CASE STUDY

I. DEMOGRAPHICAL DATA

Name: E.V.E

Age: 11 years old

Gender: Male

Address: Sitio Ibabaw Dulumbayan, Teresa, Rizal

Civil Status: Single

Date of Birth: Septemr 14, 2001

Place of Birth: Taytay, Rizal

Nationality: Filipino

Ethnic Group: None

Primary Language Spoken: Tagalog

Highest Educational Attainment: Grade 4

Occupation: N/A

Religious Orientation: Roman Catholic

Health Care Financing: Family

A. PRESENT HEALTH HISTORY

The patient was admitted last April 16 at around 8:00 pm due to chief complains of vomiting and episodes of loose stools, specifically 5 times. His admitting diagnosis is Acute Gastroenteritis with mild dehydration due to Amoebiasis. According to the patient’s mother, they went on swimming last April 7 which she thought her son got the infectious agent. Moreover, the patient had been hospitalized for 4 days from now and so he is already in possible discharge.

B. PAST HEALTH HISTORY

According to the patient’s mother, E.V.E have had Amoebiasis before when he was still 6 years old and he was also been hospitalized for 3 days due to it. “Hindi ko na kasi matandaan kung pano siya nagka-Amoebiasis noon, per siguro dahil sa pagkain,” the patient’s mother verbalized. Also, the patient had pneumonia when he was still on his neonatal period but according to his mother, he was no longer manifesting the condition today. The patient has complete vaccinations. He usually got colds and fever at approximately 2-3 times a year and

over the counter medications is their way of treating it. He had also childhood diseases such as chicken pox and mumps. His chicken pox just happened last May 2012 at lasted for more than a week. He had mumps when he was still on Grade 2. He was breastfed up to 2 years of age as his mother stated. Also, he is not taking any vitamins or supplements.

C. FAMILY HEALTH HISTORY

GENOGRAM

D.V G.V (-) old age arthritis D.B W.E (-) DM (-) HPN

E.R.EL.V L.J.V L.R.E (A/W)(A/W) (A/W) (A/W) E.L.E E.M.E (A/W) (DM)

J.E E.E (Patient) E.J.E (A/W) asthma E.V.E (A/W)

The patient’s father is Edmundo 48 years old and his mother, Leah rose is 39 years old. They are both alive and well with no present illnesses according to the patient’s mother. He has 4 siblings. The eldest is Junro, 16 years old male, the 2nd is Edrolyn, 15 years old female, who has asthma, the patient is the 3rd child and the youngest is Edmund Jun, 4 years old. All are alive and well aside from her sister who has asthma. The patient’s grandmother from his mother’s side was already deceased and her gradmother has arthritis. E.V.E’s mother has 3 siblings, she is the youngest and all of them are alive and well. However, his grandparents from his father’s side were already both deceased. Her grandmother died due to Diabetes Mellitus and his grandfather passed away due to Hypertension. His father has also 3 siblings; he is the eldest and the only male in the family and all of them are all alive and well.

II. GORDON’S FUNCTIONAL HEALTH PATTERNS

A. Nutrition

Before Hospitalization:

The patient eats 3 times daily. He loves to eat sweets and salty foods. Usually for breakfast, he eats bread and drink milo. For lunch and dinner they often have vegetable dish and sometimes with meat and fish according to the patient’s mother. “Hindi naman sila namimili ng ulam. Kahit anong ihain kinakain naman nila,” the patient’s mother verbalized. In every meal, the patient drinks 2 glasses of water. They seldom eat out on fast foods or restaurants. His sister often cooks food for them as a family. Sometimes he eats junkfoods and soda for snacks. Also, the patient does not have any food allergies noted. In the past 2 days prior to hospital admission, the patient had difficulty eating. He lost appetite and had vomited several times. He only had lugaw each meal time.

During the hospitalization:

The patient’s appetite is becoming better compared to 2 days prior his hospitalization according to her mother. He eats a lot more compared to the past 2 days before he was admitted. He usually drinks up to 700ml of water daily. He is not nauseated and doesn’t suffer from any gastric upset. However, episodes of vomiting were still noted during the first 2 days of hospitalization. He had several medications; these are as follows, ceftriaxone 500mg TIV q8, Buscupan ½ ampoule TIV, Erceflora 1 tube daily, Paracetamol 7.5ml q4 if with fever, Metronidazole 500mg tablet TID and Zithromax 500mg tablet daily.

