VELEZ COLLEGECOLLEGE OF NURSING

F. Ramos St., Cebu City, Philippines

A CASE STUDY ON Y. M., 13 YEARS OLD, FEMALE, BIBLE

BAPTIST, SINGLE, FILIPINO, DIAGNOSED WITH
AMOEBIASIS

SUBMITTED TO:
MS. MARIGOLD KRISTINE B. UY, RN, MN
SUBMITTED BY:
LEVEL II
BERNUS, ANDREA
BOMBIO, SONNY BOY
CENIZA, PHILIP
DICDIQUIN, JONAS MAJOR N.
FRANCISCO, JOASH M.
SALINAS, FIONA
VISCAYNO, KYLA
LEVEL III
BATAYOLA, KATHLEEN JUNE
CORTES, ALMIRA D.
GO, JOHN JEFFREY A.
ROMERO, KIM CARL JUNETTE S.
LEVEL IV
DE ASIS, LORDELYN
DESIDERIO, MIKA

PPS3rd FLOOR
December 2014-January 2015

A case study on Y.M., 13 years old, female, Bible Baptist, Single, Filipino, admitted last
January 4, 2015 at CVGH for complaints of fever and diarrhea noted 18 hours PTA,
diagnosed with amoebiasis.
INTRODUCTION
Amoebiasis, or amebiasis, refers to infection caused by the amoeba Entamoeba histolytica. The
infective stage of this parasite is called cyst, which can be ingested from contaminated water and food.
Upon ingestion, the cysts go down into the digestive tract and in the lower part of the small intestine.
Four new parasites called the metacysts will emerge. These metacytes will then move to the colon
where they will develop into the trophozite stage. Trophozites are capable of intestinal colonization and
invasion resulting either in mucoidal stool with or without blood streaks. Entamoeba cysts are resistant
to standard chlorine treatment, but are killed by iodine or boiling.
Signs and
Mild
3 days
diarrhea
- cramping
Moderate
4days-3 weeks
-fever
diarrhea
-vomiting
Severe
More than 3
-weight loss
diarrhea
weeks
-dehydration
*The incubation period of E. Histolytica infection
days to years.
*Asymptomatic infections are common.

symptoms
moderate diarrhea with blood and mucus
abdominal pain

is commonly 2-4 weeks but may range from a few

Cause
Entamoeba histolytica
Transmission and contamination
-ingestion of contaminated food and water with infective cysts
-contaminated hands of food handlers
-sexual transmission is possible (oral-anal practices)
Diagnosis
-Stool exam for ova, parasite and Entamoeba histolytica (3 or more specimens at 3 or 4 days interval)
-Serological tests
Management
Collaborative management
Drug of choice: Metronidazole
intravenous (IV) volume replacement
Nursing management
1.Provide health education:
a.Boil water for drinking or use purified water;
b.Avoid washing food from open drum or pail;
c.Cover leftover food;
d.Wash hands after defecation or before eating;
e.Wash/cook properly ground vegetables (lettuce, carrots, and the like).
f. maintain proper hygeine
2.Proper collection of stool specimen
A. Instruct patient to avoid mixing urine with stools.
b. If whole stool cannot be sent to laboratory, select as much portion as possible containing blood and
mucus.
c. Send specimen immediately to the laboratory; stool that is not fresh is nearly useless for
examination.
d. Label specimen properly.
3.Hydration
a. Encourage oral fluids
b. Monitor intake and output
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 prevalence of Entamoeba infection is as high as 50% in
areas of Central and South America, Africa, and Asia.

CLIENT IN CONTEXT
Identifying Information
Y.K.M., 13 years old, female, Filipino, Bible Baptist, born on October 25, 2001 in Cebu Doctors Hospital,
currently residing in Phase 2 Blk 2 lot 11 Buenavista Home, Consolacion, Cebu, was admitted for the 1 st
time in Cebu Velez General Hospital (CVGH) last January 4, 2015 at 10:13 PM via private vehicle
accompanied by her parents for complaints of fever and diarrhea noted 18 hours PTA under the service
of Dr. Cheryl Bullo of the Department of Pediatrics with a case number and a hospital number of
025172/ 1500061966.
History of Present Illness
18 hours PTA, patient had a sudden onset of gnawing epigastric pain with a pain scale of 9/10 with 10
as the highest and 1 as the lowest. Patient also had a sudden onset of vomiting previously ingested
food amounting to - cup per episode and of diarrhea consisting of brownish watery stool
constistency, non mucoid, non-bloody stool amounting cup per episode. SOs attributed the
patients condition to eating food consisting of grilled meat and fish, spaghetti, macaroni salad and
other various food in their picnic also to the ingested water from the pool as verbalized by the patients
father nag duwa duwa man na sila pagpangaligo nila, kadtong mga nakainom ug tubig sa swimming
pool maoy nagkalibanga, kadtong iyang manghod ug ig-agaw, 3 days prior since patients younger
brother and cousin experienced the same symptoms. Both vomiting and diarrhea was noted to be
more than 10 episodes. This was associated with intermittent fever with the highest temperature of
39C/axilla. Patient was given Paracetamol (Biogesic) 500 mg at around 4am. Fever subsided, and all
other symptoms were still noted. Patient was given with Neo-Kiddielets 80 mg around 8am and 12pm
for fever but with no relief. Patient took Loperamide (Diatabs) 2 mg/ cap 2 capsules at 12pm with only
little relief of symptoms noted. Paracetamol (Biogesic) 500mg was given at 3pm and fever had
subsided. Hydrite Powder with unrecalled dosage was given to patient at 6pm.
Hours PTA, symptoms persisted, patient was pale, skin was cold to touch, and as verbalized by the
mother nakuyawan naman mi day kay mo action na man ug bawog iyang kamot, pero dili sya ka
control, mura kanang walay umoy dai, wala ra man hinoon nanggahi, kung among e straight ma
straight ra pud siya ug balik which prompted them to seek consult, thus this admission.
Past Health History
Prenatal history
Patient was born to a then 27 year old G2P0 (0010) mother. First prenatal checkup was at 1 month
AOG at Cebu Doctors Hospital with an obstetrician & regularly thereafter visiting clinic 1x/month from
1-7months AOG, 1x/2 weeks upon 7-8 months AOG & 1x/week upon 9 months AOG. Patients mother
had no maternal illness like fever, UTI, measles, or pre-eclampsia throughout pregnancy. Mother is not
a known hypertensive, diabetic & asthmatic. Mother claims to be a nonsmoker & non-alcoholic
beverage drinker. She claims to have received unrecalled vaccination during the course of pregnancy
& was prescribed with Folic Acid, Ferrous Sulfate, and Calcium all taken with good compliance.
Labor and delivery
Patient was born cephalic, full term at 39 weeks AOG via NSVD at Cebu Doctors Hospital after 15
hours of labor. Patient was noted to have a good & loud cry, no cyanosis, jaundice, pallor, meconium
staining, cord coiling or other complications during birth. No congenital anomalies. Birth weight was
2.78kg(6.12 lbs). APGAR score and BS was unrecalled. Patient and client stayed for 2 days at hospital
and was discharged with an improved condition.
Postnatal History
Patient was previously hospitalized when she was 7 months old due to an onset of diarrhea as claimed
by the mother nagkalibanga sya dai after eating ice candy at Chong Hua Hospital and was
discharged after 3 days with an improved condition. Patient was given unrecalled take home
medications.
Feeding history
First feeding was unrecalled. Patient was exclusively breastfed until 2 months old. Mixed feeding was
started thereafter with NAN1, 90ml (3oz.) every 2-3hours or per demand, mother verbalized kusog jud
sya mo totoy ug gatas. Complimentary feeding was initiated at 5 months old with cerelac and mashed
potatoes & squash at 7 months old. By 8 months patient started to eat rice. Patients appetite was said
to be good and that she didnt have any particular diet restrictions, and food preference. Currently,
patient eats 3 meals/day with snacks in between consuming rice, vegetables, meat and chicken. She
drinks 3-8 glasses of water/day with mineral water as their source of drinking.
Health History
Patient has not had menarche yet. Telarche was at 12 years old.
Patient was allergic to shrimp before and has occasional episodes of allergic rhinitis and pruritus as
claimed. Slowly, patient becomes desensitized and allergic symptoms were no longer noted every time
she eats shrimp. Has no drug allergies, and has not undergone blood transfusions previously. Patients
father claimed to have the patient completely immunized with DPT, OPV, BCG, and MMR.

