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A CASE STUDY
on
AMOEBIASIS
CASE ABSTRACT:
December 29, 2010 Wednesday, 8 days prior
to admission, Patient Y suffered from LBM with
an on and off fever. And her parents did not
bring her to the hospital because they thought
that it was just normal because their child
usually eliminate after stool.
January 06, 2011 Thursday at around 11:30 am,
Patient Y was brought to the hospital cuddled
by her mother at the emergency room because
she was suffered from continuous LBM and
has an episode of vomiting with an elevated
body temperature. Upon assessment, Patient
Y has a body temperature is 37º Celsius with a
cardiac rate of 127 beats per minute and a
respiratory rate of 27 breaths per minute.
On that day, the attending physician suggested to her
parents to admit her. By then, the attending physician
ordered Paracetamol Drops (Calpol Drops) 120 mg/ml
oral, PRN when temperature is >37.5º Celsius, Bacillus
Clausil (Erceflora) BID1 ampule, Zinc Sulfate (Prozinc
Drops) 1ml OD, oral. Plain NSS 500 ml to run for 10 hours
with a drop factor of 50 uggt/min. She also requested to a
CBC test, Urinalysis and Fecalysis. After few days, it
reveals on the result in CBC, WBC and lymphocytes
increase. Segmenters decrease together with hemoglobin
and hematocrit level. Entamoeba Histolytica appears
positive on the pathological test.
LEARNING OBJECTIVES:
To be able to know the precipitating and predisposing factors that
caused the onset of amoeba to the patient.

To be able to gain knowledge and understanding the underlying

condition as a health care provider.

To be able to assess the patients health condition.

To be able to recognize possible family problem based on the

assessment.

To be able to motivate the parents to set priorities regarding

safeties of their children.
 ANATOMY
AND
PHYSIOLOGY
The Digestive System
Cardiac
Pharynx Sphincter
Mouth
Larynx

Small Stomach
Pyloric
Duodenum Intestine
Sphincter

Ileum Anus
Jejunum Ileocecal
Valve
PATHOPHYSIOLOGY
 PREDISPOSING
PREDISPOSING
FACTOR:
FACTOR:
 Ingestion of
Children aged 0-3
contaminated foods/
years old
drinks
Ingestion of
Enatmoeba
Histolytica

Invasion of the
E.histolytica in the
intestinal wall
 Stimulate
Infection Ulceration Inflammation WBC mucosal lining of
occurs the occurs (11.3) the intestine
intestinal
wall

Abdominal Peristaltic
Bacteria Damage the movement
Pain
breaks intestinal
down the wall
food faster
vascular
response
Bleeding
amount of gas
on the
digestive
Blood tinged Stimulates by
system
semi-mucoidal hypothalamus
stool
 Release of
Flatulenc bradikinin,
Hgb histamine, Reseting body temp.
e
level serotonin an above its normal temp.
prostaglandin
hormone
Slight
anemia Release of production of
Edem interferon
Vascula a
r
permea
bility Pain Fever (39°C)
(on and off)

Functio
lasea
 PART I- PATIENT
ASSESSMENT DATA BASE
HEALTH HISTORY:

Age: 1 year and 7 mos. Address: # 0803 Brgy. Sirang Lupa

Calamba City

Sex: Female Date of Admission: January 06, 2011

Nationality: Filipino Attending Physician: Dra. Holgado

Civil Status: Single Initial Diagnosis: AGE

Religion: Roman Catholic Final Diagnosis: c

Source of Income: Parents Source of History: Relatives

Rank in the Family: 2nd Chief Complaint: LBM

HEALTH PERCEPTION-HEALTH
MANAGEMENT PATTERN
A. Present Health Status:
Upon assessment, her mother told me that while
Patient Y was playing with her brother, LBM started.
That was happened last December 29, 2010. After a
few days, Patient Y continuously suffered from LBM
with an episode of vomiting. She also experienced an
on and off fever with a body temperature of 39º
Celsius, so her parents give her an anti pyretic
medication.
B. Past Health History:
Upon the interview, her mother told me that
Patient Y has no other disease from the past except
from cough and colds and fever. She has no known
allergic reaction to any medications and has not
suffered from any accidents and injuries. Patient Y
had completed her immunization from BCG to
measles. She doesn’t even admit to hospital except for
this situation.
C. Family Health History:
Upon the interview, according to her grandmother, their
family has no known diseases except from cough and colds
and fever. But her brother suffered also to LBM that leads
to diarrhea. Her grandmother always suffered from
extreme muscle cramp.