Norms:Various daily food guides have been developed to help healthy people meet the daily

requirements of essential nutrients and to facilitate meal planning. Food group plans emphasize

the general types or groups of foods rather than the specific foods, because related foods are

similar in composition and often have similar nutrient values. For example, all grains, whether

wheat or oats, are significant source of carbohydrate, iron, and the B vitamin thiamine. Daily

food guides that are currently used includes Dietary Guidelines for Americans and the Food

Guide Pyramids

(Source: Fundamentals of Nursing. Kozier and Erb. 2008. Pp 1246.)

Interpretation: The patient usually eats vegetables and is not picky. He also drinks water every

time he eats. They do not eat on fast food chains often. So, they prepare their own food; which

is better compared to commercially prepared ones. However, as like other kids of his age he

loves eating junk foods and sweets for snacks. In the morning he consumes mainly

carbohydrates which is good in order to keep him active during the day considering his age

where in he is at playful stage.

B. Rest and Sleep

Before Hospitalization:

The patient has average hours of sleep. He often sleeps at 9:00 pm and wakes up at 8:00am

making it up to 11 hours of sleep in total. However, when he has school, the patient’s mother

said that by 8:00 pm he was already asleep and wakes up at 5:00am. At present, because it’s

summer break, there are no classes the patient also takes a nap at noontime. Usually around

1:00 to 3:00pm. E.V.E also mentioned that he is satisfied with his sleeps and does not have any

disturbances during his resting period. He does not have any difficulty sleeping. He is refreshed

during the day and does not sleepy.

During Hospitalization:

According to the patient, he does not have any difficulty sleeping in the hospital. He still sleeps

at 9:00pm and wakes up at 7 or 8:00am. However, he has slight sleep disturbances as he said,

sometimes when the doctors or nurses checks them in the ward he wakes up; also whenever he

has to take medications, he has to wake up.

Norms: Most healthy children need 10 to 12 hours of sleep a night to function optimally.

(Source: Fundamentals of Nursing 8th edition by Kozier and Erb pp. 1168)

Interpretation:

The patient has adequate sleep and rest because he has a total of 11 hours of sleep at night

and also he mentioned that he also sleeps during noontime. During his hospital admission, he

has minimal disturbances which is appropriate because due medications have to be taken

within the time prescribed and nurses’ checking them at the ward from time to time is inevitable

and it is on purpose of their stay in the hospital.

Elimination

Before Hospitalization:

2 days prior to hospital admission the patient had several episodes of loose bowel movement, 5

times during the day of April 16 to be exact. He described his stools as black and tarry

according to his mother. Usually he urinates 3 times a day and the color of the urine is often

slightly turbid with no foul odor. Also, he does not have any difficulty urinating.

During Hospitalization:

In the first 2 days of hospital admission the patient still have episodes of loose stools though the

frequency is decreasing day by day. During the day assessed, he is already for discharge and

he had his bowel movement once. He does not have any difficulty moving his bowel and the

consistency is not loose anymore. He urinates 4 to 5 times daily and describes the color of his

urine as yellowish with no foul smell. Also, he does not have any problems urinating.

Norms: Voiding or urination all refer to the process of emptying the urinary bladder. This occurs

when the adult bladder contains between 250 and 450 mL of urine. Each person must take 8-10

glasses of water every day. The frequency of defecation is highly individual, varying from

several times per day to two or three times per week. Many people believe that “regularity”

means a bowel movement every day.

(Source: Fundamentals of Nursing 8th edition by Kozier and Erb pp. 1326 and 1325.)

Interpretation: The patient was able to void without any discomfort as reported by him. From

having loose stools, he said that his stools become better than before and that he only moves

his bowel once a day already. So, he no longer has problems regarding his bowel movement

and urination pattern.

