OBJECTIVES

 To acquire more knowledge regarding amoebiasis, its causes, risk factors, signs and symptoms,
complications, incidence as well as the prognosis.
 To know the profile information, history of past and present illnesses, and the Maslow’s hierarchy of
needs of the patient.
 To review the anatomy and physiology of the digestive system.
 To illustrate the pathophysiology of amoebiasis.
 To identify the ideal and actual diagnostic examinations for such case.
 To draw attention to the ideal and actual, medical, pharmacological, surgical and nursing management
and treatments.
 To utilize the nursing process as framework in giving care to the patient.
 To impart appropriate health teachings to the patient and significant others.
 To be updated on the trends of treatments and management of amoebiasis.

INTRODUCTION

Amoebiasis is an intestinal illness that’s typically transmitted when someone eats or drinks something that’s
contaminated with a microscopic parasite called Entamoeba histolytica (E. histolytica). The parasite is an
amoeba, a single-celled organism. That’s how the illness got its name – amoebiasis.
In many cases, the parasite lives in a person’s large intestine without causing any symptoms. Primarily, it
invades the lining of the large intestine, causing bloody diarrhea, stomach pains, cramping, nausea, loss of
appetite, or fever. In rare cases, it can spread into the liver.
Amoebiasis typically occurs in areas where living conditions are crowded and where there is a lack of adequate
sanitation. The illness is very prevalent in parts of the developing world, including Africa, Latin America, India,
and Southeast Asia. It is rare in the United States, occurring mostly in immigrants, recent travelers to high-risk
countries, and people with HIV/AIDS.

Causes
The cause of amoebiasis is mainly the protozoan parasite called Entamoeba histolytica. It usually enters the
human body when a person ingests cysts through contaminated food or water. It can also enter the body through
direct contact with fecal matter.
The cysts are relatively inactive form of the parasite that can live for several moths in the soil or environment
where they were deposited in feces. The microscopic cysts are present in soil, fertilizer, or water that’s been
contaminated with infected feces. Food handlers may transmit the cysts while preparing or handling food.
Transmission is also possible during anal sex, oral sex, and colonic irrigation.
When cysts enter the body, they lodge in the digestive tract. Then they release an invasive, active form of the
parasite called a trophozoite. The parasites reproduce in the digestive tract and migrate to the large intestine.
There, they can burrow into the intestinal wall or the colon. This causes bloody diarrhea, colitis, and tissue
destruction. The infected person can then spread the disease by releasing new cysts into the environment
through infected feces.

Risk Factors
 age – below 5 years old
 sex – males are more prone due to occupational hazard
 climate – cold season
 social condition
 familial incidence

Signs and Symptoms

 body weakness
 prostration
 nausea and vomiting
 gripping pain
 tenesmus

Complications
 bowel perforation
 gastrointestinal bleeding
 stricture formation
 intussusception
 peritonitis
 empyeme

Incidence
Amoebiasis occurs worldwide, although much higher rates of incidence are found in the tropics and subtropics.
About 5,000 to 10,000 cases are diagnoses each year in the United States, leading to about 20 deaths annually.

Prognosis
Treatment of amoebiasis includes pharmacologic therapy, surgical intervention, and preventive measures, as
appropriate. Most individuals with amoebiasis may be treated on an outpatient basis. Several clinical scenarios
may favor inpatient care, as follows:
 severe colitis and hypovolemia requiring intravenous volume replacement
 liver abscess that is of uncertain etiology or is not responding to empiric therapy
 fulminant colitis requiring surgical evaluation
 peritonitis and suspected amoebic liver abscess rupture
 intestinal amoebiasis may be mistakenly treated as if it were inflammatory bowel disease (IBD).
Accordingly, in all patients with suspected IBD, lower gastrointestinal endoscopy should be performed
before treatment with steroids as initiated.
The following consultations may be helpful:
 infectious disease specialist
 general surgeon
 gastrointestinal specialist
 follow-up stool examination after therapy completion is recommended to ensure intestinal eradication. No
special diet is recommended.
II. Patient’s Profile

