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A case study on amoebiasis
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INTRODUCTION
PIA Press Release2006/03/30
Small amoebiasis outbreak hits pacific towns in Southern Leyteby R.G. Cadavos
Southern Leyte (30 March) -- An epidemic due to amoebiasis affected Pacific towns here since last Saturday believed to have came from the source of water they drank.
A 9-month old boy did not arrive safe or "dead on arrival" in Anahawan District Hospital because of vomiting and diarrhea due to amoebiasis wherein 63 patients from (6) Pacific towns already came for treatment since last Saturday, March 25.
Gov. Rosette Lerias personally visited the patients last March 28 at the Anahawan District Hospital. Of the 63 patients served, 55 were left admitted at the hospital wherein 24 of them were children and 31 adults.. It was reported that some patients already went home to continue the treatment there and others who were hit by the epidemic did not go to the hospital, they just asked for medicines and antibiotics for home medications.
PIA Infocen Manager Erna Sy Gorne who accompanied the
governor said that Hospital Chief Dr. Ernesto Cahoy suspected that the primary cause of the vomiting and loose bowel movement of these patients was the drinking water they drank particularly in the municipality of Anahawan where officials saw leaks in the intake tank of the reservoir.
As of press time, Anahawan Mayor Jose Ma. Miñana already ordered to seal the leaks and the water treatment will immediately follow.
Gov. Lerias already sent medicines to the district hospital through Dr. Cahoy, to treat the ailing patients from Pacific towns. Medicines sent were as follows: dextrose, syringes, antibiotics and other medicines related to the illness.
The lady governor also instructed the hospital management that all medicines given to these patients should be free.
As of this writing, Anahawan District Hospital record showed patients afflicted with amoebiasis came from whole of Pacific towns. Silago town had 2 victims; San Juan-2; St. Bernard-8; Anahawan-40; Hinundayan-2 and Hinunangan-1. (PIA-Maasin)
[article from: http://www.pia.gov.ph/?m=12&fi=p060330.htm&no=49]
1
Here in the Philippines, there are a lot of places that serve delicious food, at a very
low and affordable price, but are located in areas exposed to a wide variety of germs.
Because of this, Amoebiasis is the usually feared illness that would possibly result from
eating foods that are suspected to be ‘dirty.’
Still, Filipinos are prone to ingesting amoebas because they find it convenient to
drink water straight from the faucet. Even good restaurants do this. What is worse is that
some public water fountains already have defective filtering systems.
It is estimated by the World Health Organization that about 70,000 people die due
to Amoebiasis annually worldwide.
For three days, the group has been able to observe and care for a 59 year old man
suffering from amoebiasis. This case presentation will be about that man, whose name
will be known only as “Mr. Mamugz” He has been chosen for a case presentation
because out of all the cases available during the exposure, he was the only one who was
the most entertaining; Thus, he had the greatest potential of sharing the most information.
2
OBJECTIVES
General Objectives:
To conduct a thorough and comprehensive study about the Mr. Mamugz’s disease
according to the data that was gathered by conducting a series of interviews and through
the use of data gathered from extensive research.
Specific Objectives:
To organize our patient’s data for the establishment of good background
information
To show the family health history as well as the history of past and present illness
for the knowledge of what could be the predisposing factors that might contribute
to the patient's illness
To present the family’s genogram containing information that will help out in
tracing any hereditary risk factors
To trace the psychological development of our patient through analysis of different
developmental theories with comparison to the patient’s data
To give different definitions of the complete diagnosis of our patient for better
understanding of unfamiliar terms
To present the data from the physical assessment performed on our patient using
the cephalocaudal approach for a good overview of his over-all health
To discuss the human anatomy and physiology of the systems involved in the
disease process of our patient
To identify the symptoms, predisposing and precipitating factors that contribute to
the present illness of the patient
3
To organize a flow chart showing the pathophysiology of amoebiasis for a clear
visualization of how this condition affects a person
To correlate the different orders of the physicians assigned to our patient with their
rationale for a general knowledge of what consists of the medical management for
amoebiasis.