C. Health and Illness

The patient describes a healthy individual as a person who is active, playful, happy and does

not have any sickness. He stated, “Syempre kapag wala kang sakit, nakakapaglaro ka at

masaya ka.” He said that he likes all vegetables. He is not picky when it comes to food. “Para

po maging malusog, kelangan kumain ng maraming gulay,” the patient verbalized.

Norms: Health is a highly individual perception. Many people define and describe health as the

following:

• Being free from symptoms of disease and pain as much as possible

• Being able to be active and to do what they want or must

• Being in good spirits most of the time

These characteristics indicate that health is not something that a person achieves suddenly.

(Source: Fundamentals of Nursing. Kozier and Erb. 2008. Pp 295).

Interpretation: Observing the patient’s response, he is right that he should eat a lot because

considering his age. He is active and quite playful. Thus, eating a lot will give him energy to

sustain in his activities during the day. Parents with school aged children do have a hard time

having their child eat vegetables because they prefer processed foods such as hotdogs and

sausages but the patient said that he eats vegetables and that he is not picky which is again

appropriate in having a proper balanced diet.

Activity/ Exercise

The patient’s daily activities are mainly outside playing with his playmates. He said he plays

basketball and other outdoor games. He often goes biking with his playmates around the vicinity

of their place during the afternoon. He also plays computer games but not usually because he

said his mother does not give him money sometimes to pay in the computer shop.

Norms: Make an activity or exercise for at least 30 minutes.

(Fundamentals of Nursing 8th edition by Kozier and Erb pp. 1105)

Interpretation: The patient is active, he is outside all day often and so his lifestyle is not

sedentary.

III. PHYSICAL ASSESSMENT

A. Initial Vital Signs

Time: 8:00am

Date: April 20, 2013

Temp: 36.0°C / Axillary

PR: 92 beats/minute= regular; strong

RR: 21 cycles/minute= regular;shallow

BP: 90/60 mmHg

Norms: For the body to function on a cellular level, a core body temperature between 36.5°C and 37.7°C must be maintained.

(Source: Health Assessment in Nursing. Weber and Kelley. Third Edition.)

Pulse rate of adults ranges from 60- 100 beats/minute. A normal adult inspiration lasts 1 to 1.5 seconds and an expiration lasts 2 to 3 seconds. A typical blood pressure for a healthy adult is 120/80.

(Source: Fundamentals of Nursing. Kozier and Erb. 2008. )

Interpretation: The patient’s vital signs are within the normal range and are stable.

B. General Appearance

Actual Findings: The patient has a dark even complexion with no presence of

hyperpigmentation and lesions on skin. He wears appropriate clothing to situation and weather.

His nails on toes are a bit long. Since his hospital admission, he never took a bath just sponge

bath. However, he does not have any foul odor. He is conscious, cooperative and coherent. He

responds to my questions promptly during the interview. He is also aware of person, place and

time.

Norms: Color is even without obvious lesions: light to dark beige-pink in lighted skinned client;

light tan to dark brown or olive in dark-skinned clients. Dress is appropriate for the occasion and

weather. The client is clean and groomed appropriately for occasion. Stains on hands and dirty

nails may reflect certain occupations such as mechanic or gardener. Client is cooperative and

purposeful in his or her interactions with other. Affect is appropriate for the client’s situation.

(Source: Health Assessment in Nursing. Weber and Kelley. Third Edition.pp.)

Interpretation: In general appearance, the patient looks not properly groomed because he

didn’t take a bath for days. Nevertheless, he is very cooperative in participating during the

interview. His thoughts are appropriate to the situation and he is in a good mood because he

knew he is on possible discharge. Thus, the patient is somewhat aware and oriented to person,

place and time

C.HEENT

Actual Findings:

S: The patient stated, “Hindi naman po sumasakit ang ulo ko. Malinaw ang mga mata ko. Hindi

din po ako bingi, naririnig naman kita ng maayos.”