Growth and Development

Onset of primary teeth (upper incisors) noted at 4 months. First eruption of permanent teeth was at 7
years old. Present number of teeth is 14 on superior side and 13 on inferior side, total number of 27
teeth; all permanent.

Developmental milestone
Patient was able to smile & hold head steadily while in sitting position at 2 months, roll over & sit with
support at 5 months, sit unsupported at 8 months, stand with support at 10 months, stand alone at 12
months, walk alone at 1 year & 2 months, say first word with meaning at 6 months, talk in sentences
at 2 years & month and dress self at 3 years.
Toilet training was initiated by the time patient can already say poo poo and wee wee. Parents
approach involve accompanying patient to the comfort room, coaching and demonstrating to her the
proper way of voiding, defecation & aftercare.
Patient is currently studying in Mandaue School for the Arts, and is now in grade 7 with good scholastic
grades. Patient has no problems in school as claimed.
Sleeping pattern
Before hospitalization, patient usually sleeps at 10pm and wakes up at 5:30 am during weekdays, and
wakes up late during the weekends. Patient usually takes a nap for 1 -2 hours in the afternoon if there
are no classes. During hospitalization, patient claimed that she doesnt have any changes in her
sleeping pattern before and during hospitalization except that shes always awaken up to go to the
comfort room to defecate. Patient verbalized naka tulog ra ko, pero mag mata-mata lang jud ko ug
kalibangon ko.
Elimination pattern
Before hospitalization, patient usually defecates once a day, usually early in the morning, with browny
soft and well-formed stools. Patient urinates 3-4 times at any time of the day with yellowish colored
urine amounting to -1 glass per episode.
During hospitalization, patient urinates with minimal amount right after she defecates. She was able to
defecate 28 times on Monday (01/05/15), 32 times on Tuesday (1/6/15), and 28 times on Wednesday,
amounting to - cup per episode. Patient experiences abdominal pain during and after defecation
with a pain scale of 8/10 to 10/10 with 1 as the lowest and 10 as the highest. Patient had vomiting
during the full course of assessment amounting to - glass per vomitus.
Environmental history
Patient is currently living in Phase 2 Blk 2 lot 11 Beunavista, Consolacion, Cebu with her parents and 3
siblings ,and 1 helper. Father claimed that their place is not a flood and landslide prone area. Their
house and lot is not rented but owned. House is made up with mixed materials and has 5 doors
including the main door, and 5 windows in the house, 1 bathroom with a flushed type toilet, and 3
rooms for sleeping. Garbage is collected every night and is put to an area where the garbage truck will
collect it in the morning thrice a week . Utilizes purified drinking water for drinking and MCWD as a
source of water for household use. Their electricity is powered by VECO. The family has no pets at
home. Their helper usually cleans the house every day.
Family history (appendix A)
Genogram (appendix B)
Personal and Social History
Patients parents are her primary caretaker. During infancy and toddlerhood, patients grandmother
and helper are her primary caretakers while parents are working.
Patient sleeps in her room together with her brother.
Patient and her familys religion is Bible Baptist and her parents are married. Their family were active
in church activities, both parents of the patient are members of their church choir. Patient usual
activities during the weekend is to stay at home, watch movies and draw/make projects and
assignments, and on Sundays the patient together with her family attend church service for the whole
day. The family practices proper hygiene at home like hand washing every before and after meals,
tooth brushing at least twice a day, and doing half bath before sleeping.

PHYSICAL EXAMINATION
Day 1: January 5, 2015 (Monday)
At. 11:00 am, patient was examined while lying in bed . Conscious, cooperative and febrile with IV
infusion of bottle 2 PLR 1 liter at 40 drops per minute infusing well at right arm with the following vital
signs:
BP: 120/ 80 mmHg PR: 79 bpm RR: 17 cpm Temp: 38.2 C
SKIN: slightly pale skin color; dry and warm to touch with smooth even texture. good mobility & skin
turgor; no edema; no tenderness noted.
HEAD & FACE: head is normocephalic, erect at midline; hard and smooth without any lesions or lumps
noted; hair is black, short and evenly distributed; scalp is clean; face is symmetric with no abnormal
facial movements noted; temporomandibular joint is free from swelling, tenderness or crepitation
movement; mouth opens & closes fully, lower jaw moves 1-2cm in each direction.
NAILS: Transparent pinkish nail bed; 160o between nail base & skin; no nail clubbing; with black dirt
deposits on sides of all nails, well-trimmed; smooth, firm & hard; nailplate firmly attached to nail bed.
EYES & VISION: eyeballs symmetrically aligned in sockets protruding or sinking; anicteric sclerae;
lashes are short & evenly spaced & curled outward; lower lid margin at bottom edge of iris; upper lid
margin cover approx. 2mm of iris; palpebral conjunctivae is pinkish, moist and free from swelling &
lesions; bulbar conjunctivae clear, moist, smooth & tiny vessels visible; sclerae are white; puncta
visible swelling or redness; no tenderness or drainage noted; minimal lacrimation; cornea is
transparent, moist & opacities; lens are clear, iris is round and uniform in color; PERRLA; reflections
of light noted at same location on both eyes; uncovered eye remains fixed, covered eye does not move
as cover is removed; both eyes move in a smooth, coordinated manner in all 6 directions; able to
identify colors in exam room and television screen, able to read nameplate, Dicdiquin, Jonas Major N.
approximately 2 ft. distance; sees examiners finger at the same time the examiner sees it (visual
fields full by confrontation)
EARS & HEARING: equal in size bilaterally approx 4 cm; pinna in line lateral canthus of both eyes &
within a 10o angle from vertical position, earlobe is free; external ears are smooth lesions, lumps or
nodules, color is consistent with facial color; no discharges noted; non-tender auricle & mastoid
process; no tenderness on external canal upon manipulation of auricle; small amount of moist, yellow,
odorless cerumen noted; repeats whispered 2-syllable word at 3 ft distance AU; reports hearing watch
tick within 5 inches from ear AU; Weber and Rinne test not assessed due to unavailability of pitch fork.
NOSE & SINUSES: color of the external portion of the nose is consistent with the rest of the face,
smooth and symmetrical; both nostrils patent, nasal mucosa is dark pink, moist, free of exudate, nasal
septum intact, at midline & free of ulcers or perforations; clear frontal & maxillary sinuses on
transillumination.
MOUTH & PHARYNX: pinkish, moist lips lesions or swelling; whitish to yellowish teeth; dental
cavities noted; tongue is moist, pinkish, at midine, lesions, nodules, or fasciculations; papillae
present on dorsal surface; frenulum in midline visible Whartons ducts on each side; whitish hard
palate firm transverse rugae & moist soft palate no lesions noted; no unusual or foul odor noted;
pinkish, moist, hangs freely in midline redness or exudate; tonsils 1+, pink, symmetric exudate,
swelling or lesions; oropharynx is pink exudate or lesions; gag reflex intact.
NECK: symmetric with head centered midline; thyroid cartilage, cricoid cartilage & thyroid gland move
upward symmetrically as client swallows; full ROM, smooth & controlled; trachea at midline; thyroid
gland -palpable & slight tenderness noted; lymph nodes are non-palpable.
BREASTS: assessment was not done because of patients request.
CHEST & LUNGS: scapulae symmetric & non-protruding; anteroposterior less than transverse
diameter; sternum at midline & straight; ribs slope downward symmetric intercostal spaces; costal
angle <90o; regular, relaxed, effortless & quiet use of accessory muscles; no tenderness, pain or
unusual sensations reported; temperature equal bilaterally; no crepitus noted; symmetric fremitus in
upper lung fields, intensity lowers from apices to the bases; symmetric chest expansion at approx. 3cm
apart anteriorly & posteriorly; resonance upon percussion over all lung fields; symmetric diaphragm
excursion at approx.. 3cm bilaterally; bronchial sounds noted over trachea, bronchiovesicular over
major bronchi & vesicular over peripheral lung fields; no adventitious sounds noted; egophony is soft &
muffled; letter e is distinguishable, intensity lowers from apices to bases; bronchophony is soft,
muffled & distinct, intensity lowers from apices to bases; whispered peqtoriloquy is soft, muffled &
distinct, intensity lowers from apices to bases.
HEART & PERIPHERAL VASCULATURE: No heaves noted, apical impulse at 5 th ICS to the left of the
MCL; no thrills or other unusual pulsations noted; apical PR= 79 bpm, regular rhythm; no pulse deficit
noted; S1 sound distinct, heard best at mitral area, S2 sound distinct, heard best at bases; no extra
heart sounds & murmurs noted; jugular venous pulse not noted when client is upright; jugular vein

