Liceo de Cagayan University College of Nursing R.N.P. Blvd.

, Carmen Cagayan de Oro City NCM501x First Semester In Partial Requirement for NCM501x Submitted by: x)x x

Table of Contents I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV. XV. XVI.

INTRODUCTION PATIENTS PROFILE DEVELOPMENTAL TASK GEMENT . HEALTH TEACHINGS .. EVALUATION . PR

I. INTRODUCTION Amebiasis is an infection caused by the protozoal organism Entam oeba histolytica and includes amebic colitis and liver abscess. In developed cou ntries, infection occurs primarily among travelers to endemic regions, recent im migrants from endemic regions, homosexual males, immunosuppressed persons, and i nstitutionalized individuals. Transmission usually occurs by food-borne exposure , particularly when food handlers are shedding cysts or food is cultivated in fe ces-contaminated soil, fertilizer, or water. Less common means of transmission i nclude contaminated water, oral and anal sexual practices, and direct rectal ino culation through colonic irrigation devices. In 1875, in St. Petersburg, Russia, Fedor Losch was credited with the initial documentation of amebae in stool. Los ch described the amebae in the stool as having a "round, pear shaped or irregula r form and which are in a state of almost continuous motion." In 1890, Sir Willi am Osler reported the first North American case of amebiasis, when he observed a mebae in stool and abscess fluid from a physician who had previously resided in Panama. In 1913, in the Philippines, Walker and Sellards documented the cyst for m of E histolytica as the infective form of the parasite; in 1925, Dobell furthe r described Internationally: Entamoeba species infect approximately 10% of the w orld s population. The prevalence of infection is as high as 50% in areas of Cen tral and South America, Africa, and Asia. E histolytica probably is second only to malaria as a protozoal cause of death. The prevalence of amebic colitis and l iver abscess is estimated at 40-50 million cases annually worldwide, resulting i n 40,000-110,000 deaths.

Asymptomatic intestinal infection occurs in 90-99% of infected individuals. Most infected individuals eliminate the parasite from the gut within 12 months; howe ver, colonization with E histolytica carries a low but definite risk of developi ng into invasive amebiasis. Amebic liver abscess is one of the common complicati on, more common in men than in women, although the sex distribution is equal in children. Amebic colitis affects both sexes equally. Young children appear to be at higher risk for fulminant invasive disease, resulting in a higher mortality rate.

II. PATIENTS PROFILE Name: ? Birthdate: ? Address: ? Age: 38 years old Sex: femal e Height: 5 4 Weight: 55 kilograms Civil Status: Married Allergy: No known food an d drug allergy Chief complaint: LBM, VOMITING AND FEVER Diagnosis: Acute Infecti ous Diarrhea with some dehydration, amoebiasis Physician: ? Religion: Roman Cath olic Nationality: Filipino Educational Attainment: College Level Occupation: ? I ncome: 4 thousand plus per month Name of Spouse: ? Number of Children: 4 Vital s igns: (during the first day of assessment) BP: 90/870 mmHg Temperature: 36.5 C P ulse: 96 bpm Respiration: 24 cpm

III. DEVELOPMENTAL DATA ERIK ERICKSON (PSYCHOSOCIAL THEORY) According to Erik Er ickson, Mrs. ? belongs to adulthood stage (30-65years) since she is 38 years old . The central task for her stage is Generative vs. stagnation. Care is the virtu e during this stage and the task is being creative and productive and establishi ng the next generation. Generative vs. stagnation is the stage which is the pers on is working and productive and stable with his\her family. If the person until this stage is not yet stable with his work and the family. The person is stagna ted, person feels that he is hopeless and is not productive. In our actual patie nt Mrs. Tion was 38 years old and she was in the generative vs. stagnation stage . She married a barangay official and had 4 children which are still studying. S he was working in barangay as a clerk with a monthly income of 4 thousand plus a month as a source of there physiologic needs. Mrs. ? was productive and her inc ome was enough for her family. Safety sand security was being met and happily li ving with her family with love and care. She has the confident, determination an d moral support with all the respect of her family which strengthening her selfesteem. Mrs. ? now was still in self-actualization in the Maslows hierarchy of n eeds. Important nursing intervention is enhancing patients interpersonal relation ship and improve social skills as an important tool in working in a community. SIGMUND FREUD ( PSYCHOSEXUAL THEORIES ) Based on Sigmund Freuds theory, Mr. ?belo ngs to the Genital Stage (13 years and after) since he is 48 years old already i n this stage energy is directed toward attaining a mature sexual relationship. T his stage involves a reactivation of the pre-genital impulses. These impulses ar e usually displaced and the

