the nurse to ask the person if they had soil-
transmitted worm infections, including roundworm, for it is the most common
infection worldwide. Also, they could ask if one has recently had contact with
soil feces.

Physical Examination - It is required that the nurse see manifestations like

fever, jaundice, cachexia, pallor, and urticaria; pulmonary symptoms
include wheezing, rales, and diminished breath sounds. There could also
be gastrointestinal symptoms provides for abdominal tenderness,
distention, nausea, and vomiting.

Furthermore, it is also the nurse’s duty to provide nursing interventions

to make their patients feel better. It includes the following:
Improve the Fluid and Electrolyte Balance - A nurse can appraise this
by monitoring the intake and output of fluid and observing signs of
dehydration. If there are signs of dehydration, one can give an oral
rehydration solution to assist in adequate hydration and observing also the
accurate intravenous fluid administration.

Maintain Normal Temperature - Teaching the client and his or her family
about the importance of adequate feedback like monitoring the vital signs.
Moreover, the nurse can provide tepid sponge baths, and administer
analgesics as indicated and ordered by the physician.

Reduce Pain and Discomfort - Assess the extent and characteristics of

pain; have a pain scale to verbalize the pain. Also, give a warm compress
on the abdomen and teach the method to distract and reduce pain like a
breathing exercise.

Improve Nutrition - Give sufficient and nutritious food thus, explain the
significance of adequate nutrition as well as a good oral hygiene.

Health Promotion - As mentioned above, it is essential to educate the

patients regarding the prevention and control of the infection, especially
those in impoverished areas. Health promotion can also be a promising
intervention, like teaching people, most specifically children, about proper
handwashing and avoiding contaminated water or food. Of course,
healthcare professionals can also suggest ways on how to improve
sanitation and nutrition.
IV. Conclusion

As Ascariasis is noted as the most prevalent parasitic infection, each of

us must know some facts and studies about it. Indeed, knowledge about such
can benefit us through health and economic perspectives. Despite the massive
cases and wide range of impacts on the health of human hosts, Ascariasis
remains to lack attention as a tropical disease. With that, it should be addressed
seriously. In addition, one should also consider the parasite’s persistence and
present prevalence difficulties regarding control strategies for the worm itself
as well as concurrent infectious diseases. Therefore, further research on how
the mechanism of resistance to infection is a must to facilitate future initiatives
in reducing the prevalence and infection morbidity.

V. References

Case Scenario: M.Z.M. Abdellatif, Belal, E.H. Abdel-Hafeez, A.M.

Atiya  and K. Norose . (n.d.). Eastern Mediterranean region. World Health
Organization. Retrieved from http://www.emro.who.int.

Christina Dold, Celia V. Holland, Ascaris and ascariasis, Microbes and

Infection, Volume 13, Issue 7, 2011, Pages 632-637, ISSN 1286-4579.
Retrieved from:
https://www.sciencedirect.com/science/article/pii/S1286457910002443

Crompton DWT Ascariasis and childhood malnutrition. Trans R Soc

Trop Med Hyg I86:57f, 1992. Retrieved from: https://www.sciencedirect.com

Showkat Ali Zargar, Mohammad Sultan Khuroo, Treatment of biliary

ascariasis and its rationale, Gastroenterology, Volume 93, Issue 3, 1987,
Page 668,ISSN00165085. Retrieved from:
https://www.sciencedirect.com/science/article/pii/0016508587909528