O: The patient’s head is normocephalic, round and symmetrical. His hair is evenly distributed,

dyed in brown color. The scalp is lighter in color than the skin color. His face is uniform in color

and temperature with a scar on the forehead. His eyebrows are black in color and aligned; eye

lashes are curled outward; the eyelids blink bilateral; pink conjunctiva; the cornea is shiny,

transparent and equal in size; pupils are black in color; he can move his eyes without any

discomfort. Both ears have the same color with the patient’s face and aligned to the outer

canthus of the eye; pinna moves back when palpated; there is a presence of cerumen on both

ears, and it is yellowish in color. He can hear well because he responds to my questions

attentively during the interview. His nose is at the center and is symmetrical; uniform in color,

and has patent airways. The patient can breathe freely on both nares. The lips is pinkish in

color; the teeth are white; no missing teeth and tooth decays noted; the tongue is also pinkish in

color as well as the gums, uvula, soft and hard palate.

Norms: The skull is round, normocephalic and symmetrical with frontal, parietal, and occipital

prominences. Smooth skull contour. Hair is evenly distributed, thick hair, silky, resilient hair, no

infection and no infestations. Eyebrows are evenly distributed; skin intact, eyebrows

symmetrically aligned, equal movements. Eyelashes are equally distributed and curled slightly

outward. Bulbar conjunctiva is transparent, capillaries sometimes evident, sclera appears white.

Ears are mobile, Firm, and not tender, Pinna recoils after it is folded. Color same as facial skin,

symmetrical, auricle aligned with outer canthus of eye, about 10 degrees from vertical. Nose is

symmetric and straight, no discharge or flaring, uniform color. Lips is uniform pink in color. 32

adult teeth; smooth shiny white teeth; pink gums; moist, firm gum texture. Light pink, smooth

palate. Lighter pink hard palate and more irregular in texture. Tongue in central position, pink

color, no lesions, raised papillae, moves freely with no tenderness.

(Source: Health Assessment in Nursing. Weber and Kelley. Third Edition.)

Interpretation: In the HEENT assessment, most of the results are considered to be normal

based on the norms. However, the patient’s hair for instance is not, for the patient admitted he

dyed his hair making it brown in color. Though he doesn’t have missing tooth or tooth decays,

his teeth are not all permanent some are temporary.

C. Chest and Back

Actual Findings:

S: E.V.E verbalized, “Hindi naman po sumasakit ang dibdib ko, pati na din ang likod ko hindi

naman nangangalay o sumasakit. Hindi rin ako nahihirapang huminga.”

O: The chest is symmetric and expands as he breathes. His respiration is quiet rhythmic,

effortless and has 21 cycles in one full minute. The skin is intact and the temperature is even.

Norms and Standards: Chest is symmetric. Breasts are not tender when palapated, slightly

unequal with no presence of mass and/or lesions. Skin intact and uniform temperature. Full and

symmetric chest. Fremitus is heard most clearly at the apex of the lungs. Percussion notes

resonate, except over scapula lowest point of resonance is at the diaphragm and vesicular and

bronchovesicualr breath sounds.

(Source: Fundamentals of Nursing. Kozier and Erb. 2008.)

Interpretation: There are no deviations from normal noted.

D. Abdomen

Actual Findings:

S: “Hindi na po sumasakit ang aking tyan. Nakakakain ako ng marami at hindi na ko nagsusuka

buhat nung isang araw pa.”

O: The patient’s abdomen is round, uniform in color with no lesions noted.

Norms: Unblemished skin, uniform color, no lesions, silver-white striae or surgical scars. Flat,

rounded or scaphoid. No evidence of liver/spleen enlargement. Symmetric contour. Symmetric

movements caused by respiration. Visible peristalsis in very lean client.

(Source: Health Assessment in Nursing. Weber and Kelley. Third Edition.)

Interpretation: The patient’s abdomen has no deviation from normal findings noted.

E. Extremities

Actual Findings:

S: “Hindi naman po masakit at nangangalay ang mga binti at braso ko.”

O: The patient has smooth coordinated movements; he can move his extremities without any

discomfort. His muscle tone is equal in both upper and lower extremities. The skin’s

temperature and color are uniform.

Norms and Standards: Equal size on both sides. No fasciculation/tremors. Joint moves

smoothly. Normally firm. Smooth coordinated movement. Equal strength on both sides. No

swelling, no tenderness, no nodules.