To present the different results of our patient’s diagnostic exams together with
comparisons of normal values for the understanding of what changes during the
disease
To study the different drugs used by our patient to have a better understanding of
its actions and indications
To analyze the different nursing theories applicable to our patient
To formulate specific, measurable, attainable, realistic and time-bounded nursing
care plans
To impart appropriate health teachings specifically for the patient to promote
wellness
To present an appropriate discharge plan for our patient
To have an over-all conclusion and recommendation about the case study
4
PATIENT’S DATA
Patient’s Code name: Mr. Mamugz
Age: 59
Sex: Male
Nationality: Filipino
Religion: Seventh Day Adventist
Civil Status: Single
Occupation: Teacher
Ward: Male Ward
Date of Admission: April 27, 2009
Time of Admission: 10:40am
Vital Signs on Admission:
BP – 180/100 mmHg
RR – 20 cpm
Temp - 37.6 C
PR – 80 bpm
Mode of Arrival: Ambulatory
Admitting Doctor: Dr. Claire Miyake
Admitting Nurse: Francis Sison, R.N.
Admitting Clerk: M, Mira, R.M.
Admitting Diagnosis: LBM and Fever
5
FAMILY BACKGROUND AND HEALTH HISTORY
Mr. Mamugz, a 59 year old male, was born in Davao City, on November 23,
1950. He is currently residing at Agdao, Davao City. They are 9 in the family including
his parents. He is the 5th child among the 7 children. Our patient was completely
immunized since he received the needed immunizations before he reached 1 year old.
Regarding his educational background, he finished high school at Leyte Normal
University. He finished his course, Bachelor of Science - Commerce major in accounting
in University of Mindanao in the year 1978. He then obtained his Certificate for Public
Accountancy or CPA 8 years after graduating college. In 1990, he pursued his Masteral
degree in Public Administration in UP Diliman. After getting his master’s degree, he then
became a Doctor of education in 2005 at University of Mindanao. Finally he was able to
accomplish his first year in Law in his Alma Mater in the year 2008.
Mr. Mamugz has been married for 28 years with his wife. They have 2 offspring.
Their eldest is 27 years old graduate of Bachelor of Science in English Literature and
their youngest is 22 year old graduate of Bachelor of Science major in English Education.
Lifestyle: Daily ScheduleMr. Mamugz verbalized that being a teacher entails great responsibilities. He
usually wakes up 4am to take bath and change into working clothes. After that he then
goes to Agdao via motorcycle to have his breakfast. Then he goes to teach at University
of Mindanao using his own car. He shared that he always experiences stress from
students.
6
Lifestyle: Vices
Mr. Mamugz verbalized that he smokes and drinks at the same time, but only does
so occasionally (during parties, birthday celebrations, fiesta and others special occasions).
During these celebrations he would be able to consume 5 sticks of cigarette and finish 3
bottles of beer.
Lifestyle: Diet
Mr. Mamugz usually eats three meals a day. They are restricted from eating pork
but they are allowed to eat seafoods except for the one that do not have scales such as
crabs, eel, squids and etc. Mr Mamugz is fond of drinking kamote tap juice from his own
garden. He shares that he had his garden for a long time, however, a house was built next
to it and the new house’s bathroom was built closest to the garden. A canal for the
bathroom was also built near the garden
During times without special occasions, he would have meals that would consist
of the following kamote tap juice mixed with honey, egg, hotdog and bread for breakfast;
kamote tap juice mixed with honey, and vegetable salad for lunch; kamote tap juice and
fried chicken for dinner.
History of Patient's Past Illness
Mr. Mamugz verbalized that he was hospitalized five years ago at Davao Doctors
Hospital due to loose bowel movements and he was also diagnosed with amoebiasis at
that time.
He verbalized that six months ago he also experienced productive cough and self
medicated with carbocistine.
Mr. Mamugz verbalized that when he was 40 years old, he was diagnosed with
7
hypertension by their University Physician. Whenever he gets hypertensive he will
experience pain at the back of his neck
History of Patient's Present Illness
Mr. Mamugz verbalized that he experienced loose bowel movement three times;
at 10pm of April 26, 2009, and at 1am and 4am of April 27, 2009. He took Loperamide,
the “generic” kind, to treat LBM. Eventually he started taking Diatabs instead of the
generic.
On the same day he experienced fever that made him decide to admit himself at
Ricardo Limso Hospital.