D. Socio-Economic Status:
Their family has a simple life. The family lives in a concrete
house. They have electricity and good ventilation. They
also have an adequate living space. Her parents both work
at ISUZU Auto Parts, that’s why her grandmother on her
father side is the one taking care of them.
E. Developmental Task/ History:
Patient Y’s Developmental Task according to Eric Erickson’s
Psychosocial Developmental Task is autonomy versus mistrust.
At this stage, the child learns to be independent and make
decision for herself. The problem of autonomy can be
symbolized by holding on and letting go. The development of
autonomy during this period is centered on children’s increasing
ability to control their bodies, themselves and environment.
They want to do things for themselves, using their newly
acquired motor skills of walking, climbing and manipulating
their power of selection and decision making. Much of their
learning is acquired through imitating the activities and
behavior of others. Negative feelings of shame and doubt arise
when children are made to feel small and self conscious to
dependent in areas which they are capable of assuming controls.
II. NUTRITION-METABOLIC PATTERN:
Patient Y was breast fed for almost 7 months
according to her mother. After that she starts bottle
feeding up to now. Her mother starts giving her solid
foods when she was 9 months old.

III. ELIMINATION PATTERN:

Upon admission, Patient Y experienced an episode
of LBM from loose watery stool, semi-mucoid and
greenish in color to soft stool. Her urine is color.
IV. REST- SLEEP PATTERN:
Before admission, Patient Y has a different sleep
pattern depending on her mood. She sleeps well with
her mother.
 
V. COGNITIVE- PERCEPTION PATTERN:
Patient Y can responds to sounds. She can
vocalized and mimic what her mother said.
PART II- PHYSICAL
EXAMINATION
A. GENERAL SURVEY:
Upon assessment, Patient Y is 32 cm. and weighs 10
kg. She is always clean and neat and healthy in
appearance. She has no any signs of dehydration with
a good skin turgor. She was active, conscious and
coherent. Not in distress. She was also cooperative
sometimes. She has a good posture and with a
coordinated body movement. She can walk well
according her age. She can also speak some words and
mimic what her mother said.
 1 2 3 4 5 6 7 8
12 nn 8 12 nn 8 12 nn 8 12 nn 8 12 nn 8 12 nn 8 12 nn 8 12 nn
am am am am am am am

Tempe 37. 5 36. 9 35. 5 36. 5 36. 5 37. 2 36. 3 36. 9 37 36. 5 37 36. 4 36 36 36. 5
rature

Cardia 97 120 106 120 132 110 114 130 120 130 120 116 110 98 108
c Rate

Respir 24 26 26 24 26 32 27 30 25 30 27 23 24 26 26
atory
Rate

Blood 90/6 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60 90/60
Pressu 0
re
III. INTEGUMENT:
a. Skin:
Patient Y has a light brown complexion. Skin is smooth
and soft to touch and has no any presence of scar and
scratches. The skin returns fast to normal position
when pinching.

b. Mucous Membrane:
Patient Y has a pinkish lips in color. No signs of dryness.

c. Nails:
Patient Y’s finger and toenails are short, clean and wide.
But on her right toenail, one of the nail is fractured and
brownish in color.
d. Hair:
Patient Y’s hair is evenly distributed over scalp.
Shiny, smooth and soft to touch hair. No presence of
dandruff and lice. Always on a pony tale.
IV. HEENT:
a. Head:
Upon inspection, she has a round and symmetrical
skull. Her anterior fontanel is closed. No nodules and
tenderness.

