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Loose, liquid stools Increased frequency of defecation Urgent need to defecate Bloating, gas Abdominal pain or cramps Nausea,

vomiting Fever Blood or mucus in the stool Loss of appetite, weight loss Mechanism of action/Effect:

Luminal amebicide. {01} {03} {09} {13} {14} The mechanism of action of diloxanide is unknown. {07} {13} This agent destroys the trophozoites of E. histolytica that eventually form into cysts. The cysts are then excreted by persons infected with asymptomatic amebiasis. {24} {25} Flatulence, occasional nausea, itching, early urticaria. HEENT Head: Configurationnormocephalic Hair- normal texture Scalp- lesions, tenderness Eyes: Sclera- white Conjunctiva- pink Fundoscopyo Red Reflex: present o Disc: round, sharp margins, nl color o Vessels: nl caliber, A/V ratio ~ o Background: abn pigmentation, hemorrhages or exudates o Macula: visualized Ears: External Ear- lesions, masses, tenderness Auditory Canal- normal Eardrum- TMs gray, translucent, with nl light reflex Nose: C olor- pink discharge Septum midline Inferior and Middle Turbinates normal Throat and Mouth: Teeth: Present and in good dentition Tongue: lesions Gums and Mucosa: swelling, bleeding, infection Pharynx and Tonsillar Fossa: normal Openings of Stensen's and Wharton's Ducts: identified NECK Active ROM: nl flexion, extension, lateral rotation and tilting Trachea: midline, mobile Thyroid: non-palpable or palpable, nl size & consistency, lesions Suprasternal Notch: pulsation BREASTS Inspection (Breasts and Nipples)nl size, symmetrical--nipples symmetrical and everted

Palpation (Breasts and Nipples) masses, nipples discharge HEART Neck Veins- JVD at 45 Carotid Arteries: Palpation (Amplitude and Contour)nl upstroke & amplitude bilaterally Auscultation: bruits Precordium: Inspection- lifts or heaves - PMI not visible Palpation- parasternal impulses, thrills PMI- palpable in 5th ICS, MCL; nl size Auscultation: S1- heard best at apex, nl intensity S2- heard best at base, nl splitting, A2 > P2 Extra Sounds- S3, S4 Murmurs- murmurs THORAX & BACK Observation: symmetrical expansion with respiration Percussion: spinal tenderness, CVA (costovertebral angle) tenderness LUNGS Percussion and Palpation of Lung Fields- nl resonant percussion Auscultation clear, nl vesicular breath sounds (An accepted abbreviation for normal lung Percussion & Auscultation is Clear to A&P) ABDOMEN Observation: scaphoid scars, striae Auscultation: nl bowel sounds, bruits Palpation: Superficial- tenderness, masses, guarding Deep tenderness, masses Liver: Palpation- liver edge not palpable Percussion Size- ~10 cm in R midclavicular line Spleen: Palpation- non palpable Kidneys: Left- non palpable Right non palpable Femoral Pulses: Palpation 4 / 4 bil equal Auscultation bruits EXTREMITIES Upper: Nails- cyanosis, clubbing Palms nl color, texture Muscles nl size Joints (including ROM) Interphalangeal- nl ROM deformities Wrists- flexion = 90, = extention 70, radial deviation = 20, ulnar deviation = 50 Elbows- flexion = 160 Radial pulse- 4 / 4, nl and symmetric

Lower: Nails- nl ( cyanosis, clubbing) Muscles- nl size Joints (including ROM) Ankle- dorsiflex = 20, plantar flexion = 40, eversion = 20, inversion = 20 Knee- flexion = 130 Hip- flexion = 100, internal rotation = 40, ext rotation = 40 Pulses: o Posterior Tibial- 4 / 4 bil equal o Dorsalis Pedis- 4 / 4 bil equal SKIN: nl, lesions LYMPH NODES Neck: Submental- not palpable Submandibular not palpable Anterior and Posterior Cervicalnot palpable Pre and Post Auricular- not palpable Suboccipital not palpable Supraclavicular not palpable Axillary: C entral Axillary- not palpable Pectoral not palpable Subscapular not palpable Lateral Axillary- not palpable Epitrochlear: not palpable Superficial Inguinal (horizontal and vertical): not palpable NEUROLOGIC Mental Status: Awake & Alert; oriented to person, place & time Cranial Nerves: II: Visual Acuity- 20/20 with pocket screener, both eyes Visual Fields- intact in all fields II and III: Pupillary Reaction to Lightdirect & consensual nl Accommodation- nl (Can say PERRLA, pupils, equal, round, reactive to light, and accommodation for both) III, IV, VI: EOM- intact V: Light Touch Face- nl in all 3 divisions of V VII: Wrinkle Forehead, Close Eyes, Show Teeth- nl VIII: Hearing- nl by rough testing X: Cough- nl XI: Shrug Shoulders and check sternocleidomastoid muscles - nl XII: Protrude Tongue- midline protrusion Motor System: Normal tone 5 / 5 strength in all extremities Sensory: Light Touch- nl Position Sense- nl Vibration nl Sharp nl Reflexes: Deep tendon Biceps (C5-6)- 2/4 o Triceps (C6-7)- 2/4 o Brachioradialis-2/4 o Knee (L2-4)- 2/4 o Ankle (S1)- 2/4 Pathological - Plantar Reflexnone (bil down going toes)