Effects of Illness to the Family
During the interview, Mr. Mamugz was asked regarding the effects of his
illness to his family. They are financially stable; they do not have any problems in terms
of money. However he said that his family is greatly affected because he is the
breadwinner of the family. Even if this condition may be considered minor, having the
breadwinner hospitalized is truly a concern for all the members of the family. Aside from
that Mr. Mamugz is also a very important person to the family as he is the father and
husband.
8
GENOGRAM
DEVELOPMENTAL DATA
Theorist Theory Stage Justification
Lawrence
Kohlberg
Stages of Moral
Development:
The theory holds
that moral
reasoning, the basis
for ethical behavior,
has six
identifiable develop
mental stages, each
more adequate at
responding to moral
dilemmas than its
predecessor. Kohlbe
rg followed the
development of
moral judgment far
beyond the ages
studied earlier
by Piaget, who also
claimed that logic
and morality
develop through
constructive
stages. Expanding
on Piaget's work,
Kohlberg
determined that the
process of moral
The post-conventional
level, also known as the
principled level, consists of
stages five and six of moral
development. There is a
growing realization that
individuals are separate
entities from society, and
that the individual's own
perspective may take
precedence over society's
view. Because of this
level's "nature of self
before others", the
behavior of post-
conventional individuals,
especially those at stage 6,
can be confused with that
of those at the pre-
conventional level.
In Stage six (universal
ethical principles driven),
moral reasoning is based
on abstract reasoning using
universal ethical principles.
Laws are valid only insofar
as they are grounded in
justice, and a commitment
Mr. Mamugz is already
in stage six of the post
conventional level in
moral development.
Evidence of this can be
found in something as
simple as his reaction to
food that was given to
him. He definitely
knows that food
containing oil cannot be
for him, yet this is the
food that was being
served to him for a total
of 3 days already. The
self-before-others kind
of behavior kicks into
his psyche as he knows
that the food served was
not the kind that the
doctor ordered. So, as
the policy of the hospital
remains that the food
served cannot be
replaced, he still decides
to approach the nurse’s
station and complain
about the issue. In this
act, he knows that
development was
principally
concerned with
justice, and that it
continued
throughout the
individual's
lifetime, a notion
that spawned
dialogue on the
philosophical
implications of such
research.
to justice carries with it an
obligation to disobey
unjust laws.
whether he complains or
not, the oily food that
was served cannot be
changed. However, in
his morality, he is driven
to do something about it
because he feels the
injustice that has been
done to him. The very
act of complaining can
give justice to his
situation simply because
something was done
about it.
Theorist Theory Stage Justification
Erik
Erikson
Erikson's stages of
psychosocial
development as
articulated by Erik
Erikson explain
eight stagers throug
h which a healthily
developing human s
hould pass
from infancy to late
adulthood. In each
stage the person
confronts, and
hopefully masters,
new challenges.
Each stage builds
on the successful
completion of
earlier stages. The
challenges of stages
not successfully
completed may be
expected to
reappear
as problems in
the future.
Middle adulthood (40 to
60 years)
Psychosocial Crisis:
Generativity vs. Stagnation
Generativity is the concern
of establishing and guiding
the next generation.
Socially-valued work and
disciplines are expressions
of generativity. Simply
having or
wanting children does not
in and of itself achieve
generativity.
Central tasks of Middle
adulthood [bold tasks
indicate accomplished
tasks by Mr. Mamugz]
Express love
through more
than sexual
contacts.
Maintain healthy
life patterns.
Develop a sense of
unity with mate.
Help growing and
grown children to
Mr. Mamugz is probably
one of the best examples
of successful
generativity. First of all,
he has successfully
achieved a doctorate
degree in education. He
couldn’t have achieved
this if he didn’t get his
master’s degree in
public administration.
Furthermore, this
master’s degree could
not exist if he didn’t
have his college degree
in BS-Commerce and
being a CPA too. With
all of these
achievements, Mr.
Mamugz is able to
achieve even more. His
achievements have given
him such a strong
foundation. All the
education that he went
through gave him all
that he needed to
successfully achieve this
stage in psychosocial
be responsible
adults.
Relinquish central
role in lives of
grown children.
Accept children's
mates and friends.