undistended head of bed elevated 30o & head facing left; JVP 3cm above sternal angle head of bed
elevated 30o & head facing left; no bruits noted; upper & lower extremities bilaterally symmetric & no
edema noted; CRT of upper & lower extremities <2 secs bilaterally; ulnar & radial arteries patent on L
hand, right arm not assessed due to presence of hand splint & IV; no varicosities noted; Homans sign
negative on both feet.
ABDOMEN: flat contour; symmetric; umbilicus at midline, recessed bulging, slight pulsations noted;
no peristaltic waves seen; gurgles & clicks were heard; Hyperactive bowel sounds were heard;
Bowel Sounds:
18
Left Upper quadrant
25
Left Lower quadrant

15
Right Upper quadrant
23
Right Lower quadrant

no bruits, venous hums or friction rubs noted; generalized tympany over all four quadrants;
tenderness noted; no mass palpated; kidney non-palpable & tender on blunt percussion of CVA; empty
bladder is non-palpable & emits flat tone upon percussion; constant borders bet. tympany & dullness
throughout position changes; no fluid wave transmitted; no rebound tenderness noted; no pain
reported upon Psoas sign; no pain reported upon Obturator sign.
ANUS: Not assessed. SO claims that patients anus is slightly reddened due to frequent washes.
FEMALE GENITALIA: Not assessed.
BACK & EXTREMITIES:
Slightly erect stature normal curvature of cervical, thoracic & lumbar spine; upper extremities full
ROM but lower extremities has passive ROM.
Musculoskeletal: Equal size on both sides of the body, no contractures, no fasciculation or tremors,
smooth coordinated movements, no deformities, no tenderness or swelling, no edema.
Muscle strength
5/5

5/5

5/5

5/5

Grading Scale:
5- full ROM against gravity, full resistance
4- full ROM against gravity, some resistance
3- full ROM with gravity
2- full ROM with gravity eliminated, passive motion
1-slight reaction
0- no reaction
NEUROLOGIC ASSESSMENT:
Mental Status/Cerebral Function:
Client is alert(awake and responsive). In the Glasgow Coma Scale, client scores 13 observed by as
follows: eye opening response is spontaneous (rated 4); oriented verbal response (rated 5); obeys
verbal commands (rated 4).
GCS scoring:
Eye response:
1 - no eye opening
2 - eye opening in response to pain stimulus
3 - eye opening to speech
4 - spontaneous eye opening
Verbal Response:
1 - no verbal response
2 - incomprehensible sounds
3 - inappropriate words
4 - confused
5 - oriented
Motor response:
1 - no motor response
2 - extension to pain
3 - abnormal flexion to pain
4 - flexion/withdrawal to pain
5 - localizes to pain
6 - obeys commands

Client is cooperative and expresses feelings appropriate to the situation. Client appears neat and
clothes are appropriate for the weather. Client maintains eye contact. She smiles and frowns
appropriately accordingly to the situation. Client talks in short understandable a clear high pitched
tone.. Client has difficulty in naming familiar items. Client expresses full, free-flowing thoughts,
sensible and easy to understand. Client is able to state her name and names of known family
members, knows where she is. Client is attentive, listens well and can follow instructions without
difficulty. Client was able to recall her birthday and her assigned student nurse during hospitalization.
Client is able to copy simple figures without difficulty.
Motor/Cerebellar Function:
Client is able to turn palms up & down rapidly without difficulty. Client is able to touch finger to thumb
and finger to nose smoothly, accurately and without difficulty. Client runs each heel down each shin
smoothly.. With eyes closed and opened, client is not able to stand due to fatigue. No fasciculation,
tics, or tremors noted.
Sensory Function:
With eyes closed, client correctly identifies light touch on her arms, thigh, and hands; able to
differentiate between dull & sharp sensations and hot & cold temperature on various body parts;
identifies correctly the sensation on the bony prominence of his metacarpal joints on both hands;
discriminate two points on finger tips at 2-5 mm apart; back at 40 mm apart; dorsal hands at 20-30
mm apart; thighs at 70 mm apart; forearm at 40 mm apart; correctly identify coin on his hand and
number 8 written on her palm; easily state direction of finger being manipulated.
CRANIAL NERVE TESTING:
CN I (Olfactory): correctly identifies scent of gatorade.
CN II (Optic): able to identify colors in exam room and television screen,; can read nameplate at 2 ft.
distance; sees examiners finger at the same time the examiner sees it (visual fields full by
confrontation)
CN III, IV, VI (Oculomotor, Trochlear, Abducens): full extraocular movements, PERRLA
CN V (Trigeminal): corneal reflex present, identifies light, sharp, & dull sensations on forehead, cheek
& chin, clenches teeth.
CN VII (Facial): correctly identifies taste of sugar & salt; able to smile, frown, wrinkle forehead, show
teeth, puff out cheeks, purses lips, raise eyebrows & close eyes against resistance
CN VIII (Vestibulocochlear): whispered words heard within 3ft AU; vibration heard equally well AU
CN IX & X (Glossopharyngeal and Vagus): uvula & palate rise symmetrically when client says
ah; gag reflex present; swallows difficulty
CN XI (Spinal Accessory) equal shoulder shrug against resistance; turns head in both directions
against resistance
CN XII (Hypoglossal): protrudes tongue in midline; able to push tongue depressor to R & L difficulty
DEEP TENDON REFLEXES:
Not assessed due to lack of reflex hammer.
SUPERFICIAL REFLEXES:
Abdominal: abdominal muscles contract upon stimulation
Plantar: plantar flexion upon stimulation
PATHOLOGIC REFLEXES:
Brudzinkis sign: hips & knees remain relaxed & motionless
Kernigs sign: no pain felt
DAY 2
01/06/15
GENERAL APPEARANCE: Patient is conscious, cooperative and afebrile. With the following Vital
Signs:
BP: 120/80 mmHg PR: 77 bpm RR: 17 cpm Temp: 37.2 C
SKIN: slightly pale skin color; dry and warm to touch with smooth even texture. good mobility & skin
turgor; no edema; no tenderness noted.
ABDOMEN: Peristaltic waves absent; slight pulsations noted; Hyperactive bowel sounds noted on all
quadrant;
Bowel Sounds:

15
Left Upper quadrant
26
Left Lower quadrant

15
Right Upper quadrant
22
Right Lower quadrant

ANUS: Flatulence is noted; Reddened anal orifice as claimed by SO. Not fully assessed due to patients
request.
DAY 3
01/07/15
GENERAL APPEARANCE: Patient is conscious, cooperative and afebrile. With the following Vital
Signs:
BP: 110/90 mmHg PR: 81 bpm RR: 18 cpm Temp.: 36.6 C
SKIN: slightly pale skin color; dry and warm to touch with smooth even texture. good mobility & skin
turgor; no edema; no tenderness noted.
ABDOMEN: Peristaltic waves absent; slight pulsations noted; Hyperactive bowel sounds noted on all
quadrant;

Bowel Sounds:
19
Left Upper quadrant
28
Left Lower quadrant

18
Right Upper quadrant
27
Right Lower quadrant

ANUS: Flatulence is noted; Reddened anal orifice as claimed by SO. Not fully assessed due to patients
request.