b. Eyes:
Patient Y’s eyebrow is fairly distributed; eye lashes
are long and curl. No noted discharge. Her eyes are
black in color.
c. Ears:
Smooth and soft to touch, its color is the same as
her color of the skin. No presence of any discharge, she
could recognize to any sound.

d. Nose:
Small and smooth to touch, no presence of any
discharge and deformities. She can noticed bad smell.
e. Mouth/Throat/Pharynx/Teeth
Upon assessment my patient’s lips is pinkish in
color, symmetry and contour, no noted sores in gums.
She has eight teeth.

f. Face:
Fair looking skin, symmetrical in both sides.
V. NECK/LYMH NODES:
No noted lesion, palpable lymph nodes.

VI. PULMONARY:
Spine is vertically align has intact skin, no noted
lesion. Chest circumference is about 20cm.

VII. CARDIOVASCULAR:
Upon auscultation, she has a normal breath sound,
no difficulty in breathing.
VIII. ABDOMEN:
Abdomen circumference is 18 cm.

IX. MUSCULO-SKELETAL/EXTREMETIES:
Upon auscultation the patient has no sign of skin
lesion, tenderness or swelling in both upper and lower
extremities.

X. NEUROLOGICAL:
Upon assessment, Patient Y is active, conscious and
coherent. She is not in distress.
B. DIAGNOSTIC EXAMINATION:
I. HEMATOLOGY
Laboratory Test Result Normal Values

RBC (Red Blood Cell) 4.0 4-4.5 x 10^12/L

Hemoglobin 119 120-150

Hemoglobin 0.35 0.37-0.47
Platelet Count 220 150-400 x 10^9/L

WBC (White Blood Cell) 11.3 5-10 x ^9/L

INTERPRETATION:
Based on the table that was interpreted, hemoglobin and hematocrit
level was decreased with fluid retention. White blood cell increased
with infection.
 DIFFERENTIAL COUNTS:
Laboratory Test Result Normal Values

Lymphocytes 0.60 0.25- 0.35

Segmenters 0.40 0.55- 0.65

INTERPRETATION:
Based on the table that was interpreted,
segmenters decreased and lymphocyte level increase
with viral infection.
 II. PARASITOLOGICAL REPORT
Laboratory Test Result
Color Dark Brown
Consistency Semi Mucoid
Occult Blood:
WBC Plenty/HPF
RBC 8-10/HPF
Bacteria +2
Entamoeba Histolytica Positive
INTERPRETATION:
Based on the parasitological result, it reveals that
there is presence of entamoeba histolytica.
A. DIET :
Patient Y’s diet is a milk formulated and lactose
free.
PART III- COLLABORATIVE
PLAN OF CARE
MEDICATIONS
B.1. STANDING ORDER/S

Brand Dose/ Indication Action/ Side Effect Nursing

Name/ Dosage/ Mechanical Precaution
Generic Frequency Action
Name

Brand
Name:
ProZinc 1 ml OD, Oral Promotes  Nausea Hypersensitivity
Drops normal to drugs.
biochemical Vomiting
Generic reactions,
Name: strengthen the Headache
Zinc Sulfate immune system,
supports normal
growth and
development and
helps to prevent
growth retardation
in children and
young adult.
 Brand Dose/ Indication Action/ Side Effect Nursing
Name/ Dosage/ Mechan Precaution
Generic Frequency ical
Name Action

Generic
Name:
ORS  Dissolve Use for the Nausea Should be
Hydrite sachet to 80 replacement used only in
distilled water, of fluids and Vomiting severe
2 oz./ loose electrolytes dehydration if IV
watery stool/ losses therapy is not
vomiting associate available.
with acute
diarrhea and Recommended
vomiting. dilution should
be strictly
followed.
Brand Name/ Brand Indication Action/Mechanic Side Effect Nursing
Generic Name/ al Action Precaution
Name Generic
Name

Brand Name:
Erceflora
 1 ampoule Use to Contributes to Nausea Shake the
Generic BID treat the recovery of drug well
Name: chronic the intestinal Vomiting before
Bacillus Clausii diarrhea. microbial flora administration
altered during the Headache .
coarse of
microbial Dizziness Monitor
disorders of patient for any
diverse origin. unusual effects
from drug.