Create a
comfortable home.
Be proud of
accomplishments
of self and
mate/spouse.
Reverse roles with
aging parents.
Achieve mature
civic and social
responsibility.
Adjust to physical
changes of middle
age.
Use leisure time
creatively.
Love for others
development. Through
this, he is very much
ready for the next stage
in his life, which is Late
Adulthood.
Theorist Theory Stage Justification
Robert
Havighurst
The developmental-
task concept
occupies middle
ground between two
opposed theories of
education:
the theory of
freedom—that the
child will develop
best if left as free as
possible, and
the theory of
constraint—that the
child must learn to
become a worthy,
responsible adult
through restraints
imposed by his
society. A
developmental task
is midway between
an individual need
and societal
demand. It assumes
an active learner
interacting with an
active social
environment
(Ages 30-60) [bolded
indicates accomplished]
Assisting teenage
children to
become
responsible and
happy adults.
Achieving adult
social and civic
responsibility.
Reaching and
maintaining
satisfactory
performance in
one’s occupational
career.
Developing adult
leisure time
activities.
Relating oneself to
one’s spouse as a
person.
To accept and
adjust to the
physiological
changes of middle
age.
Adjusting to aging
parents.
Mr. Mamugz falls into
this category. He is 59
years old. Yet regardless
of his age, all of these
developmental tasks
were accomplished
successfully. Towards
his two daughters, he
was able to be a very
good inspiration to their
success. As an adult, he
is able to be all he can
be because of all his
experience and
knowledge. Even at
home, he is able to
spend leisure time by
taking care of his very
own garden. With all of
these tasks
accomplished, Mr.
Mamugz is well and
ready for the next stage
in his life when he
becomes 60 and over.
DEFINITION OF COMPLETE DIAGNOSIS
Amoebiasis
-protozoal infection of human beings initially involves the colon, but may spread
to soft tissues, most commonly to the liver or lungs, by contiguity or hematogenous or
lymphatic dissemination.
www.nursingcrib.com
-(also known as spelt amebiasis) is an infection caused by the parasite entamoeba
histolytica. It is usually contracted by ingesting water or food contaminated with amoebic
cysts.
http://www.health-disease.org/skin-disorders/amoebiasis.htm
-Amoebias is an inflammation of the intestines caused by a parasite, Entamoeba
histolytica. This microscopic parasite enters the body through contaminated food or
water. The infection is common in areas with poor sanitation or living conditions. This
parasite can live in the intestine without causing symptoms, or it can produce severe
symptoms. It is a very common problem in India.
http://www.doctorndtv.com/topicsh/Amoebiasis.asp
PHYSICAL ASSESSMENT
Date of Assessment: April 27, 2009 @ 4pm
Patient’s Name: Mr. Mamugz
Age: 59 years old
Sex: Male
Ward: DMC - Med CP
GENERAL SURVEY
Mr. Mamugz was received sitting up on bed awake, conscious and coherent. He
had an ongoing IVF of PNSS 1 liter at 30gtts/min infusing well at his right metacarpal
vein; noted at 680cc level. He weighs 72 kgs and has a height of 5’6”. He has an
endomorphic body structure. Calculation of his BMI reveals that he is overweight
(25.62kg/m2).
VITAL SIGNS
4:00 pm
BP - 150/80 mmHg
PR - 98 bpm
RR - 20 cpm
Temp. – 38.8 ۫� C
VERBALIZATIONS
“Naa pa ba ko’y tambal nga pain reliever? Sakit man gud ang akuang likod.” [pain scale:
6]
“Murag lima ka beses na ko naka libang kaganinang buntag.”
“Dili gahi ang akuang tae… Daghan pud ug tubig.”
“Dili kaayo ko makatulog kay pirminti lang ko momata para maglibang bisan kadlawon
pa na.”
HEAD
Mr. Mamugz’s head is normocephalic. Some hair strands are already grayish in
color, but he still has black strands of hair. All hair strands are equally distributed
throughout his scalp. Lesions, bleeding and bruises were not seen upon inspection.
EYES
Mr. Mamugz’s eyes are symmetrical. The cornea is white and adequately moist.