LABORATORY RESULTS
Urinalysis
Taken: January 5, 2015
Purpose:
Evaluates physical characteristics of urine; determines specific gravity and pH; detects and measures
protein, glucose, and ketone bodies; examines sediment for blood cells, casts and crystals. This test is
used to screen the urine for renal or urinary tract disease; to help detect metabolic or systemic disease
unrelated to renal disorders.
Macroscopic

Normal
Values

Result

Color

Clear-Light
Yellow

Dark
Yellow

Appearance

Clear

Cloudy

pH

4.5 8.0

8.0

Specific
gravity

1.005
1.035

Proteins

negative

Positive
+

Glucose

negative

negative

RBC/hpf

0 3/hpf

1-2/hpf

WBC/hpf

0 5/hpf

4-5 /hpf

Epithelial
Cells

0 5/hpf

3-5/hpf

Blood

Negative

Negative

Ketone

Negative

++

1.005

Microscopic

Implication:
Cloudy urine may occur occasionally due to mild dehydration which may be brought about by diarrhea
secondary to Amoebiasis.
Protein in the urine may be caused by the infection caused by Entamoeba histolytica.
Ketone bodies are usually absent in urine. The presence of ketones in the urine probably indicates that
the body is using fats rather than carbohydrates for energy. Patient uses an alternative source of
energy because she is not eating the right amount of carbohydrates as stated wa koy gana mukaon
kay maglain ako tiyan.
Stool Exam
Taken: January 5, 2015
Purpose:
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 parasites, viruses, or bacteria.
Macroscopic: SE- OPEH
Color: Reddish Brown
Consistency: Watery
Microscopic:
RBC/hpf: 20-25/HPF
WBC/hpf: 10-15/HPF
Ova & Parasites: Entamoeba Histolytica Cyst 0-2/HPF
Bacteria: Abundant
Implication: Entamoeba Histolytica present which causes the stool to be watery. The parasite invades
the lining of the large intestines causing bloody diarrhea.
Complete Blood Count
Taken: January 5, 2015

10

Purpose:
To assess the patient for anemia, hemorrhage, infection, inflammation, hemolytic disease and the
effects of ABO incompatibility, and hydration status. It also used to identify the cellular characteristics
of the peripheral blood and manage treatment for peptic ulcer disease and abnormal bleeding
tendencies.
TEST

EOS
BASO

RESULT
1/5/15
7.40
5.38
H72.
6
1.03
L13.
9
H.844 H11.
4
.001
.015
.151
2.04

RBC
HGB
HCT
MCV
MCH
MCHC
RDW

4.66
12.7
39.8
85.4
27.3
32.0
L10.4

4.14
11.1
34.3
82.8
26.7
32.3
L10.0

10e6/uL
g/dL
%
fL
pg
g/dL
%

4.10 5.30
12.0 16.0
36.0-49.0
78.0 102
25.0 35.6
31.0 36.0
11.6 18.0

PLT
MPV

238.
4.47

202.
4.42

10e3/uL
fL

140 440
0.00 99.9

WBC
NEU
LYM
MONO

1/6/15

UNIT

LIMIT SET

5.70
3.71 65.0

10e3/uL
%

4.50 13.0
1.80 8.00
25.0 70%

L.95
9
H.9
16
.005
.113

1.20 5.80

20.0-65.0%

0.00 .800

0.00-9.00%

%
%

0.00 - .500
0.00 - .200

0.00-8.00%
0.00-3.00%

L16.
8
H16
.1
.095
1.99

Implications:

Neutrophils act to
defend the body
against microbial invasion through phagocytosis. Damage or inflammation of tissues caused by the
parasite Entamoeba Histolytica can lead to high Neutrophil count. The decrease in neutrophil count on
the next day may be due to the effects of the medication, Metronidazole.
Monocytes, which are considered as the bodys second line of defense, are presented to initiate the
bodys recovery from infection. An increased number of monocytes in the blood (monocytosis) occur in
response to the infection caused by Entamoeba Histolytica.
Lymphocytopenia or lymphopenia are alternate terms for low lymphocyte counts. When the
lymphocyte count is lowered, the body's ability to resist and fight off infections is severely
compromised and its susceptibility to infection is increased.
Red cell distribution width (abbreviated as RDW) is a measurement of the amount that red blood cells
vary in size. Red blood cells help carry oxygen in the blood. A low RDW means that the red blood cells
vary very little in size. Bleeding in the lining of the large intestines can cause a low RDW.

11

ANATOMY AND PHYSIOLOGY

THE GASTROINTESTINAL SYSTEM

The gastrointestinal
tract (GIT)
consists of a hollow muscular tube
starting from the oral cavity, where
food enters the mouth, continuing
through the pharynx, oesophagus,
stomach and intestines to the
rectum and anus, where food is
expelled.
There
are
various accessory
organs that
assist the tract by secreting
enzymes to help break down food
into its component nutrients. Thus
the salivary glands, liver, pancreas
and gall bladder have important
functions in the digestive system.
Food is propelled along the length
of the GIT by peristaltic movements
of the muscular walls.

The primary purpose of the gastrointestinal tract is to break food down into nutrients, which can be
absorbed into the body to provide energy. First food must be ingested into the mouth to be
mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and small
intestine where proteins, fats and carbohydrates are chemically broken down into their basic building
blocks. Smaller molecules are then absorbed across the epithelium of the small intestine and
subsequently enter the circulation. The large intestine plays a key role in reabsorbing excess water.
Finally, undigested material and secreted waste products are excreted from the body via defecation
(passing of feces).
Individual components of the gastrointestinal system
Oral cavity
The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified squamous oral
mucosa with keratin covering those areas subject to significant abrasion, such as the tongue, hard
palate and roof of the mouth.
Salivary glands
Three pairs of salivary glands communicate with the oral cavity. Each is a complex gland with
numerous acini lined by secretory epithelium. The acini secrete their contents into specialised ducts.
Each gland is divided into smaller segments called lobes. Salivation occurs in response to the taste,
smell or even appearance of food. This occurs due to nerve signals that tell the salivary glands to
secrete saliva to prepare and moisten the mouth. Each pair of salivary glands secretes saliva with
slightly different compositions.
Parotids
The parotid glands are large, irregular shaped glands located under the skin on the side of the face.
They secrete 25% of saliva. They are situated below the zygomatic arch (cheekbone) and cover part of
the mandible (lower jaw bone)
Submandibular
The submandibular glands secrete 70% of the saliva in the mouth. They are found in the floor of the
mouth, in a groove along the inner surface of the mandible. These glands produce a more viscid (thick)
secretion, rich in mucin and with a smaller amount of protein.
Sublingual
The sublinguals are the smallest salivary glands, covered by a thin layer of tissue at the floor of the
mouth. They produce approximately 5% of the saliva and their secretions are very sticky due to the
large concentration of mucin. The main functions are to provide buffers and lubrication.
Esophagus
The oesophagus is a muscular tube of approximately 25cm in length and 2cm in diameter. It extends
from the pharynx to the stomach after passing through an opening in the diaphragm. The oesophagus
functions primarily as a transport medium between compartments.