Hospital Case #: 10-4042

Name: Bulaay, Rain Luiz
Age: 3 y/o
Gender: Male
Address: Pob. Sallapadan, Abra
Civil Status: Child
Birthplace: Bangued, Abra
Birthday: April 23, 2014
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: January 6, 2018
Time of Admission: 11:30 am
Chief Complaint: watery stool for 2 days, convulsion for few hours
Admitting Physician: Dr. Dexter Apolonio
Attending Physician: Dr. Dexter Apolonio
Admitting Diagnosis: BFC
Principal Diagnosis: Amoebiasis
Final Diagnosis: BFC
Diet: DAT
Ward: Pedia Ward

III. HISTORY OF PAST AND PRESENT ILLNESSES

PAST HISTORY
As stated by his grandmother, Patient X claimed to have suffered from common viral illnesses such as
flu, colds and cough but manages them with over the counter drugs. He even finished all his immunization
vaccine. But his granny couldn’t recall if he had experienced chicken pox or measles before. She told me that
her grandson was hospitalized last July 17, 2018 with a diagnosis of Acute Bronchitis. They stayed at the
hospital for five days.

PRESENT HISTORY
Two days before his confinement he began to experience six times of watery stool in a day. On January
06, 2018 at 2:00 am, Patient X suffered from convulsion as verbalized by his granny. His temperature was
40º©, so they immediately rushed him to Abra Provincial Hospital. At 11:30 am in the morning he was
examined and admitted by Dr. Apolonio with admitting diagnosis of BFC (Benign Fever Convulsion). And he
was transferred to Pedia ward for further treatment.

FAMILIAL HISTORY
His maternal side has a history of hypertension while his paternal side has no history of DM, hepatitis
and degenerative diseases such as heart disease. Patient X has no known allergies to drugs or foods.

SOCIOECONOMIC STATUS
According to his granny, his mother and father are high school graduates. His mother is a plain
housewife who is now at home attending the needs of his little sister while his father is a farmer. His mother
helps her husband in the farm especially in harvesting rice and vegetables. His mother sells these to their
neighborhoods. As claimed by his granny they have a simple life, they eat three times a day and manage to eat
foods rich in protein because they have a small poultry product.

LIFESTYLE
According to his grandmother, Patient X is fond of eating non-nutritious foods like junkfoods and
softdrinks, As stated, she often plays with the other kids in their barangay outside of their house. He don’t
practice proper handwashing especially before eating. They drink water that comes from the mountain. His
mother cannot give him enough care because she has a child who is at 5 months old.
IV. MASLOW’S HIERARCHY OF NEEDS (01/09/18)

PHYSIOLOGIC NEEDS
 Could breathe in an atmospheric room temperature
 With an ongoing IVF D5lRS 1000cc 45 gtts/mins, hooked at the left metacarpal vein @ 140cc level
patent and infusing well.
 On DAT
 He had defecated 6x with watery stool and slightly odorous and urinated 2x with yellowish in color
within the shift.
 Sleep 8 hours at night and takes a nap in the afternoon for 3 hours.
 Unremarkable

SAFETY AND SECURITY


According to his grandmother they were felt safe and secured with the facilities and services provided
by the hospital
 Safe and secured because his grandmother were there, who took good care of him and looked after his
needs.
 They are financially unstable.
 Medication were prepared and administered on time by the nurse on duty and student nurses observing
the 16R’s
 Bed side rails were raised
LOVE AND BELONGINGNESS

By the presence of his grandmother, physicians, nurses on duty, student nurses throughout his
confinement showing support, affection and reassurance would be manifestation that he was loved and
care of.
SELF-ESTEEM
 Unremarkable
SELF-ACTUALIZATION
 Unremarkable

V. PHYSICAL ASSESSMENT (1-8-18)

GENERAL PHYSICAL ASSESSMENT

 With an ongoing IVF of PLRS 1L x 15gtts/min hooked at the left metacarpal vein at 140cc level patent
and infusing well
 With endomorph body built
 Looks the same with his actual age
 Cooperative
 Vital Signs:
TEMP: 36.8 Degree Celsius
PR: 109 bpm
RR: 24 cpm