Both his irises are colored dark brown. His pupils are equally round and reactive to light
and accommodation with a papillary size of 3mm. He verbalizes that he never needed the
use of glasses. His eyebrows were thick and eyelashes were evenly distributed along the
margins of the eyelids. Both eyes move in unison. No signs of redness, jaundice, or
discharges were noted on both eyes. [Due to the lack of a Snellen Chart, an alternative
method to determine visual acuity was used] Mr. Mamugz was able to read a news paper
up close without the aid of eyeglasses. On the other hand, he was able to identify three
different ballpen colors of a student nurse who was standing approximately 7 meters
away only with the aid of eyeglasses; this reveals that Mr. Mamugz has near-sightedness.
EARS
The shapes of Mr. Mamugz’s auricles were symmetrical. No discharges were
noted around and within each external acoustic meatus. Tenderness was not experienced
by Mr. Mamugz when his ears were palpated. There were no lesions, wounds or
discoloration noted upon inspection.
To determine his level of hearing, he was made to sit on his bed and have a
student nurse whisper a phrase behind his head. He was then instructed to repeat this
phrase. He was able to do so in his first try. This reveals that Mr. Mamugz has an
adequate level of hearing.
NOSE
Mr. Mamugz’s nose was symmetrical. Both nostrils were patent and had no
discharges. No nasal flaring was noted. His nasal septum was not deviated from the
midline of his face. Short nasal hairs were present upon inspection. In determining
olfaction, Mr. Mamugz was instructed to be blind folded. Different scents were then
placed under his nose and he was instructed to identify the smells as each scent is tested.
He was able to identify the smell of alcohol, feminine perfume, and food.
MOUTH
Mr. Mamugz’s lips were adequately moist. Generally, his teeth had a yellow color.
His gums and buccal mucosa are pinkish in color. His tongue is moist and is not deviated
from the midline of the mouth. He was able to speak well and was understood well by
every person who interacted with him. His tonsils and uvula show no sign of
inflammation. No bleeding was seen upon inspection. No nausea or vomiting noted.
NECK
Mr. Mamugz did not complain of any pain on his neck. He was also able to tilt,
rotate, flex and extend his neck without any difficulty. Both carotid pulses were palpable
with normal pulse rhythm. There were no lymph nodes that were observed to be swelling
or enlarged. The trachea was in midline. The thyroid gland was not observed to be
enlarged or inflamed.
CHEST AND LUNGS
Expansion and relaxation of Mr. Mamugz’s chest wall was symmetrical and in
unison during respiration. He did not complain of any dyspnea or distress in breathing.
Upon auscultation, his lung fields were clear. He complained of having pain in his back
whenever he coughs.
ABDOMEN
Mr. Mamugz’s abdomen was flabby, globular and non-distended. He had
hyperactive bowel sounds. 21 bowel sounds were counted within one full minute. He
refused to give permission for the student nurse to perform deep palpation on his
abdomen because he knows that he will experience pain. However, he verbalized that he
had experienced 5 episodes of loose bowel movement in the morning before the
assessment.
BACK
Mr. Mamugz’s back was observed to be moist with his sweat. Upon inspection,
his back does not have any lesions, deformities, or signs of altered skin integrity. Light
palpation along Mr. Mamugz’s spine reveals that he does not have scoliosis. During
repositioning, he complains about pain in his lower back, which radiates to his buttocks
until the upper parts of the posterior and lateral areas of his thighs.
GENITO-URINARY
Mr. Mamugz refused to have his genital area assessed. However, he did not
complain of any pain or discomfort in the area. He also verbalized that he did not have
any problems in urinating. His average urine output within 8 hours was 800cc.
UPPER EXTREMITIES
Mr. Mamugz was able to have an adequate range of motion without any pain or
weakness. The grip power of both his hands was strong. His long nails weren’t trimmed
and had presence of dirt under them. His palms were observed to be calloused upon
palpation. Skin pinching reveals that he has good skin turgor. There were no wounds,
deformities and swelling noted on both his arms.
LOWER EXTREMITIES
Mr. Mamugz did not have any complaints regarding walking in general. However,
he did explain that he easily gets tired due to his heavy weight. Still, he was able to
demonstrate strong range of motion and was able to resist the downward force of a
student nurse’s hand towards his knees.