individual passes to the genital stage of maturity. An inability to resolve conf licts can result in sexual problems, such as frigidity, impotence and the inabil ity to have a satisfactory sexual relationship obviously, Mrs? is a married and has a good relationship with her husband because I can see it the way Mrs. ? tel l us abut her family. I can see that she is good at decision making and know how to handle things, but theirs anxiety right now because of his situation so cons tant encouragement need to be done.

HISTORY OF PAST AND PRESENT ILLNESS A case of ? a 48 year old female, married fr om ? who was diagnosed with Intestinal Amebiasis with some Dehydration. Patient had her recent amebiasis when she was just 2 months old and was hospitalized. Tw o years after her hospitalization in 1956, she also had a disease namely scabies . Condition started a day prior to admission as sudden onset of f LBM, soft to w atery, mucoid stools with vomiting and abdominal pain. The patient started to co nsult at PHS and had her stool examination and the result showed that she is pos itive for Amebiasis. She then started to take metronidazole 1 tab once daily. Si gns and symptoms of amebiasis still persisted and fainted thus the client sought for admission last December 3, 2006 at 10 oclock in the evening. Upon admission the patients BP was 90/70 mmHg and a temperature of 36.5 degrees Celsius. Upon ph ysical examination there was absence of abdominal pain. She was very weak, her e yes was sunken, her skin was dry and skin turgor was poor. She emphasized that s he used to eat anywhere. According to the client, she havent completed the immuni zation during her younger years. And they use to live near the swampy areas.

PHYSICAL ASSESSMENT

VI. DOCTORS ORDER December 5, 2006 11pm Please admit to Female Medical Ward TPR e very four hours For further medical management and monitoring For baseline data of interventions and close monitoring of patients vital signs CBC- includes abso lute number of percentages of erythrocytes, leukocytes, platelets, hemoglobin an d hematocrit in blood sample. Used to evaluate potential for infection. Fecalysi s -It is also called stool culture. it is obtained when diarrhea is severe and w hen known exposure to enteric pathogens Urinalysis- involves examination of the urine for the overall characteristics, such as appearance, pH, specific gravity, and osmolality, as well as microscopic evaluation for the presence of abnormal cells. Star venoclysis of D5LR 1 L 1st 300cc at fast drip and remaining IVF at 4 0 drops per minute A hypertonic solution that that exerts a higher osmotic press ure. Indicated as a source of water, electrolytes, and calories or as alkalinizi ng agents. This medication is an intravenous (IV) solution used to supply water, calories, and electrolytes (e.g., sodium, chloride) to the body. For CBC, Platelet Count, Fecalysis, Urinalysis IVF to follow D5NM 1L at 40 drops per minute

Ranitidine 50mg every 8 hours IVTT Is known as an H2 histamine blocker. It works by reducing the amount of acid in your stomach. To prevent hyperacidity thus preventing ulceration of the stomach. Used to treat a variety of infections. It works by stopping the growth of bacte ria and protozoa. To immediately manage any changes in patients condition. Metronidazole IV 500mg every 8 hours IVT by piggyback to IVF (fast drip run for 30 minutes) Refer accordingly December 6,2006 IVFTF D5NM 1L at SR This medication is an intravenous (IV) solut ion used to supply water, calories, and electrolytes (e.g., sodium, chloride) to the body. December 7,2006 IVFTF with D5NM at same rate This medication is an intravenous ( IV) solution used to supply water, calories, and electrolytes (e.g., sodium, chl oride) to the body. December 8, 2006 May Go Home This indicate that the patient is in good condition and return to its functional level. Used to treat a variety of infections. It w orks by stopping Home meds: Metronidazole 1 tab OD for 1 week

the growth protozoa. of bacteria and

VII. LABORATORY RESULTS Dx Exam Result Normal Values Significance of the Result COMPLETE BLOOD COUNT WBC Hgb Hct Platelet Count Segmenters Lymphocyytes Eosinophil 4.0 12.2 35.7 287,000 39 60 01 5.0 10.0 /L 12 16 gm/dL 35 47 Infection Normal Normal 150 450/cumm Normal 43.4 76.2% 17.4 76.2 % 2-3 Decrease Infection Infection FECALYSIS Character Browm mucoid Light brown to dark Normal