(Source: Health Assessment in Nursing. Weber and Kelley. Third Edition.)

Interpretation: The client can move his extremities without any discomfort. Thus, there are no

deviations from normal noted.

IV. LABORATORY RESULTS

Hematology

Examination: Ref. Values

Hemoglobin 133gll 125-160

Hematocrit 0.40 0.38-0.50

RBC 4.79x10/L 4.5-6.2(M)

4.5-5.5(F)

Leukocyte 21.3 x10/L 5-10

Stab 0-0.1

Neutrophil 0.84 0.40-0.60

Eosinophil 0.01-0.06

Basophil 0-0.01

Lymphocyte 0.06 0.20-0.40

Monocyte 0.20-0.40

ESR

Platelet count x10/L 150-350

Reticulocyte x10/L 5-15

Bleeding Time 2-4 minutes

Clotting Time 2-6 minutes

Clot ret. Time

Protime

Patient secs

Control secs 12-14 secs

% Activity % 70-100%

INR

APTT Secs

Control Secs

Norms Interpretation

Hematology Result04.13.07

Result04.20.07

NormalValues

Increased Decreased

WBC 14.43 x109/L

16.03 x109/L

5–10 x109/L

◊ Infection◊ Inflammation◊ Trauma

◊ Autoimmunedisease◊ Drug toxicity◊ Bone marrowfailure

Neutrophil 0.01 0.62 0.55-0.65

◊ stress◊ acuteinfection

◊ aplastic anemia◊ dietary deficiency

Lymphocytes 0.83 0.31 0.25-0.35

◊Chronicinfection◊ Viral Infection◊Mononucleosis

◊ Leukemia◊ Sepsis◊Immunodeficiency\diseases

Eosinophils 0.01 0.03 0.02-0.07

◊ Parasiticinfections◊ Allergicreactions

◊ IncreasedAdrenosteroidproduction

◊ Leukemia

Hemoglobin 101.1 g/L 110.7 g/L 116-140g/L

◊ Polycythemia◊ Dehydration◊ COPD

◊ Hemorrhage◊ Anemia◊ Cancer◊ Kidney disease◊ Sickle Cell

Anemia

Hematocrit 0.32 0.34 0.35-0.41

◊ Polycythemia◊ Dehydration◊ COPD

◊ Hemorrhage◊ Anemia◊ Hyperthyroidism◊ Dietary deficiency

Platelet 365 x109/L

615 x109/L

150-350x 109/L

◊ Malignantdisorder◊ Polycythemia◊ RheumatoidArthritis◊ IronDeficiencyAnemia

◊ Hemorrhage◊ Leukemia◊ Pernicious anemia◊ Hemolytic anemia◊ Chemotherapy

RBC 4.76 x1012/L

5.28 3.0 -5.0x1012/L

◊ Dehydration◊ Pulmonaryfibrosis

◊ Hemorrhage◊ Anemia◊ Dietary deficiency

(Source:http://cdn.nursingcrib.com/wpcontent/uploads/case%20study/

labhypertension.pdf )

FECALYSIS

COLOR: Greenish yellow

CONSISTENCY: mucoid

PARASITES:

AMOEBA: positive for E. Histolytica cyst.

CYST:

TROPHOZOITE:

PUS CELLS: 35-40/rpf

RBC: 3-6/rpf

OTHERS: bacteria: many

Norms:

Normal Findings Interpretation

Color brown normal

Consistency soft and bulky, small

and dry, depending

on the diet

normal

Parasite none (+)infection(-)normal

Pus Cells none (+)infection(-)normal

Bacteria none (+)infection (-)normal

Red Cells 0-3 normal

(Source: http://healcon.com/health-book/health-condition/fecalysis-norms-

_AQZ5AGquLGLjKmVjAwRmAmL=.htm)

ELECTROLYTES

RESULTS UNIT REF. VALUE

SODIUM 136.5 mmol/L 135-140

POTASSIUM 3.6 mmol/L 3.5-5.5

CHLORIDE 98-107

Norms:

Normal Findings Interpretation

Sodium 135-145 <145 mmol/L: Hypernatremia

An excess in sodium levels in

the blood in relation to water

is called 'hypernatremia'.