ANATOMY AND PHYSIOLOGY
Gastrointestinal Tract
[image from: http://www.lessonsonthelake.com/_images//j0438737.jpg]
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 down food 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 faeces).
Cross-section of the small intestine
[image from: http://z.about.com/d/coloncancer/1/0/Y/3/Overview.png]
The digestive tract, from the esophagus to the anus, is characterized by a wall with four
layers, or tunics. Here are the layers, from the inside of the tract to the outside:
The mucosa is a mucous membrane that lines the inside of the digestive tract from mouth
to anus. Depending upon the section of the digestive tract, it protects the GI tract wall,
secretes substances, and absorbs the end products of digestion. It is composed of three
layers:
o The epithelium is the innermost layer of the mucosa. It is composed of simple
columnar epithelium or stratified squamous epithelium. Also present are goblet
cells that secrete mucus that protects the epithelium from digestion and endocrine
cells that secrete hormones into the blood.
o The lamina propria lies outside the epithelium. It is composed of areolar
connective tissue. Blood vessels and lymphatic vessels present in this layer
provide nutrients to the epithelial layer, distribute hormones produced in the
epithelium, and absorb end products of digestion from the lumen. The lamina
propria also contains the mucosa-associated lymphoid tissue (MALT), nodules of
lymphatic tissue bearing lymphocytes and macrophages that protect the GI tract
wall from bacteria and other pathogens that may be mixed with food.
o The muscularis mucosae, the outer layer of the mucosa, is a thin layer of smooth
muscle responsible for generating local movements. In the stomach and small
intestine, the smooth muscle generates folds that increase the absorptive surface
area of the mucosa.
The submucosa lies outside the mucosa. It consists of areolar connective tissue
containing blood vessels, lymphatic vessels, and nerve fibers.
The muscularis (muscularis externa) is a layer of muscle. In the mouth and pharynx, it
consists of skeletal muscle that aids in swallowing. In the rest of the GI tract, it consists
of smooth muscle (three layers in the stomach, two layers in the small and large
intestines) and associated nerve fibers. The smooth muscle is responsible for movement
of food by peristalsis and mechanical digestion by segmentation. In some regions, the
circular layer of smooth muscle enlarges to form sphincters, circular muscles that control
the opening and closing of the lumen (such as between the stomach and small intestine).
The serosa is a serous membrane that lines the outside of an organ. The following serosae
are associated with the digestive tract:
o The adventitia is the serous membrane that lines the esophagus.
o The visceral peritoneum is the serous membrane that lines the stomach, large
intestine, and small intestine.
o The mesentery is an extension of the visceral peritoneum that attaches the small
intestine to the rear abdominal wall.
o The mesocolon is an extension of the visceral peritoneum that attaches the large
intestine to the rear of the abdominal wall.
o The parietal peritoneum lines the abdominopelvic cavity (abdominal and pelvic
cavities). The abdominal cavity contains the stomach, small intestine, large
intestine, liver, spleen, and pancreas. The pelvic cavity contains the urinary
bladder, rectum, and internal reproductive organs.
Motility
The gastrointestinal tract generates motility using smooth muscle subunits linked by gap
junctions. These subunits fire spontaneously in either a tonic or a phasic fashion. Tonic
contractions are those contractions that are maintained from several minutes up to hours at a time.
These occur in the sphincters of the tract, as well as in the anterior stomach. The other type of
contractions, called phasic contractions, consist of brief periods of both relaxation and
contraction, occurring in the posterior stomach and the small intestine, and are carried out by the
muscularis externa.
Stimulation
The stimulation for these contractions likely originates in modified smooth muscle cells called
interstitial cells of Cajal. These cells cause spontaneous cycles of slow wave potentials that can
cause action potentials in smooth muscle cells. They are associated with the contractile smooth
muscle via gap junctions. These slow wave potentials must reach a threshold level for the action
potential to occur, whereupon Ca2+ channels on the smooth muscle open and an action potential
occurs. As the contraction is graded based upon how much Ca2+ enters the cell, the longer the
duration of slow wave, the more action potentials occur. This in turn results in greater contraction
force from the smooth muscle. Both amplitude and duration of the slow waves can be modified
based upon the presence of neurotransmitters, hormones or other paracrine signaling. The number
of slow wave potentials per minute varies based upon the location in the digestive tract. This
number ranges from 3 waves/min in the stomach to 12 waves/min in the intestines.