 E. Histolytica Platelet Count Red Blood Cells URINALYSIS 0-2 (c-1st) 25-30 hpf 1-4 Absent 150-450/cumm Absent Presence protozoa Normal Infection of Transparency Sugar SG Slightly cloudy Negative 1.005 Clear (-) 1.015 1.030 Normal Normal Depends on the collection of the urine Reaction Albumin Platelet count Red Blood Cells Epithelial 6.5 (-) 1-3 0-1 Plenty 4.6 7.5 (-) Absent Absent Absent Normal Normal Infection Infection Infection

VIII. DRUG STUDY Generic Name (Brand Name) Date ordered Classification Dosage Me chanism of Action Indication Contraindication Side Effects Nursing Precaution Ranitidine hydrochlori de Decem ber 5, 2006 Histamine2 (H2) antagonist 50mg Competitively IVTT q8 inhibits the hrs action of histamine at histamine2 re ceptors of the parietal cells of the stomach, inhibiting basal gastric acid secr etion. 500mg every 8 hours IVT by piggyba ck to IVF Synthetic compound with dire ct trichomocidal and amebicidal activity against amoeba and To Contraindicated prevent with allergy to hyperacid ranitidine. ity thus preven tin g ulceration of the stomach Headache, dizziness, insomnia, constipation, diarrhea, nausea and vomiting. Check the IV site first before administering the drug. Metronidaz Decem Antiamoebic ole IV ber 5, 500mg 2006 every 8 hours IVT by piggy back to IV For the treatment of amebiasi s and other intraabdo minal Contraindicated in: blood dyscrasias, active CNS disease, first trimester of pre gnancy. Cautious use in: vertigo, headache, restlessness, weakness, fatigue, drowsiness Monitor signs and symptoms of sodium retention Administer dru g before or after meals.

other diarrheal infections diseases. Also . exhibits antibacterial activity agai nst obligate anaerobic bacteria, gram-negative anaerobic bacilli and clostridia. Microaerophili c streptococci and most aerobic bacteria are resistant. coexistent candidiasis, alcoholism, hepatic diseases.

ANATOMY AND PHYSIOLOGY

VIII. PATHOPHYSIOLOGY Definition: Amebiasis Is caused by transmission by ingestion of fecally contamin ated food or water, or sexually by anal intercourse. It is caused by a protozoan called Entamoeba histolytica. It is characterized by diarrhea, vomiting and abd ominal pain. Predisposing Factors Age (48 years old) History of amebiasis at the age of 2 years old Precipitating Factors Environmental factors (lives near the market) Improper water sanitation Eating of foods anywhere Clinical Manifestations LBM Abdominal pain Vomiting Sunken eyes Dry skin (+) Entamoeba histolytica in stool examination result Poor skin turgor

Schematic Diagram Ingestion of protozoa s (Entamoeba Histolytica) Invasion in the intestines S/sx: (+) entamoeba histolytica in S/E result Release of endotoxins S/sx: Increase gastric secretions Inflammation of the intestines S/sx: Abdominal pain - Fever S/sx: Increased intestinal motility Decreased water absorption S/sx: LBM Passage pf watery stools Vomiting Dehydration S/sx: -Sunken eyes -Poor skin turgor -Dry skin -Weak in appearance

XI. IDEAL NURSING MANAGEMENT NURSING DIAGNOSIS: Fluid Volume, risk for deficient Risk factors may include;excessive losses through normal routes (severe frequen t diarrhea, vomiting);hypermetabolic state (inflammation, fever) INTERVENTIONS: Monitor I&O. Note number, character, and amount of stools; estimate insensible f luid losses, e.g., diaphoresis. Measure urine specific gravity; observe for olig uria. Assess vital signs (BP, pulse, temperature). Observe for excessively dry s kin and mucous membranes, decreased skin turgor, slowed capillary refill. Weigh daily. Maintain oral restrictions, bedrest; avoid exertion. Observe for overt bl eeding and test stool daily for occult blood. Note generalized muscle weakness o r cardiac dysrhythmias. Administer parenteral fluids, blood transfusions as indi cated.

