Our Lady of Lourdes College Foundation Daet, Camarines Norte

CASE PRESENTATION

Prepared by: Agagad, Rocky O. Balce, Eruel Jess Borcillo, Geraldine

Submitted to: Mrs. April De Leon Clinical Instructor Rizaldy Emata Head Nurse

Joesabel Tanay JCI

INTRODUCTION

One of the most common parasitic infestations in the gastrointestinal tract is ascariasis. Heavy ascaris infections are most popular in children, and prevalence is alarming in areas where there is poor sanitation practices and hygiene. The highly durable ascaris eggs are the key for its survival in every part of the globe. Children are the most likely to get the infection, especially those who love playing with sand and soil. The causative organism of ascariasis, which is Ascaris lumbricoides, is also known as the giant roundworm in humans. These common roundworms are frequently found in the small intestine, with larvae typically located in the lungs of infected individuals. Ascariasis is common worldwide. Infection follows after ingestion of viable eggs through contaminated food. The usual path followed by the roundworms after ingestion is that at first the larvae hatch in the small intestine, infiltrate their way into the bloodstream which will then allow them to have access to the lungs Ascaris is the most common parasite that victimize humans. It is so common that among people who harbor more than one type of roundworms, it is almost a certainty that one of them is an ascaris. Experts estimate that 25 percent of the worlds population plays host to the worm. In some underdeveloped countries, the prevalence rate of ascaris infection is a high 90 percent. In the Philippines, as per UP National Institute of Health and Department of Health figures, 70 percent of the population has ascaris. The adult ascaris looks like an earthworm, but it is slightly smaller and is white, not brown, in color. It resides in the small intestines where it feeds on digested food. The female lays as many as 200,000 eggs a day that are discharged with the feces. The eggs are very small and not visible with the naked eye. They have to undergo development in the soil for at least two weeks before they can be infective, thus, ascaris cannot be transmitted directly from human to human.

Objectives
Nurse centered:
To be able to know what is Parasitic Infestation To develop thinking skills necessary for providing safe and effective nursing care To have a comprehensive assessment and implement care base on our knowledge To create awareness to our client on the risk factors contributing Parasitic Infestation To develop the family support system and distinguish their respective roles in providing support to our client. Familiarize ourselves with effective interpersonal skills to emphasized health promotion and illness prevention.

Client centered:
1. Awareness of his condition 2. Causes 3. Identify measures that could minimize the risk of occurrence of his condition 4. Develop the familys support system and distinguish their respective Roles in improving patients health status

Patients Profile
Name: Age: Squid 20 y/o

Address: Brgy. Palanas Paracale, Camarines Norte Sex: Female

Civil status: Single Religion: Roman Catholic

Husband: Swan Chief complaint: Impression: Final diagnosis: LBM and Vomiting

Acute Gastroenteritis with some dehydration Intestinal Parasitism (Ascaris) Pregnancy uterine 34-35 weeks AOG, (TPAL- 1001)

Date of Admission: Time admitted:

January 8, 2012 02:00 pm

Attending physician: Dr. Carlos

Patients Health History

Present Health History:
Two days prior to admission Ms. Squid ate 3 sticks Barbeque isaw and 2 sticks of balunbalunan along the road, 3hours after that she felt abdominal cramping. She vomit 2 times and LBM 5times. She drunk Gatorade for rehydration and ate banana and when they noticed that there is no changes on her status they decided to seek medical attention to Camarines Norte Provincial Hospital where she was confined. She is 8months pregnant for the second time but her first baby was delivered premature, 6 months and died.

Past Health History:

Ms. Squid is 20y/o she had been pregnant last 2010 she confided that she delivered her first baby at 6months old premature and died after her delivery, She also confided that it is her second time being hospitalized. She also added that on her father side she had a history of diabetes and hypertension. While on her mother side had a history of hypertension and cardiac disease.

PHYSICAL ASSESSMENT

Mouth: Dry lips No swelling and redness Neck: Symmetrical in shape With palpable lymph node Trunk: Pregnant Upper Extremities: Symmetric With IVF on the left arm Dry skin Lower Extremities: Symmetrical in shape Dry skin

ANATOMY AND PHYSIOLOGY

Digestive System The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste. Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.

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
Roundworm (contaminated foods)

Attach to the lining of the small intestine Absorbed nutrients Excrete toxins Irritation to the lining of the small intestine Increase peristaltic movement Signs and symptoms: -diarrhea -vomiting

Laboratory Results
Fecalysis Result
01-09-2012 Color consistency Ascaris brown soft 4-6 hpf

Urinalysis Result
01-09-12 Color transparency Reaction Specific gravity Sugar Albumin Pus cell Epithelial cell yellow clear 5.0 1.010 (---) (---) 0-4 hpf few

Hematology result
01-08-12 FINDINGS Hematocrit WBC Neutrophils Gf455 Lymphocytes 0.43 6.6 X 10 0.62 0.38 NORMAL VALUE (0.36-0.48) 5.0-10.0 X 10 0.25-0.70 0.20-0.40 ANALYSIS & INTERPRETATION The level of Hct is in the normal rate The level of WBC is in the normal rate Normal level Normal level

Medical Management
Upon admission the doctor ordered for the following: CBC typing, Urinalysis Fecalysis Plain LR 1L 60 gtts/min.

He also ordered for BRAT diet and after 1 day doctor change it to soft diet. Drug therapy Ampicillin 500mg IV Ranitidine 50mg IV

Discharge Planning
MEDICATION: Ranitidine 100mg #30 1 tablet 3x a day Mebendazole 500mg #3 @ bedtime

EXERCISE: Simple ROM exercise such as walking

TREATMENT: Instructed and advised to continue home meds. HEALTH TEACHINGS: Encouraged to avoid eating salty foods Advised to increased oral fluid intake as tolerated Eat nutritious FOOD (Green leafy vegetables and fruits) Emphasized the importance of proper hygiene. Encouraged to perform proper handling of foods and beverages

OPD FOLLOW UP CHECK UP : Advice to follow up check up after 1 week DIET: Advised to eat foods rich in Vit C and protein to boost immune system Advised nutritious foods such as vegetable and fruits

SPIRITUAL: Encouraged to attend mass every Sunday with her family.