Contraction Patterns
The patterns of gastrointestinal contraction as a whole can be divided into two distinct patterns,
peristalsis and segmentation. Occurring between meals, the migrating motor complex is a series
of peristaltic wave’s cycles in distinct phases starting with relaxation followed by an increasing
level of activity to a peak level of peristaltic activity lasting for 5-15 minutes. This cycle repeats
ever 1.5-2 hours but is interrupted by food ingestion. The role of this process is likely to clean
excess bacteria and food from the digestive system.
Peristalsis
Peristalsis is the second of the three patterns and is one of the patterns that occur during and
shortly after a meal. The contractions occur in wave patterns traveling down short lengths of the
GI tract from one section to the next. The contractions occur directly behind the bolus of food
that is in the system, forcing it toward the anus into the next relaxed section of smooth muscle.
This relaxed section then contracts, generating smooth forward movement of the bolus at between
2-25 cm per second. This contraction pattern depends upon hormones, paracrine signals, and the
autonomic nervous system for proper regulation.
Segmentation
The third contraction pattern is segmentation, which also occurs during and shortly after a meal
within short lengths in segmented or random patterns along the intestine. This process is carried
out by longitudinal muscles relaxing while circular muscles contract at alternating sections
thereby mixing the food. This mixing allows food and digestive enzymes to maintain a uniform
composition, as well as to ensure contact with the epithelium for proper absorption.
Secretion
Every day, seven liters of fluid are secreted by the digestive system. This fluid is composed of
four primary components: ions, digestive enzymes, mucus, and bile. About half of these fluids are
secreted by the salivary glands, pancreas, and liver, which compose the accessory organs and
glands of the digestive system. The rest of the fluid is secreted by the GI epithelial cells.
Ions
The largest component of secreted fluids is ions and water, which are first secreted and then
reabsorbed along the tract. The ions secreted primarily consist of H+, K+, Cl-, HCO3- and Na+.
Water follows the movement of these ions. The GI tract accomplishes this ion pumping using a
system of proteins that are capable of active transport, facilitated diffusion and open channel ion
movement. The arrangement of these proteins on the apical and basolateral sides of the
epithelium determines the net movement of ions and water in the tract.
H+ and Cl- are secreted by the parietal cells into the lumen of the stomach creating acidic
conditions with a low pH of 1. H+ is pumped into the stomach by exchanging it with K+. This
process also requires ATP as a source of energy; however, Cl- then follows the positive charge in
the H+ through an open apical channel protein.
HCO3- secretion occurs to neutralize the acid secretions that make their way into the duodenum
of the small intestine. Most of the HCO3- comes from pancreatic acinar cells in the form of
NaHCO3 in a watery solution. This is the result of the high concentration of both HCO3- and
Na+ present in the duct creating an osmotic gradient to which the water follows.
Digestive Enzymes
The second vital secretion of the GI tract is that of digestive enzymes that are secreted in the
mouth, stomach and intestines. Some of these enzymes are secreted by accessory digestive
organs, while others are secreted by the epithelial cells of the stomach and intestine. While some
of these enzymes remain embedded in the wall of the GI tract, others are secreted in an inactive
proenzyme form. When these proenzymes reach the lumen of the tract, a factor specific to a
particular proenzyme will activate it. A prime example of this is pepsin, which is secreted in the
stomach by chief cells. Pepsin in its secreted form is inactive (pepsinogen). However, once it
reaches the gastic lumen it becomes activated into pepsin by the high H+ concentration,
becoming a enzyme vital to digestion. The release of the enzymes is regulated by neural,
hormonal, or paracrine signals. However, in general, parasympathtic stimulation increases
secretion of all digestive enzmes.
Mucus
Mucus is released in the stomach and intestine, and serves to lubricate and protect the inner
mucosa of the tract. It is composed of a specific family of glycoproteins termed mucins and is
generally very viscous. Mucus is made by two types of specialized cells termed mucus cells in the
stomach and goblet cells in the intestines. Signals for increased mucus release include
parasympathetic innervations, immune system response and enteric nervous system messengers.