NURSING DIAGNOSIS: Nutrition: imbalanced, less than body requirements May be rel ated to Altered absorption of nutrients, Hypermetabolic state Medically restrict ed intake; fear that eating may cause diarrhea INTERVENTIONS: Weigh daily. Encou rage bedrest and/or limited activity during acute phase of illness. Recommend re st before meals. Provide oral hygiene. Serve foods in well-ventilated, pleasant surroundings, with unhurried atmosphere, congenial company. Avoid/limit foods th at might cause/exacerbate abdominal cramping, flatulence (e.g., milk products, f oods high in fiber or fat, alcohol, caffeinated beverages, chocolate, peppermint , tomatoes, orange juice). Record intake and changes in symptomatology. Promote patient participation in dietary planning as possible. Encourage patient to verb alize feelings concerning resumption of diet.

NURSING DIAGNOSIS: Pain, acute May be related to Hyperperistalsis, prolonged dia rrhea, skin/tissue irritation, perirectal excoriation, fissures, fistulas INTERV ENTIONS: Encourage patient to report pain. Assess reports of abdominal cramping or pain, noting location, duration, intensity (010 scale). Investigate and report changes in pain characteristicsNote nonverbal cues, e.g., restlessness, relucta nce to move, abdominal guarding, withdrawal, and depression. Investigate discrep ancies between verbal and nonverbal cues. Review factors that aggravate or allev iate pain. Encourage patient to assume position of comfort, e.g., knees flexed. Provide comfort measures (e.g., back rub, reposition) and diversional activities . Cleanse rectal area with mild soap and water/wipes after each stool and provid e skin care, e.g., A&D ointment, Sween ointment, karaya gel, Desitin, petroleum jelly. Provide sitz bath as appropriate. Observe for ischiorectal and perianal f istulas. Observe/record abdominal distension, increased temperature, decreased B P. Implement prescribed dietary modifications, e.g., commence with liquids and i ncrease to solid foods as tolerated. Administer medications as indicated, e.g.: Analgesics

ACTUAL NURSING MANAGEMENT S O A P At the end of the shift (8hrs.} the pt. o maintain fluid volume at a functional level as evidenced by a balanced intake & output record. I Maintained bed rest to prevent vomiting and straining at stool. Monitored pts intake and output. This provides guidelines for fluid replacement. Provided clear/ bland diet and avoid dark-colored, caffeinated and carbonated b everages. Caffeine and carbonated beverages stimulates hydrochloric acid product ion.. Administered fluids/ volume expanders as prescribed to replace lost fluids . Fluid volume deficit related to vomiting and watery stools dry and pale skin w eak watery stool Basa pa gyapon akung tae , as verbalized by the client

 Administered medications as indicated such as famotidine to reduce gastric acid production & irritation. E Goal partially met. The pt was able to receive adequate fluids throughout the sh ift but still claims to have defecated watery stools in a minimum amount. But ot her than that, the patient was able to maintain normal vital signs.

S O A P At the end of 30 minutes, the patient will verbalize relief of pain ates relaxed body posture. I Encouraged pt. to verbalize concerns. Reduction of an xiety can promote relaxation/comfort. Encouraged use of relaxation techniques (d eep breathing). Help pt. to rest more effectively and refocuses attention thereb y reducing pain and discomfort. Pain related to irritation of the gastric mucosa facial grimace moderate pain Sakit akong tiyan usahay, as verbalized by the patie nt.

 Administered medication as indicated analgesics. Relieves pain, enhances comfort and promote rest. We let the patient applied local massage gently to affected a reas.\ helps reduce muscle tension. E Goal met. The patient was able verbalize relief of pain and demonstrated a relax ed body posture and is able to sleep or rest.

S Cge lagi ko ug libang-linang:, as verbalized by the pt. O A P I Mo rsistent diarrhea may be a sign of bleeding.. Restrict foods and fluids that pro mote diarrhea: raw vegetables, fruits, whole grain cereals, and carbonated drink s. Administered fluids/ volume expanders as prescribed to replace lost fluids. A t the end of the shift (8hrs.}pt. will verbalized the relief of diarrhea Diarrhe a related to dry and pale skin weak watery stool

 Monitored pts intake and output. This provides guidelines for fluid replacement. Increased fluid intake of 2500-3000 mL/day. To assist in improving stool consist ency and helps maintain hydration. E Goal was partially met. Patients diarrhea reduces it was no longer like yesterda y. Pt. verbalizes that he was improving of getting well.