12

Stomach
The stomach is a J shaped expanded bag, located just left of the midline between the oesophagus and
small intestine. It is divided into four main regions and has two borders called the greater and lesser
curvatures. The first section is the cardia which surrounds the cardial orifice where the oesophagus
enters the stomach. The fundus is the superior, dilated portion of the stomach that has contact with
the left dome of the diaphragm. The body is the largest section between the fundus and the curved
portion of the J.
This is where most gastric glands are located and where most mixing of the food occurs. Finally the
pylorus is the curved base of the stomach. Gastric contents are expelled into the proximal duodenum
via the pyloric sphincter. The inner surface of the stomach is contracted into numerous longitudinal
folds called rugae. These allow the stomach to stretch and expand when food enters. The stomach can
hold up to 1.5 litres of material. The functions of the stomach include:

The short-term storage of ingested food.

Mechanical breakdown of food by churning and mixing motions.

Chemical digestion of proteins by acids and enzymes.

Stomach acid kills bugs and germs.

Some absorption of substances such as alcohol.

Small intestine
The small intestine is composed of the
duodenum, jejunum, and ileum. It averages
approximately 6m in length, extending from the
pyloric sphincter of the stomach to the ileocaecal valve separating the ileum from the
caecum.
The small intestine is compressed into
numerous folds and occupies a large proportion
of the abdominal cavity.
The duodenum is the proximal C-shaped
section that curves around the head of the
pancreas. The duodenum serves a mixing
function as it combines digestive secretions
from the pancreas and liver with the contents expelled from the stomach. The start of the jejunum is
marked by a sharp bend, the duodenojejunal flexure. It is in the jejunum where the majority of
digestion and absorption occurs. The final portion, the ileum, is the longest segment and empties into
the caecum at the ileocaecal junction.
The small intestine performs the majority of digestion and absorption of nutrients. Partly digested food
from the stomach is further broken down by enzymes from the pancreas and bile salts from the liver
and gallbladder. These secretions enter the duodenum at the Ampulla of Vater. After further digestion,
food constituents such as proteins, fats, and carbohydrates are broken down to small building blocks
and absorbed into the body's blood stream.
The lining of the small intestine is made up of numerous permanent folds called plicaecirculares. Each
plica has numerous villi (folds of mucosa) and each villus is covered by epithelium with projecting
microvilli (brush border). This increases the surface area for absorption by a factor of several hundred.
The mucosa of the small intestine contains several specialized cells. Some are responsible for
absorption, whilst others secrete digestive enzymes and mucous to protect the intestinal lining from
digestive actions.
Large intestine
The large intestine is horse-shoe shaped
and extends around the small intestine
like a frame. It consists of the
appendix,
caecum,
ascending,
transverse, descending and sigmoid
colon, and the rectum. It has a length
of approximately 1.5m and a width of
7.5cm.
The caecum is the expanded pouch that
receives material from the ileum and starts to
compress food products into faecal
material. Food then travels along the
colon. The wall of the colon is made up of several pouches
(haustra) that are held under tension by three thick bands
of muscle (taenia coli).
The rectum is the final 15cm of the
large intestine. It
expands to hold faecal matter before it passes through the anorectal canal to the anus. Thick bands of
muscle, known as sphincters, control the passage of faeces.
The functions of the large intestine can be summarised as:

The accumulation of unabsorbed material to form faeces.

Some digestion by bacteria. The bacteria are responsible for the formation of intestinal gas.

13

Reabsorption of water, salts, sugar and vitamins.

Liver
The liver is a large, reddish-brown organ situated in the right upper quadrant of the abdomen. It is
surrounded by a strong capsule and divided into four lobes namely the right, left, caudate and
quadrate lobes. The liver has several important functions. It acts as a mechanical filter by filtering
blood that travels from the intestinal system. It detoxifies several metabolites including the breakdown
of bilirubin and oestrogen. In addition, the liver has synthetic functions, producing albumin and blood
clotting factors. However, its main roles in digestion are in the production of bile and metabolism of
nutrients. All nutrients absorbed by the intestines pass through the liver and are processed before
traveling to the rest of the body. The bile produced by cells of the liver, enters the intestines at the
duodenum. Here, bile salts break down lipids into smaller particles so there is a greater surface area
for digestive enzymes to act.
Gall bladder
The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior surface of the
liver's right lobe. It consists of a fundus, body and neck. It empties via the cystic duct into the biliary
duct system. The main functions of the gall bladder are storage and concentration of bile. Bile is a
thick fluid that contains enzymes to help dissolve fat in the intestines. Bile is produced by the liver but
stored in the gallbladder until it is needed. Bile is released from the gall bladder by contraction of its
muscular walls in response to hormone signals from the duodenum in the presence of food.
Pancreas
Finally, the pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its head
communicates with the duodenum and its tail extends to the spleen. The organ is approximately 15cm
in length with a long, slender body connecting the head and tail segments. The pancreas has both
exocrine and endocrine functions. Endocrine refers to production of hormones which occurs in the
Islets of Langerhans. The Islets produce insulin, glucagon and other substances and these are the
areas damaged in diabetes mellitus. The exocrine (secretrory) portion makes up 80-85% of the
pancreas and is the area relevant to the gastrointestinal tract.
It is made up of numerous acini (small glands) that secrete contents into ducts which eventually lead
to the duodenum. The pancreas secretes fluid rich in carbohydrates and inactive enzymes. Secretion is
triggered by the hormones released by the duodenum in the presence of food. Pancreatic enzymes
include carbohydrases, lipases, nucleases and proteolytic enzymes that can break down different
components of food. These are secreted in an inactive form to prevent digestion of the pancreas itself.
The enzymes become active once they reach the duodenum.

14

DRUGS
Metronidazole 500 mg OD PC started at 1/5/15 9 AM, for 10 days
C:
Anti-infectives, Anti-protozoals
A:
Disrupts DNA and protein synthesis in susceptible organisms
Bactericidal, or amebicidal action
I:
Amoebiasis
C:
Hypersensitivity
A:
CNS: seizures, dizziness, headache
GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, vomiting, glossitis,
unpleasant taste.
Hematologic: Leukopenia
Skin: Rashes, urticaria
N:
Administer with food or milk to minimize GI irritation.
Tablets maybe crushed for patients with difficulty in swallowing
Inform patient that medication may cause an unpleasant metallic taste
Inform patient that medication may cause urine to turn dark
Caution patient that medication may cause dizziness
Ranitidine 50mg/amp 1 amp q 8H IVTT
C:
H2 receptor antagonist
A:
potent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2
receptor sites on parietal
cells, thus blocking gastric acid secretion; shown to inhibit 50% of the
stimulated gastric acid secretion
I:
Treatment of GI hypersecretory conditions
C:
Hypersensitivity to ranitidine
A:
headache, malaise, dizziness, bradycardia, anaphylaxis, constipation, hypersensitivity
reactions
N:
Allow 1 hour to lapse before administering any other antacid
Be alert for early signs of hepatoxicity such as jaundice, dark urine, pruritus, yellow sclera.
Monitor liver enzyme tests.
Long term therapy may lead to vit B12 deficiency
Assess for epigastric or abdominal pain and frank or occult blood in the stool.
Inform the patient that the medication may temporarily cause stools and tongue to appear
gray black