Causes of hypernatremia may

include kidney disease, lack

or little water intake or loss of

water due to diarrhea and/or

vomiting.

>135 mmol/L: Hyponatremia

A decrease in sodium levels in

the blood in relation to water

is called 'hyponatremia'. This

occurs when there is an

increase in the amount of

body water in relation to

sodium. This occurs with

diseases of the liver, kidney,

burn victims and those who

suffer from congestive heart

failure and other conditions.

Potassium 3.5-5 <3.5mmol/L: hypokalemia

>5 mmol/L: hyperkalemia

An abnormal increase in

potassium (hyperkalemia) or a

decrease in potassium

(hypokalemia) can seriously

affect the nervous system and

increases the chance of

arrhythmias.

Chloride 98-107 <107 mmol/L: hyperchloremia

Increased chloride levels is

'hyperchloremia'. Elevated

levels are seen in diarrhea,

some kidney disease and

sometimes in overactive

parathyroid glands.

>98 mmol/L: hypochloremia

Decreased chloride levels is

'hypochloremia'. Chloride is

normally lost in the urine,

sweat and stomach secretions

but an excessive loss can

happen from heavy sweating,

vomiting and adrenal gland or

kidney disease.

Calcium(ionized) 4.5-5.5 <5.5: hypercalcemia

LOW:

muscle twitching and

cramping

seizures

varying degrees of depression

hair loss

cataracts

conjunctivitus (inflammation of

the mucuos membrane of

inner eyelid)

>4.5: hypocalcemia

HIGH:

muscle weakness

fatigue

abdominal cramps

loss of appetite

nausea and /or vomiting

constipation

possible coma if left untreated

Magnesium 1.5-2.5 <2.5: hypermagnesemia

>1.5: hypomagnesemia

Signs and symptoms

associated with abnormal

levels:

decreased mental function

ranging from drowsiness to

coma in severe states

decreased tendon reflex

leading to paralysis

Nausea / vomiting

hypotension due to dilated

blood vessels

Phosphate 1.7-2.6 <2.6mmol/L:

hyperphosphatemia

Causes of increased

phosphate leves are due to

excess vitamin D, impaired

colon motility,

hypoparathyroidism, addisons

disease and increased intake

of phosphate foods

>1.7 mmol/L:

hypophosphatemia

Causes of decreased

phosphate are due to

malnutrition, excess use of

antacids, cushing syndrome,

and hyperparathyroidism

Signs and Symptoms:

Decrease cardiac respiratory

function

Muscle weakness

Fatigue

Confusion

Seizures

Bone pain

(Source: http://www.mdhealthnetwork.org/Blood-Tests-Electrolytes.htm)

V. DRUG STUDY

Home Medications

Name Dosage Action Indication Contraindication

Side Effects Nursing Responsibilities

Generic:AzithromycinBrand name:ZithromaxDrug Class:Macrolide antibiotic

500 mg/1 tab OD for 3 days

Azithromycin is an antibiotic (macrolide-type) used to treat a wide variety of bacterial infections. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (e.g., common cold, flu).

Indicated for the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms.

Ketolide or related allergy.

GI upset, abdominal pain, rash, chest pain; hepatotoxicity, allergy (eg, angioedema, cholestatic jaundice), C. difficile associated diarrhea.

Inform patient not to share medicationsDo not take drug with food or antacidsTake antacids 2h before or after taking the drugDirect sunlight (UV) exposure should be minimized during therapy with drug or patient might use sunblockReport immediately if onset of diarrhea occurs

Generic: 500 mg 1 Metronidaz Acute History of GI Take full

MetronidazoleBrand name:FlagylDrug Class:Anti-infectives,Anti-protozoals

tab for 7 days

ole is converted to reduction products that interact with DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms. It is effective against a wide range of organisms including E. histolytica, T. vaginalis, Giardia, anaerobes e.g. Bacterioides sp, Fusobacterium sp, Clostridium sp, Peptococcus sp and Peptostreptococcus sp, and moderately active against Gardnerell

infection with susceptible anaerobic bacteriaAcute intestinal amebiasisAmebic liver abscessTrichomoniasis (acute and partners of patients with acute infection)Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgeryTopical application: Treatment of inflammatory papules, pustules, and erythema of rosacea

hypersensitivity to metronidazole or other nitroimidazole derivatives. Pregnancy (1st trimester) and lactation.