S Gamay raman ang akong gakan-on kay usahay mawala akong gana sa pag-kaon, as verbal ized by the patient. Niniwang ko karon as verbalized by the patient. O A Alte tion less than body requirements related to altered absorption of nutrients. P At the end of two days, the patient will be able to attain an optimum level of nutr ition as evidenced by an increase in appetite and willingness to eat. I weight= dr y and pale skin vomitus

 Encouraged bedrest and limited activity during illness. Decreasing metabolic nee ds and in presenting caloric depletion and conserves energy. Recommended rest be fore meals. Quiets peristalsis and increases available energy for eating. Provid ed oral hygiene {gurgle water or brushing teeth}. A clean mouth can enhance the taste of food. Resumeed diet as indicated, e.g. clear liquids, bland, low residu e and high protein and calorie. E Goal partially met. The patient was able to show willingness to eat even though he claimed that he doesnt have the appetite to ea t. S O A Activity intolerance related to a decrease in energy due to lack of ap At the end of the shift the patient will be able to increase his activity level and perform activities of daily living. I Provided adequate rest periods to preser ve energy. Weak ambulates with assistance Luya paman akong lawas, as verbalized b y the patient.

 Facilitated range of motion activities both passive and active to increase muscl e strength. Assisted the patient in performing his activities of daily living. I nstructed patient how to do unfamiliar activities and alternate ways of doing fa miliar activities to promote independence. Give vitamins as prescribed to facili tate trapped energy within the cells. E Goal partially met. Adequate rest and exer cises were provided and the patient was able to perform her activities of daily living but only to a minimum level.

DISCHARGE PLANS (HEALTH TEACHINGS) Medication It is important to comply regularl y its medication as prescribed by his attending physician and to comply the enti re therapeutic regimen. And explain to the patient the side effects of the medic ations so that he will be aware of Exercise Treatment Out-patient Diet ts. To bring her body back to normal functioning Mrs. Lydia Tion was advised to do the range of motion exercise Active is adviced to enhance recovery. Deep brea thing exercise with pursued lips. Have a regular exercise like walking early in the morning. The patient was instructed to avoid over work for the following day s and must have adequate bed rest Boiling the water she drink Environmental sani tation to prevent contamination of food Water must be boiled Proper hand washing Lifestyle modification, sensation of smoking and alcohol consumption. We Remind ed her that she must come back to the hospital (OPD) one week after, for the fol low-up check-up Mrs. Lydia Tion was advised to have a low fat and low cholestero l diet. Eat food that is not too oily. More emphasize on nutritious foods like f ruits and vegetables. Increase fluid intake 8-10 glasses/day.

 We instructed her to maintain her diet, to eat green leafy and yellow vegetables that are abundant in their place.

EVALUATION

PROGNOSIS

XV. BIBLIOGRAPHY Doenges, M., & Moorhouse M.F Nurses Pocket Guide: Nursing diagno sis With the Interventions, 4th ed. F.A. Davis Company Philadelphia USA. Doenges, M., & Moorhouse M.F Nurses Pocket Guide: Nursing diagnosis With the Intervention s, 8th ed. F.A. Davis Company Philadelphia USA. Deglin, J.H & Harvard Vallerand A .H Davis Drug guide for Nurses, 8th edition F.A, Davis Company, Philadelphia USA. Mosbys Medical and Nursing Dictionary, 2nd ed. The C.V, Mosby Company. 11830 West line Industrial St. Louis Missouri 63146. Karch, Amy, 2005, Nursing Drug Guide, Lippincott Williams & Wilkins Philadelphia, USA Smeltzer & Bare, medical Surgica l Nursing, 10th ed. Vol. 1, Lippincott Williams & Wilkins, Philadelphia, USA pp. 856-857, 581-582 Port, Carol Hattson, concepts of Altered Health Status, 6th ed, lippincott & Williams, Philadelphia USA, pp.464-465, 583,0634-635 Cotran, et.al , 1999, Pathologic Basis of Disease, 6th ed: WB Saunders Company, Usa, pp 514, 7 50-751 Tortora, Grabinski, 2003, Principles of Anatomy and Physiology 10th ed., John Wiley & Sons