Administer
drug within 30
mins. after
opening
container.
It produces various
vitamins, Dilute drug
particularly group B with sweetened
vitamins thus milk, orange
contributing to juice or tea.
correction of
vitamins disorders Administer
caused by antibiotic drug orally.
and
chemotherapeutic
agents.

Promotes
normalization of
intestinal flora.
 Name/ Dosage/ Mechanical Precaution
Generic Frequency Action
Name

Brand
Name:
Amikacide  130 mg Serious Generally Nausea Monitor renal
VSIVP infection bactericidal. function.
Generic every 24 caused by Vomiting
Name: hours sensitive >Inhibits Instruct parents
Amikacin strains of protein Headache to promptly
Sulfate Psuedomas synthesis by report adverse
Aeruginosa, binding Dizziness reaction to
Escherichia directly to prescriber.
Coli, the 3o’s
Staphylococc ribosomal Instruct the
us submit. parents to
encourage the
patient to
increase or
maintain
adequate fluid
intake.
 Brand Dose/ Indication Action/ Side Effect Nursing
Name/ Dosage/ Mechanical Precaution
Generic Frequency Action
Name

rand
Name:
lagyl  140 mg Severe Bactericidal Nausea Monitor renal
every via infection against function.
Generic soluset to run cause by anaerobic Vomiting
Name: for 30 infection bacteria, Instruct parents
Metronida minutes. caused by Fusobacteriu Headache to promptly report
ole susceptible m Veillonella, adverse reaction
bacteria. many gram dizziness to prescriber
positive
Acute anaerobic  Instruct the
intestinal bacteria such parents to
amoebiasis as Entamoeba encourage the
or extra histolytica, patient to increase
intestinal Trichomas or maintain
disease cause Vaginalis, adequate fluid
by Giardia intake.
entamoeba Lambia and
hystolica.
 Brand Dose/ Indication Action/ Side Effect Nursing
Name/ Dosage/ Mechanical Precaution
Generic Frequenc Action
Name y

Brand
Name:
Calpol 1.2 ml, Treatmen Use to  Nausea Tell parents to
every 4 t of mild to relieve fever and consult prescriber
Generic hours moderate by central Vomiting before giving drug
Name: PRN, when pain as an action in the to children
Paracetamo Temp. anti pyretic. hyphotalamic May younger than the
l > 37. 5° heat decrease age of 2.
Celsius regulating glucose
Brand center. level. Tell parents that
Name: drug is only for
Aeknil May short term use and
110 ml decrease to consult
Generic IVP, every hematocrit, prescriber if giving
Name: 4 hours hemoglobin to children for
Paracetamo when and longer than 5 days.
l Temp. Is neutrophil
>39° level. Warn parents
Celsius that high doses or
unprescribe or
long term use can
cause liver
IV Fluids Classificatio Indications Action/ Side Effect Nursing Precaution
n Mechanical
action

PNSS Isotonic An aqueous 0.9% NaCl CNS Blood pressure

(Plain sodium solution of solution ataxia should be raised to
Normal chloride 0.9 % sodium ( normal slightly less than
Saline solution chloride, saline, Nystagm normal level for the
Solution) isotonic with physiological us individual patient
the blood and saline) is to avoid excessive
tissue fluid. used to give Dysarhia blood pressure
intravenous response.
Used in fluids to the Confusio Headache maybe a
medicine patients n symptom of
chiefly for suffering hypertension
bathing tissue from salt and GIT rapidly. Induced
and in a water nausea and hypertension may
sterile form, deprivation. vomiting cause acute
as a solvent pulmonary edema,
for drugs that It can be arrhytmiasis and
are to be used to wash cardiac arrest.
administered the wound.
parenterally
to replace
body fluids.
 Mechanical Precaution
action