15

DISCHARGE PLAN
Medications
-Stressed out the importance of compliance of take home medications
-Instructed to take the right drug at the right time, dose, frequency, route
-Discuss with the client about the contraindications and the effects of the drugs being given
-Have client report if any adverse effects occur
-Advise patient not to discontinue any medications without consulting the physician
Environment
-Keep surroundings clean and hazard free
-Instruct client to maintain a conducive environment for rest and sleep
-Avoid stressful environments like places with noise or crowding
-Provided a comfortable environmental temperature
-Encouraged client to stay in a well-ventilated room for fresh air
-Instructed to stay away from hazardous places that could lead to injury
Treatment
-Instructed client to have follow up check up with physician on scheduled date
-Instructed to take full course of the medication regimen as prescribed
-Stressed the importance of the compliance of treatment
Health Teachings
-Store food in a hygienic manner and prevent exposure to insects and germs.
-Avoid eating peeled vegetables and fruits from street vendors.
-Avoid buying or eating street food that is kept uncovered or cooked with dirty water.
-Always carry drinking water with you while travelling or buy bottled water.
-Avoid adding ice cubes in your drinks as they may be made with contaminated water.
-Use only pasteurized milk and dairy products.
Observable signs and symptoms
-Instructed client to report to the doctor when signs and symptoms of amoebiasis occur
-Instructed to report for recurrence of symptoms
Diet
-Instructed to eat dry food, low residue food such as refined or enriched white breads and plain
crackers, cooked cereals,
cold cereals, such as puffed rice and corn flakes, white rice, noodles, and refined pasta
-Instructed to avoid consuming foods rich in refined sugar, caffeinated beverages, processed foods and
alcohol
- Instructed to eat foods rich in zinc and vitamin C
-Instructed to have a potassium rich diet to help resist the infection
Spirituality
-Continue to attend church service every Sunday for reflection
-Encouraged reading the bible for guidance and enlightenment
-Continue to build up hope and faith in the plan or will of God
-Pray as a family as much as possible

16

PATHOPHYSIOLOGY
AMOEBIASIS
HOST

AGENT

ENVIRONMEN

Ingestion of mature
Entamoeba histolytica
cysts

Y.K.M, 13 years
old

Swimming pool
Food at picnic

Cysts embed in the

digestive tract
Trophozoites are released
at terminal ileum
(excystation)
Reproduction

Vomiting previously
ingested food
amounting to -

Administered Metronidazole
500 mg/tab 1 tab OD PC

Signs and symptoms

subside:
Diarrhea: 1/8 = 11 episodes
1/9 = 7 episodes
1/10 = 1 episode

Migration to the large

intestine
Burrowing into the
intestinal wall and release
of toxins
Inflammation of intestinal
lining

Death and elimination of

trophozoites

Gnawing epigastric/hypogastric pain with

pain scores of 9/10 and 8/10

Diarrhea:
Mild: 3 days
Moderate diarrhea consisting of
brownish watery stool constistency, non
mucoid, non-bloody stool amounting
cup per episode (10 episodes as of
1/4/15); 1/6/15: Bloody stool
Severe: More than 3 weeks

Intermittent fever with highest

temperature of 39.0 C/axilla

Laboratory results:
CBC:
NEU: 72.6
MONO: 11.4
LYM: 13.9
RDW: 10.4

U/A: dark yellow, cloudy, +protein,

+ketone
S/E: reddish brown, watery stool, +
Entamoeba
histolytica cyst 0-2/HPF

Discharge

17

NURSING CARE PLANS

KEY ISSUES
Date Identified: 1/5/2015
1. Acute pain related to inflammation of
the lining of the large intestine secondary
to amoebiasis as manifested by guarding
behavior of the abdomen and
intermittent gnawing pain on hypogastric
region aggravated during and right after
defecation and little relief in fetal position
with a pain scale of 8/10 with 1 as the
lowest and 10 as the highest
SB: The E. histolytica parasite can cause
inflammation of the lining of your gut
(intestines). This condition is known as
amoebic colitis. 'Colitis' is a general term
used for inflammation of the lining of the
large intestine (the colon). 'Amoebic'
refers to the fact that the colitis is caused
by the amoeba E. histolytica. The disease
is often mild and can just lead to tummy
(abdominal) pain and diarrhoea.
However, more severe inflammation with
ulceration of the intestinal lining can
occur in some people and so-called
'amoebic dysentery' can develop.
(Dysentery is any infection of the
intestines, causing severe diarrhea with
blood and mucus.)
The use of guarding (restricting the use
or movement of a body part) was found
to be a strong indicator of pain.
Acute pain is a highly complex, dynamic,
subjective experience that is useful to
growing children, serving to warn them of

DESIRED OUTCOME
Within 8 hours of student nurse patient
interaction, the patient will be able to
report relief of pain or decreased pain
perception such as absence of facial
grimacing and verbalize reduction of pain
scale of less than 8/10 after having
demonstrated the use of relaxation skills
and diversional activities provided by the
student nurses.

INTERVENTIONS
Independent Interventions:
1. Assessed pain using OLDCARTS and
observed patient for manifestations of
pain.
R: To monitor patients report of pain and
observed data.
2. Monitored skin color and vital signs.
R: Skin color and vital signs are usually
altered in acute pain.
3. Diverted attention of patient from pain
by talking to her.
R: Promotes non-pharmacological
management of pain.

ACTUAL OUTCOME
January 5, 2015
Pain scale reduced to 5/10 with reduced
facial grimacing. Diversional activities
provided by student nurses were done.
January 6, 2015
Pain scale increased to 9/10, facial
grimacing still noted. Diversional
activities provided by student nurses
were done.
January 7, 2015
Pain scale remained at 8/10, facial
grimacing still noted. Diversional
activities provided by student nurses
were done.

4. Provided a therapeutic environment by

minimizing noise, placing her things
within her reach and fixing bed of client.
R: Minimizes patient stimulation that
predisposes feeling of pain.
5. Reinforced to do deep breathing
exercises by inhaling deeply then
exhaling slowly through pursed lips
R: DBE promotes relaxation of muscles
leading to alleviation of pain in the
incision site and promotes adequate air
exchange and distracts attention thus
reducing tension.
6. Positioned patient according to her
comfort.
R: Position changes promote comfort,
reduce muscle tension, and relieve
pressure.

18

danger and limiting exposure to

additional injury. Children usually learn
effective methods of preventing and
coping with the everyday pains of
growing up. However, untreated acute,
recurrent, or chronic pain related to
disease or medical care may have
significant and lifelong physiological and
psychological consequences. Children are
more commonly found trying to get
comfortable or
to gain relief by assuming
the fetal position

7. Encouraged adequate rest periods by

doing all nursing interventions at one
time.
R: To reduce stress and fatigue.
8. Advised verbalization of progress of
pain.
R: To attend to his needs and to help
student nurse provide other comfort
measures to minimize pain.
Collaborative Interventions
1. Administered anti-ulcer drug,
Ranitidine 50mg/amp 1 amp q8H
IVTT
R: To reduce gastric secretions which
leads to relief of pain

Source:
Amoebiasis. (n.d.). Retrieved January
12, 2015, from
http://www.patient.co.uk/health/
amoebiasis-leaflet
Franck, Linda S., Cindy S. Greenberg,
and Bonnie Stevens. "PAIN
ASSESSMENT IN INFANTS, N.p.,
15 July 2005. Web.
Ebert, M., Kerns, R., Behavioral and
Psychopharmacologic Pain
Management

Date Identified: 1/5/2015

2. Diarrhea related to inflammation of
the intestinal lining secondary to
Amoebiasis as manifested by passing out
of loose watery stools amounting to cup per episode.
SB: The epithelium of the digestive tube

Within 8 hours of student nurse-patient

interaction, the patient will not show
signs of dehydration.

January 5, 2015
No signs and symptoms of dehydration
noted. Patient appears weak.