disturbances Furred tongue, glossitis, and stomatitis due to overgrowth of Candida. Weakness, dizziness, ataxia, headache, drowsiness, insomnia, changes in mood or mental state. Numbness or tingling in the extremities, epileptic form seizures (high doses or prolonged treatment). Transient leucopenia and thrombocytopenia. Hypersensitivity reactions. Urethral discomfort and darkening of urine. Raised liver enzyme values, cholestatic hepatitis, jaundice. Thrombophlebitis (IV).

course of drug therapy; take the drug with food if GI upset occurs.Do not drink alcohol (beverages or preparations containing alcohol, cough syrups); severe reactions may occur.Your urine may be a darker color than usual; this is expected.Refrain from sexual intercourse during treatment for trichomoniasis, unless partner wears a condom.Apply the topical preparation by cleansing the area and then rubbing a thin film into the affected area. Avoid contact with the eyes. Cosmetics may be applied to the area after application.You may experience these side effects: Dry mouth with strange

a sp and Campylobacter sp.

metallic taste (frequent mouth care, sucking sugarless candies may help); nausea, vomiting, diarrhea (eat frequent small meals).Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.

Generic:Bacillus ClausiiBrand name:ErcefloraDrug class:Antidiarrheals

1 vial of 2 billion/ 5 ml suspension

Contributes to the recovery of the intestinal microbial flora altered during the course of microbialdisorders of diverse origin. It produces various vitamins, particularly group B vitamins thus contributingto correction of vitamin disorders caused by antibiotics & chemotherapeutic agents.

Acute diarrhea with duration of ≤14 days due to infection, drugs or poisons. Chronic or persistent diarrhea with duration of >14 days.

Not for use in immunocompromised patients (cancer patients on chemotherapy, patients takingimmunosuppressant meds)

No known side effects

Shake drug well before administrationAdminister drug within 30 minutes after openingDilute drug with sweetened milk or fruit juiceAdminister per oremMonitor patient for any unusual effects from drug

Promotesnormalization of intestinal flora.

VI. PATHOPHYSIOLOGY

Infective cysts are ingested through water or food contaminated with infected feces. The cysts travel through the digestive track until the small intestine. There, excystation occurs, forming a motile trophozoite. It then travels to the large intestine and colon. Here the infection can follow either of two phases: pathogenic and non-pathogenic.

In the pathogenic phase, the virulent trophozoite invades the gut, intestinal lumen, and sometimes the mucosa. Here they kill epithelial cells, neutrophils, and lymphocytes. In the process, they destroy tissues and cells, and produce colitis. Occasionally they manage to enter the capillaries, where they can be transported to the liver, lungs, or the brain. Once in those organs, the parasite can cause abscesses. The abscesses may subsequently burst, releasing many trophozoites which can re-enter the lumen. After feeding, the trophozoites extrude all

ingested material and binary fission occurs. They “round up” and form cysts, where they areresistant to the environment. The cysts pass through the digestive system and are contained in the feces. In feces, they can live anywhere from2-5 weeks, waiting for a new host.

In the non-pathogenic phase, the trophozoites feed on bacteria and detritus from the outer lining of the gut. They do not invade the membrane, and do not form ulcers or abscesses. After feeding, they round up and form cysts, as in the pathogenic phase.

(Source: http://nursingcrib.com/case-study/amoebiasis-amebiasis-amoebic-dysentery-case-study/)

VII. PRIORITIZED LIST OF PROBLEMS

Nursing Diagnoses Cues Rationale

Readiness for enhanced

self-care

S: “Gusto ko na pong maligo pero sabi ng nanay ko sa bahay na lang daw namin kase uuwi na naman daw kami.”

-to assist client in maintaining

responsibility for planning and

achieving self-care goals/general well

being

-to support client in making healh-

related decisions and pursuit of self-

care practices that promote helth to

foster self-esteem and support positive

self-concept.