Coordination: Gait and Balancenl Finger to Nose- nl Rapid finger movements- nl Tandem Walking- nl Romberg negative Pathophysiology (Client Centered) NonModifiable ModifiableAge (children)EnvironmentFood HandlingIncrease motility Microorganisms attach and enter mature enterocytes serotonin releaseof intestines at the tips of small intestinal villistimulateschemoreceptorPAIN Structural changes to the small bowel mucosa and trigger zoneinflammation of the lamina propria BACTEREMIABacteria invades blood stream across lamina propria INCREASE WBCBacteria releases endotoxin Releases pyrogens that stimulates hypothalamusIncrease amount of diarrheal Fluid FEVERActive Secretion of Chloride Inhibition of Na & water reabsorption& Bicarbonate IonsDIARRHEA Digestive system: The digestive system includes the organs, structures and substances that break down food into basic nutrients that the body needs for energy, growth and repair. These include carbohydrates, fats, vitamins, minerals, and protein. The digestive system also processes waste products and eliminates them from the body in the form of feces. The digestive system includes the organs of the digestive tract, including the mouth, pharynx, esophagus, stomach, small intestine, and large intestine. It also includes accessory organs, including the pancreas and gall bladder. The digestive system interacts directly or indirectly with every other system in the body, including the nervous system, genitourinary system, musculoskeletal system, immune system, circulatory system, respiratory system and endocrine system. NURSING IMPLICATIONS Assessment & Drug Effects Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities).

Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly. Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated. Patient & Family Education Adhere closely to the established regimen without schedule interruption or changing the dose. Refrain from intercourse during therapy for trichomoniasis unless male partner wears a condom to prevent reinfection. Have sexual partners receive concurrent treatment. Asymptomatic trichomoniasis in the male is a frequent source of reinfection of the female. Do not drink alcohol during therapy; may induce a disulfiram-type reaction (see Appendix F). Avoid alcohol or alcoholcontaining medications for at least 48 h after treatment is completed. Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance. Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue, glossitis, stomatitis; vaginitis, curdlike, milky vaginal discharge; proctitis. Treatment with a candidacidal agent may be indicated.

Do not breast feed while taking this drug.

What is Diloxanide Furoate (Damizol)? Diloxanide furoate belongs to category of amebicides drugs. Diloxanide furoate is a type of diloxanide. It is highly effective luminal amoebicide directly kill trophozoites responsible for production of cysts. No systemic anti amoebic activity is evident despite its absorption. Diloxanide furoate exerts no antibacterial action. It is less effective in invasive amoebic dysentery, probably because of a poor tissue amoebicidal action. It has produced high cure rates in mild intestinal amoeboid and in a symptomatic cyst passers. Diloxanide furoate is an antiprotozoal drug used in the treatment of Entamoeba histolytica and some other protozoal infections. This drug is commonly sold as Brand Name Damizol. Indication/Contraindication for use of Diloxanide Furoate (Damizol) Not to be used in systemic amoebiasis. Intestinal amoebiasis. Side Effects of Diloxanide Furoate (Damizol) Flatulence, occasional nausea, itching, early urticaria. Dosage and Prescribing Information for Diloxanide Furoate (Damizol) 500 mg thrice daily. Children 20 mg/kg body wt daily in divided doses. All for 5-10 days.

Drug Interactions of Diloxanide Furoate (Damizol) None reported. Precautions while rescribing Diloxanide Furoate (Damizol) Pregnancy & lactation: Use with caution. Diloxanide is used alone as a primary agent in the treatment of asymptomatic (cyst passers) intestinal amebiasis caused by Entamoeba histolytica. Diloxanide may also be used concurrently, or sequentially, with other agents such as the nitroimidazoles (eg. metronidazole) in the treatment of invasive or extraintestinal forms of amebiasis. Pharmacodynamics Diloxanide is a luminal amebicide, however the mechanism of action of diloxanide is unknown. Diloxanide destroys the trophozoites of E. histolytica that eventually form into cysts. The cysts are then excreted by persons infected with asymptomatic amebiasis. Diloxanide furoate is a prodrug, and is hydrolyzed in the gastrointestinal tract to produce diloxanide, the active ingredient. Mechanism of action Unknown. Diloxanide may inhibit protein synthesis. Before taking diloxanide Before taking diloxanide make sure your doctor or pharmacist knows: If you are pregnant, trying for a baby or breastfeeding. If you are taking other medicines, including those available to buy without a prescription, herbal or complementary medicines. If you have ever had an allergic reaction to this or any other medicine. How to take diloxanide Before beginning treatment, read the manufacturer's printed information leaflet. Take your medication exactly as directed by your doctor. You must take each dose of diloxanide at the same times each day. Diloxanide is usually taken three times a day. You must complete the 10day course of diloxanide. If you miss a dose, take it as soon as you remember and continue taking it at the usual times. If it is nearly time for your next dose, skip the missed

dose and continue taking your doses at the usual times. Do not take two doses together to make up. Getting the most from your treatment Important: wash your hands and scrub your nails thoroughly before each meal and after each visit to the toilet, to prevent reinfection. Can diloxanide cause problems? Along with their useful effects all medicines can cause unwanted sideeffects, which usually improve as your body adjusts to the new medicine. Speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.