Independent Interventions:
11. Observed and recorded stool
frequency, amount and characteristics.
R: To monitor any worsening of the
patients condition
2. Provided bed rest
R: To facilitate rest and decrease anxiety

January 6, 2015
No signs and symptoms of dehydration
noted. Patient appears weak.

January 7, 2015
No signs and symptoms of dehydration
noted. Patient appears weak.

3. Provide bedside commode

R: For quick access when the patient

19

is protected from insult by a number of

mechanisms constituting the
gastrointestinal barrier, but like many
barriers, it can be breached. Disruption of
the epithelium of the intestine due to
pathogens such as bacteria, viruses and
protozoa is a very common cause of
diarrhea in all species. Destruction of the
epithelium results not only in exudation
of serum and blood into the lumen but
often is associated with widespread
destruction of absorptive epithelium. In
such cases, absorption of water occurs
very inefficiently and diarrhea results.
Source:
Bowen,
R.
(2006,
July
27).
Pathophysiology of Diarrhea. Retrieved
January
12,
2015,
from
http://www.vivo.colostate.edu/hbooks/pat
hphys/digestion/smallgut/diarrhea.html

feels the need to defecate

4. Encouraged oral fluids
R: To recover the fluid lost through
defecation
5. Instructed to eat dry, low residue, and
bulk forming foods
R: To minimize the severity of diarrhea
6. Instructed to avoid eating spicy, and
oily foods
R: To minimize irritation of the GIT
7. Monitor intake and output
R: Dehydration may increase the
glomerular filtration rate, making the
output is not adequate to clear metabolic
waste.
8. Discuss possibility of dehydration and
importance of handwashing
R: To prevent spread of infectious causes
of diarrhea.
Collaborative Interventions:
1. Administered Metronidazole
R: Pharmacologic management
of amoebiasis
2.

Regulated IVF at prescribed rate

(40gtts/min)
R: To facilitate intake of fluids

3.

Ran 40cc of IVF as prescribed

R: To compensate for fluid loss

Independent Interventions:

January 5, 2015 Day 1

Within 8 hours of student-nurse patient
interaction, client appeared tired with the
verbalization of Nisuka kog kausa karon,
Kasukaon jud ko usahay.
January 6, 2015 Day 2
Within 8 hours of student-nurse patient
interaction, client appeared tired with the

20

1.

Date Identified: 1/5/2015

3. Nausea related to the stimulation
of the chemoreceptor trigger zone
due to the release of toxins by E.
histolytica trophozoites as
manifested by two vomiting
episodes(January 4,2015 and January
5,2015) secondary to amoebiasis
SB: The chemoreceptor trigger zone
(CTZ), located in the floor of the fourth
ventricle, provides specific receptors for
toxins present in the system, and
cerebrospinal fluid that excites the
vomiting reflex. Amoebas colonize the
gut, interact with bacterial flora, adhere
to and lyse tissue, and release toxins that
combat the host's inflammatory
response.

Source:
Maule, W. (1990) Clinical Methods.
Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK41
0/.
Ravdin, JI. (1986 April) Pathogenesis of
disease cause by E.Histolytica. Retrieved
from
http://www.ncbi.nlm.nih.gov/pubmed/287
1621.

Within 3 days of student nurse- patient

interaction, the client will experience a
reduction in nausea and vomiting as
evidenced by:

verbalization of decreased
nausea,

reduction in the number of

episodes of vomiting.

Assessed patient s condition

R: to check for other signs and
symptoms
2. Recorded vomiting frequency,
amount and characteristics.
3. Encouraged to Eat dry foods such
as crackers and toast
R: These foods can be digested
slowly therefore does not irritate
the stomach.
4. Encouraged client to take deep,
slow breaths when nauseated
R: It will help relieve the feeling
of wanting to vomit
5. Encouraged client to change
positions slowly
R: Sudden movement can result
in Chemoreceptor trigger zone
stimulation and excite vomiting
center
6. Instructed client to ingest foods
and fluids slowly
R: For easier digestion and
moving of food to the stomach
7. Instructed client to avoid drinking
liquids with meals if feeling
nauseated
R: Sudden intake of liquid can
excite the Chemoreceptor Trigger
zone
8. Instructed Oral hygiene after
each emesis and before meals
R: This can help prevent Nausea
9. Instructed Client to avoid spicy
foods, caffeine-containing
beverages such as coffee, tea,
and colas.
R: These foods can irritate the
gastric mucosa and will make the
client nauseated
10. Eliminated noxious sights and

verbalization of Wala ko nisuka. Dili na

kayo ko kasukaon pero lahi pajud akong
panglasa.
January 7, 2015 Day 3
Within student-nurse patient interaction,
client appeared tired with the
verbalization of dili naman ko kasukaon
unya wala napud ko nagsukasuka

21

odors from the environment

R: The surroundings can help
trigger the Nauseated feeling
Collaborative Interventions:
1. Administered IVF PLR1L as
ordered by physician
R: To prevent dehydration
Independent Interventions
1. Assessed patients condition
R: To monitor for other signs and
symptoms
2. Assessed the individual's
understanding of the reasons to maintain
adequate hydration and methods
R: For achieving goals fluid intake.
3. Monitored vital signs as appropriate
R: Vital signs changes such as increased
heart rate, decreased blood pressure,
and increased temperature indicate
hypovolemia

Date Identified: 1/5/2015

4. Fluid volume deficit related to active
fluid volume loss through vomiting and
diarrhea with the frequency of more than
10 episodes per day from Sunday to
Wednesday amounting to - cup per
episode secondary to Amoebiasis as
manifested by frequent defecation,
weakness, dry and warm to touch skin,
headache, and dark yellow urine
SB:
Fluid volume deficit is a condition when
fluid loss exceeds intake and electrolytes
in the human body become unbalanced.
Excessive sweating and high fever can
also lead to a deficit as a result of
dehydration. As dehydration progresses,
a person might become irritable, weak or

4. Weighed patient daily

R: Changes in weight can provide
information in fluid balance and the
adequacy of fluid volume replacement

After 3 days of student nurse-patient

interaction, the patient will be able to:
1. Increase fluid intake at least 2000 ml /
day (unless contraindicated)
2. Show no signs and symptoms

January 5, 2015
Skin warm to touch, presence of diarrhea
with the frequency of 28 episodes
amounting to - cup per episode and
of vomiting of more than 10 episodes
amounting to - cup.
Weight: 40.5kg
PO: 120ml
Refer to Appendix C
January 6, 2015
Skin warm to touch, presence of diarrhea
with the frequency of 28 episodes
amounting to - cup per episode and
of vomiting of more than 10 episodes
amounting to - cup.
Weight: 40.5kg
PO: 1030ml
Refer to Appendix C
January 7, 2015
Skin warm to touch, presence of diarrhea
with the frequency of 28 episodes
amounting to - cup per episode and
of vomiting of more than 10 episodes
amounting to - cup.
Weight: 40.4kg
PO: 1340ml
Refer to Appendix C

5. Ensured accurate intake and output

monitoring
R: Accurate records are critical in
assessing the patients fluid
6. Assessed likes and dislikes, provide
favorite fluids within the diet
R: To promote hydration

22

dizzy. Sometimes the skin will feel dry

and warm to the touch, and it may
appear flushed. Decreased urine output
and dark urine are other signs of mild
dehydration, along with headache.
Reference:
Wisse, B. (2013). Fluid imbalance.
Retrieved from: http://www.nlm.nih.gov

of dehydration
3. Show no signs of hypovolemic shock
and no signs of dehydration will be noted.
4. Maintain fluid volume at a functional
level