MENTAL STATUS

 Deliberate and coherent

 Able to follow instructions
 Had good sense of reality
 Good in eye to eye contact
SKIN
  Skin pinched went back immediately
 Uniformity of the skin color noted
 Scars on both feet noted

NAILS

 Cleaned and properly trimmed nails both hands and toe

 Capillary refill went back immediately
 No clubbing, beu’s line, paronychia and onychomychosis noted
HEAD

 Normocephalic and symmetrical with frontal, parietal, and occipital prominences

 No mass, nodules and tenderness noted
 Proportionate to body size
 With smooth skull contours
HAIR

 Thin and evenly distributed

 Scalp smooth and firm
 Blackish in color
 No brittleness and dryness, infestations and dandruff noted

EARS

 Aligned to the outer cantus of the eyes

 Equal in size with fair complexion to the body and face
 No lesions, discharges, visible lumps or lesions noted
 Non-tender auricle and tragus
 Bilateral symmetrical pinnae and levels at the outer canthus of the eyes
SKULL AND FACE

 Normocephalic and symmetrical with frontal, parietal, and occipital prominences

 No masses/ depressions noted
 Presence of mole on the face noted
 No involuntary muscle movements on the face

EYES

 PERRLA ( Pupils Equally Round Reactive to Light Accommodation)

 With thin eyebrows and hair evenly distributed
 Irises and sclerae noted
 With short eyelashes and evenly distributed
 Lids close symmetrically
 With pinkish bulbar conjunctiva
 No discharges noted
 With good visual acuity
NOSE AND SINUSES

 Nose had the same color on the face

 Could breathe in an atmospheric temperature
 No mass, lesions, and tenderness noted
 No redness, swelling: new growth and discharges, nasal flaring, tenderness, maxillary and frontal
sinuses noted
  Symmetrical and straight
 Mucosa was pinkish
 Nasal septum was in normal position
 With good smelling acuity

MOUTH AND OROPHARYNX

 Pink buccal mucosa, lesions noted

 With incomplete set of teeth ( 2nd premolars)
 Gums pink in color and no bleeding
 Symmetrical lips
 Tongue was pinkish in color and lesions noted
 Tongue was in central position
 With pinkish hard and soft palate
 Tonsils were not inflamed
 Uvula is at the centre freely movable
 With normal gag reflex
NECK

 Sternocleidomastoids and trapezius were equal in size

 No lumps, masses, tenderness enlarged lymph nodes, trachea deviations, thyroid enlargement noted
 No distention or jugular veins noted
 Had the same color to the face
CHEST

• With symmetrical chest expansion

• With respiratory rate of 24cpm
• No masses, lesions, tenderness, vocal fremitus and chest indrawing noted
• Presence of mole noted
• No cracklings, wheezing, gurgling and friction rub noted
BREAST AND AXILLAE

 Symmetrical
 Had the same color to the body
 Presence of mole noted
 No retraction, swelling or edema noted
 Symmetrically round brownish areola
 Brownish nipples located at the center position of the areola
 No enlarged lymph nodes and masses in the axillary area, breast masses, tenderness and discharges,
dimpling, swelling or edema noted

ABDOMEN

 Symmetrical and brownish in color

 Umbilicus centrally located
 No abdominal mass noted
 borborygmic sounds noted
UPPER EXTREMITIES

• Arms were proportionate to the color of the body

• With an ongoing PLRS x 1L x 15gtts/min hooked @ the left metacarpal vein @ 140cc level patent
and infusing well
• Capillary refill went back immediately
• With symmetrical hands and arms
 • With complete set of fingers
• Nails were cleaned and properly trimmed
• With normal ROM
ELIMINATION/GU

 defecated 4timeswithin our shift

 Urinated 2times during our shift
LOWER EXTREMITIES

 Capillary refill went back slowly

 Toenails were properly trimmed and cleansed
 With good gait
 With normal ROM

VI. ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM
The primary function of the digestive system is to break down the food we eat into smaller parts so the
body can use them to build and nourish cells and provide energy.