.3 NaCl Hypertonic Intravenous When Reactions Clinical

trose 5% solutions administered which may evaluation
3 containing intravenously, occur because and periodic
um dextrose and these of the solution laboratory
ride) sodium solutions or the determination
chloride are provide a technique of s are necessary
indicated for source of administratio to monitor
parenteral water, n include: changes in
replenishment carbohydrates -febrile fluid balance,
of fluids, and response electrolyte
minimal electrolytes. -infection at concentration
carbohydrate the site of and acid-base
calories and injection balance
sodium -venous during
chloride as thrombosis or prolonged
required by phlebitis parenteral
the clinical extending therapy or
condition of from the site whenever the
the patient. of injection condition of
the patient
-extravasation warrants such
s evaluation.

-hypervolemia
PART-V NURSING DIAGNOSIS DEVELOPED IN CARE PLAN
Assessment Diagnosis Planning Intervention Rationale Evaluat
Subjective: Fluid A after 8 IN After 8
“Nagtatae at volume hours of my DEPENDENT: To monitor for hours of m
nag susuka deficit nursing Monitor fluid loss and nursing
ang anak ko” related to intervention, intake and electrolyte interventi
as verbalized excessive patient ‘s output. imbalanced. patient wi
by the mother. loss of fluid. relatives will:

Objectives: Short Term: Monitor Changes in Short Ter

Loose watery Understand body weight body weight Underst
stool, greenish measures that for sudden reflect changes in measures
in color with can be taken decreases. body fluids. can be tak
smell to treat or to treat or
prevent fluid Instruct the prevent flu
Hematochez volume loss. parents to volume lo
ia assist the
Describe/ client with Describe
With good understand feeding as understoo
appetite symptoms appropriate. symptoms
that indicate that indic
Not in the need to Instruct the To replace fluid the need t
distress consult with to increase loss. consult wi
health care fluid intake. health car
Decreased provider. provider.
urine output
Long Term: DEPENDENT:
Maintain urine  Administer To stop the Maintaine
output and bowel anti diarrheal loss that output and
movement within medications result from bowel
normal ranges. as prescribed vomiting and movement
by the diarrhea. within
physician. normal
ranges.
Maintain To allow
patient replacement
intravenous of intra
access, set an vascular
appropriate volume.
intravenous
infusion flow
rate and
administer at
a constant
flow as
ordered.

Collaborative:
Instruct the To prevent
relative of the continuous
patient to diarrhea.
avoid oily
foods as
prescribed by
the dietician. To evaluate
degree of
 Imbalanc After 8 hours IN After 8 hours o
ed of my nursing DEPENDENT: my nursing
bjective: Nutrition: interventions: Closely To assess interventions:
Loose less than monitor intake adequacy of
atery stool body Short Term: and output of nutrition and Short Term:
requiremen Patients the patient. diet. Patients
Weight loss ts related to relatives will relatives
excessive recognize Determine To determine recognized
Episode of fluid loss. factors the healthy if the client factors
omiting contributing to body weight weight had contributing to
underweight. appropriate for loosed. underweight.

Patient will
consume
patient’s age
and height. cuus Patient
adequate Observe To know if consumed
nourishment. patient’s the patient can adequate
ability to eat. tolerate to eat nourishment.
some foods.

Discuss to To know the

the relatives clients likes
the eating and dislike.
habits
including food
preferences
that are
appropriate to
her.
Long Term: DEPENDENT:
Progressively Administer Progressively
gain weight medication as gained weight
towards desires. prescribed. towards desires

Patients will Administer To Patients

maintain parenteral maintain maintained
adequate nutrition as adequate adequate
nutritional prescribed. nutrient nutritional
status. intake in status.
patient who
Be free from cannot or Free from
malnutrition. will not eat malnutrition.
by mouth.
Pamantasan ng Cabuyao
COLLEGE OF NURSING

A CASE STUDY
on
AMOEBIASIS
Presented by:
MARY ANN C. LAS
II-NRS I

RLE 102 GROUP III

TTHS 06:00am- 2:00pm