7. Increased fluid intake providing

appealing liquids
R: Encourage her oral intake of fluids as
tolerated to replace lost volume
8.Encouraged to avoid food that causes
dehydration such as coffee, tea
R: To prevent further dehydration
9. Offered the patient ice chips followed
by clear liquids
R: Fluid electrolyte replacement provides
oral replacement therapy
10. Encouraged to eat foods with high
fluid content, such as watermelon and
grapes
R: For hydration
11. Encouraged to eat banana, rice,
apple toast
R: To prevent diarrhea, and for stool
formation
12. Monitored blood electrolyte levels,
blood urea nitrogen, urine and serum
osmolality, creatinine, hematocrit, and
hemoglobin.
R: To monitor development of
hypovolemia

Collaborative Management:
1. Administered IV therapy as prescribed
R: For fluid replacement
2. Administer medications (antiemetics or
antidiarrheals or anti-infectives) as

January 5, 2015 (Monday)

After 8 hours of student nurse- patient
interaction, the patient obtained a
temperature of 38.1 degree celsius, and
was experiencing chills.
January 6, 2015 (Tuesday)
After 8 hours of student nurse- patient
interaction, the patient obtained a
temperature of 37.0 degree celsius, and
was not experiencing any chills. Patient

23

ordered
R: To limit gastric/intestinal losses; to
treat infection

Date Identified: 1/5/2015

5. Hyperthermia related to body's
responses to parasitic infection
secondary to amoebiasis. As manifested
by skin warm to touch,and elevated body
temperature.
Monday- 38.2 degree per axilla
SB:
Fever happens when something is wrong,
usually an infection within the body, and
the hypothalamus of the brain increases
the bodys temperature to fight against
infections. When microorganisms invade
your body, causing infections, your
bodys defense mechanism is to raise its
normal temperature in an attempt to kill
off the bacteria, virus and/or parasite.
Amoebiasis is an infection of the large,
there can be full-blown symptoms of
amoebic dysentery, including high fever,
chills, weakness, nausea, vomiting,
weight loss, discomfort or severe
abdominal pain and 10 or more episodes
of diarrhea daily.
Reference:
WebMD (n.d). What is fever?.Retrieved
from http://www.webmd.com

Within 3 days of student nurse-patient

interaction, the patient will maintain core
temperature within normal range (36.537.5).

Independent Interventions:
1. Assessed patients condition.
R:to know and provide the correct
interventions.
2. Monitored patient vital signs,
especially temperature.
R: to obtain a base line data.
3. Wrapped extremities with
blankets.
R: to minimize shivering and
chills.
4. Encouraged oral fluid
R: to maintain hydration
5. Provided a cool environment.
R: to reduce heat production
6. Encouraged sleep and rest.
R: to increase comfort.
7. Educate and advise support
system (relative) to do TSB when
patient feels hot.
-Luke warm water only.
-Make sure that armpits and
groins were
included in doing TSB.
R: teaching the support system
the right
way to do TSB will
help in knowing what to do in
case the patients temperature
increase.
8. Encouraged to report unusualities
R: to monitor possible causes of
other underlying disease
Collaborative interventions:

appears to be tired and sleepy.

January 7, 2015 (Wednesday)
After 8 hours of student nurse- patient
interaction, the patient obtained a
temperature of 36.6 degree celsius, and
was not experiencing any chills nor fever.
Patient still appears to be tired.

Day 1( January 05, 2015) :

Patient still has interrupted sleep at
night but is able to rest in the afternoon
for at least an hour.
Day 2( January 06, 2015):
Patient still has interrupted sleep at night

24

WebMD (n.d).First aid and emergencies.

Retrieved from http://www.webmd.com

1.

Administered antipyretic drug as

ordered by physician.
R: to reduce fever.
2. Maintained IV fluid as ordered by
physician.
R: to prevent dehydration
.

and appears drowsy and tired in the

afternoon.
Day 3(January 07, 2015):
Patient was able to take a nap for at
least an hour in the afternoon and
verbalized mas arangan na ako tog
karon Te kay di naman sad kayo sakit

Independent Interventions:
1. Assessed possible cause of sleep
disturbance.
Rationale: For planning of appropriate
intervention
Date Identified: 1/5/2015
6. . Disturbed sleep pattern related to
interruption of sleeping pattern due to
intermittent abdominal pain and frequent
urge to defecate secondary to amoebiasis
as evidenced by drowsiness and
verbalization of Naka tulog rako pero
mag mata mata lang jud ko ug kalibangon Within 3 days of student-nurse patient
ko
interaction, the patient will be able to
take naps and will not appear drowsy.

Scientific Basis:
Any illnesses that cause physical
discomfort can result in sleep problems.
Symptoms of amoebiasis include severe
abdominal pain and diarrhea which could
alter the normal sleeping pattern.
Source: (Lippincott Williams & Wilkins.,
2002;Gulanick, 2007; Kozier, et al, 2007)

2. Assessed client's sleep patterns and

usual bedtime rituals and incorporate
these into the plan of care.
Rationale: To plan an appropriate plan of
care because each individual has unique
sleep patterns.
3. Provided calm and quite environment
by ensuring appropriate temperature and
ventilation.
Rationale: This soothes and relaxes the
patient
4. Implemented comfort measures like
back rub and repositioning .
Rationale: To provide comfort and
enhance rest

5.Encouraged client to develop a bedtime

ritual that include quiet activities such as
watching television, or listening to
music.
Rationale: Enhance client participation

25

and promotes relaxation.

6.Suggested to engage in relaxing
activities before retiring such as: reading
books and relaxation exercise.
Rationale: To reduce stress/anxiety and
promote sleep
7.Encouraged to eat foods that has milk
or cheese unless contraindicated.
Rationale: It contains L-tryptophan that
facilitates sleep.

26

APPENDIX A
FAMILY HISTORY
NAME

RELATIONSHIP
TO PATIENT

AGE

HEALTH STATUS

EDUCATION

OCCUPATION

A.M

Father

44 yrs old

College undergraduate,
commerce

Help run family

business, under the
production department.

Y.M

Mother

40 yrs old

BSED major in history

College professor at
velez college

H.C.M

Brother

12 yrs old

Only minor illnesses,

such as fever,
headache, sinuses, and
experience high blood
pressure once with
unrecalled date. Mother
claimed that father is
very careful when it
comes to health.
Only minor illnesses,
such as fever,
headache, sinuses.
Only minor illnesses,
such as fever, running
nose.

Grade 6

student

Y.K.M

Sister

6 yrs old

Kindergarten

student

H.C.M

Brother

3 yrs old

Only minor illnesses,

such as fever, running
nose.
Only minor illnesses,
such as fever, running
nose.

27

APPENDIX B

GENOGRAM
MATERNAL SIDE

PATERNAL SIDE

LIVER CIRRHOSIS (both)

DM, HPN,

old age

LEGEN
D

90+

Kidney stones

Deceased
male
Deceased
female
Male

Stillborn

2
8

F
7

Female
Patient

Measles, 1y.o

2
2

Father

Mother

Heredofamilial diseases include: kidney and renal problems at father side. Mother claimed that the patients grandparents died of liver cirrhosis.

28

APPENDIX C
Intake and Output
Date

Oral

IVF

Urine

Stool

1/4/15

120

1200

200 5x (reddish
watery stools
amounting to
approx. 1/4
glass)

1/5/15

1030

3840

1240 28x (brown

watery stool
amounting to
approximately
10-50cc per
episode)

1/6/15

1340

3120

1750 32x (brownish

red watery
stool
amounting to
approximately
30-40cc per
episode)

1/7/15

1300

2200

1720 28x (brownish

red watery
stool
amounting to
approximately
10-50 cc per
episode)

1/8/15

1110

2400

1400 11x ( brown

watery stool
with particles
approximately
10-40 cc per
episode)

1/9/15

1160

1700

1150 7x (brown
formed stool)

Vomitus

1x (previously
ingested food
amounting to
approximately
1/2 cup)

29

1/10/15

400

300

400 1x

30