The digestive system is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.
Inside this tube is a lining called the mucosa. In the mouth, stomach, and small intestine, the mucosa contains
tiny glands that produce juices to help digest food.

The Digestive Process:

The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by
the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the
salivary glands and break down starches into smaller molecules).

On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters the esophagus.
The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle
movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us
the ability to eat or drink even when we're upside-down.

In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid
(gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.

In the small intestine - After being in the stomach, food enters the duodenum, the first part of the small
intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small
intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive
enzymes produced by the inner wall of the small intestine help in the breakdown of food.

In the large intestine - After passing through the small intestine, food passes into the large intestine. In the
large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food. Many
microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large
intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is
connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen
in the transverse colon, goes back down the other side of the body in the descending colon, and then through the
sigmoid colon.

The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.
 PATHOPHYSIOLOGY

Predisposing factors: Precipitating factors:

 Age (3 y/o)  unsanitary food handling

 Race (Filipino)  ingestion of contaminated food and
 Gender (male) drinks
 poor environmental sanitation
 crowded areas
 poor hygiene

Ingestion of Entamoeba histolytica parasite

inge
Invades the small intestine

Invades the intestinal wall

Excretion of parasite

Signs and Symptoms:

 diarrhea
 abdominal pain
 fever
 distended abdomen

AMOEBIASIS

TREATED: Untreated:

 medical management  dehydration

 nursing management  anemia
 pharmacological management
 surgical management

RECOVERY DEATH
VIII. Diagnostic Examination

IDEAL:

Urinalysis- A test that is done in order to analyze urine. Urinalysis can be used to detect certain disease, such as
diadetes, gout, and other metabolic disorder as well kidney disease.

Fecalysis- Refer to a series of laboratory test done on fecal samples to analyze the condition of the person’s
digestive tract in general.

CBC –

Actual:

Hematology ( Jan. 8, 2018)

Parameter Result Normal Result SIGNIFICANCE

HEMOGLOBIN 120 130-160 G/L Due to possible anemia

HEMATOCRIT 35.1 37-49% Due to possible anemia

MONOCYTES 7.7 3-6 Due to infection

EOSINOPHILS .3 2-4 Due to infection

IX. MANAGEMENT

PHARMACOLOGICAL MANAGEMENT





 

 

 



 

 

 

 





 

 





 





 













XII. Health teaching
 Facilitated take home medications
 Advised to be back at scheduled follow up checkup.
 Educated the patient about amebicide therapy, including precautions he should take and adverse effects
of the medication
 Encouraged the patient to return for follow-up appointments at scheduled intervals.
 Teach the patient and his family how to handle infectious material and about the need for careful hand
washing.
 Advised travelers to endemic areas and campers to boil untreated or contaminated water to prevent the
disease.
 Stressed out the need for follow up checkup. (if ordered by the physician)
 REPUBLIC OF THE PHILIPPINES
ABRA VALLEY COLLEGES
BANGUED, ABRA
COLLEGE OF NURSING

IN
PARTIAL
FULLFILLMENT
OF THE
SUBJECT

NURSING CARE MANAGEMENT 102

RELATED LEARNING EXPERIENCE

A
CASE STUDY
ON

(BULAAY, RAIN LUIZ)

AMOEBIASIS
PRESENTED TO:

JAIME A. BUMOGAS, RN,

(Clinical Instructor)

PRESENTED BY:

MARIA CHRISANA P. BELENO (Maslow’s Hierarchy, Surgical management,

Anatomy & physiology, 1 drug, 1ncp)
NORLIFAYE R. VIDAL (Physical Assessment, health teaching, 1 drug, 1 ncp)
DIANA ROSE S. GAVANES (HPPI, Patients Profile, updates, 1drug, 1 ncp)
JERLYN R. FUENTES (Medical and Pharmacological management, 1drug, 1ncp)
VIENNA AMOR T. GAYYED (Objectives, Introduction, phatophysiology, 1ncp)
KIEL LIECESTER E. BELOY (Nursing and Diagnostic management, 1 ncp)