-to encourage communication among

those who are involved in client’s

health promotion.

-to provide accurate and relevant

information regarding current and

future needs.

-to maintain general health and

physical well being

-to remain free of preventable

complications

-to control feelings of anxiety and help

patient manage the situation

Risk for Infection

Risk for deficient fluid

volume

Risk factors:

Immunosuppression

Antibiotic Therapy

Increased environmental exposure to pathogens

Insufficient knowledge to avoid exposure to pathogens

Risk factors:

Excessive losses through normal routes (e.g Diarrhea)

Oral fluid intake of 6 glasses per day

-to identify etiology/precipitating factors

-to note signs and symptoms of sepsis

-to demonstrate behaviors or lifestyle

changes to prevent development of

infection

-to avoid reoccurrences of the condition

-to identify risk factors and appropriate

interventions

-to demonstrate behaviors or lifestyle

changes to prevent development of

fluid volume deficit

(Source: NANDA 11th edition)

REFERENCES:

Weber and Kelly: Health Assessment in Nursing 3rd Edition

Kozier and Erb (2008): Fundamentals of Nursing 8th Edition)

Doenges, Moorhouse and Murr: Nurse’s Pocket Guide 11th edition

Source:http://cdn.nursingcrib.com/wpcontent/uploads/case%20study/labhypertension.pdf

Source:http://healcon.com/health-book/health-condition/fecalysis-norms_

AQZ5AGquLGLjKmVjAwRmAmL.htm

Source: http://www.mdhealthnetwork.org/Blood-Tests-Electrolytes.htm

Source: http://nursingcrib.com/case-study/amoebiasis-amebiasis-amoebic-dysentery-case-study/

VIII. NURSING CARE PLAN

Nursing Diagnosis

Analysis Goal and Objectives

Nursing Intervention

Rationale Evaluation

Readiness for enhanced self-care

Subjective:The patient verbalized, “Gusto ko na pong maligo pero sabi ng nanay ko sa bahay na lang daw namin kase uuwi na naman daw kami.”

Goal:After 8 hours of nursing interventions, the client will be able to maintain responsibility in achieving proper self-care

Objectives:

After 30 minutes of nursing intervention, the client’s condition will be monitored

After 5 minutes of nursing intervention, the client will be able to identify the importance of

Administer medications as ordered

Vital signs taken and recorded

Performed initial thorough assessment

Discuss to the client the importance of maintaining

To promote faster healing

To note any changes in the vital signs

To obtain baseline data

To promote maintenance of good proper

Goal was met as evidenced by healing of the skin rashes as evidenced by visual disappearance of the rashes and a rate of 0 in itchiness from a scale of 1-10.

maintaining good proper hygiene

After 10 minutes of nursing interventions, the client will be able to demonstrate ways in achieving proper hygiene

After 15 minutes of nursing

good proper hygiene

Provide ways to the client on how to achieve good proper hygiene

Initiate daily bathing and good grooming

Promote handwashing before and after eating and voiding

Encourage client to keep nails clean and short

Assist patient in developing

hygiene

To help the client learn ways on how to achieve good proper hygiene

To promote comfort

To remove dirt and prevent contamination and transmission of microorganisms

To prevent transmission of microorganisms into the body

To prevent re-

intervention, the client will be able to participate in prevention measures and treatment program

programs for preventive care

Encourage client to avoid consumption of such food and water if in doubt of its preparation

Instruct the client’s guardian to report in cases of vomiting and diarrhea

Inform the medications to be taken at home and its specific considerations

Promote the importance of compliance to home

occurence of the condition and further complications

To avoid ingestion of infectious agents

To monitor signs and symptoms of Amoebiasis

To promote timely healing

To enhance effect of treatment program

In another 10 minutes of nursing interventions, the client will be able to show willingness to participate in health promotion

medications

Inform the client’s guardian the importance of follow up visits

Encourage client that maintaining good proper hygiene is a key role in health promotion

Offer support

To promote commitment, optimizing better outcomes

To enhance understanding and cooperation

To reduce anxiety and boost self-esteem