Bile
Bile is secreted into the duodenum of the small intestine via the common bile duct. It is produced
in liver cells and stored in the gall bladder until release during a meal. Bile is formed of three
elements: bile salts, bilirubin and cholesterol. Bilirubin is a waste product of the breakdown of
hemoglobin. The cholesterol present is secreted with the feces. The bile salt component is an
active non-enzymatic substance that facilitates fat absorption by helping it to form an emulsion
with water due to its amphoteric nature. These salts are formed in the hepatocytes from bile acids
combined with an amino acid. Other compounds such as the waste products of drug degradation
are also present in the bile.
Regulation
The digestive system has a complex system of motility and secretion regulation which is vital for
proper function. This task is accomplished via a system of long reflexes from the central nervous
system (CNS), short reflexes from the enteric nervous system (ENS) and reflexes from GI
peptides working in harmony with each other.
ETIOLOGY
Predisposing Factors
Factor Present of Absent Justification
Tropical Area Present
Mr. Mamugz has lived in the Philippines
his whole life. Philippines is a tropical
area. Tropical areas give amoeba a good
climate to proliferate.
Third World
CountryPresent
Poor sanitary conditions increase the
chances of making contact to amoeba.
Precipitating Factors
Factor Present of Absent Justification
Using vegetables
growing near a canal
as food.
Present
Mr. Mamugz verbalized that he had a
garden growing near a canal and he
uses the vegetables in this garden to
use food.
SYMPTOMATOLOGY
Symptom Present of Absent Justification
Fever PresentThis was evident in during Mr.
Mamugz’s physical assessment. This was also his chief complaint.
LBM + blood streaked stools PresentAnother one of Mr. Mamugz’s chief complaint. His verbalization during
physical assessment also confirms this.
Liver Abscess Absent Not found in Diagnostic Exams
Brain Abscess Absent Not found in Diagnostic Exams
Pleural Effusion Absent Not found in Diagnostic Exams
ingestion of bacteria
amoeba (trophozoite) survives passing through the stomach and
small intestine
trophozoite undergoes excystation
production of more trophozoites
trophozoites migrate to large intestine
trophozoites reproduce by undergoing schizomy
trophozoites become schizont as it increases in size while its nucleus and other organelles divide
schizont splits and forms two merozoites
merozoites develop into individual trophozoites
trophozoites undergo encystation
trophozoites become immature cysts
immature cysts secrete enzymes that breakdown cell membranes
and proteins
Predisposing Factors
Tropical Area
Third world country
Precipitating Factors
Using vegetables growing near a canal as
food.
penetration and digestion of mucosal lining
malabsorption of chyme components
collection of watery fecal matter in rectum
entrance of trophozoites into vascular system
LBM
Diagnostic Tests
CBC
CXR
fecalysis
UA
SGPT
lipid profile
blood chemistry
ECG
FBS
Diagnosis: Amoebiasis
Medical Management
antiprotozoal
antibiotic
antipyretic
Nursing Management
increase OFI
complete bed rest
low salt low fat diet
nonfibrous food
PO med compliance
Surgical Management
(none)
fever
Prognosis
>good compliance of medications
>cooperation during nursing management
>adequate financial support
>poor compliance of medications
>no cooperation during nursing management
>inadequate financial support
Good Prognosis extra intestinal diseases
pleural effusion
liver
abscess
brain
abscess
Poor Prognosis
DEATH
DOCTOR'S ORDER
DATE DOCTOR'S ORDER
RATIONALE REMARKS
April 27, 2009
Pls. admit under the service of Dr. E. Durban (HC)
The patient is in need of medical attention so he is admitted at Limso Hospital
DONE
Low salt and low fat diet To indicate specific diet for patient
DONE
Monitor VS Vital signs are recorded to obtain patients baseline data and are useful for further management. A temperature higher than normal may indicate the development of infection. Pulse & respiration is taken to watch out for tachycardia - a sign of hemorrhage & dehydration.
DONE
Labs:
CBC, Urinalysis, CXR, Lipid Profile, Crea, SGPT, Uric acid, SE, Serum Na+, K+, ECG, FBS (c/o watcher)
These entire lab tests are performed to screen for alteration and to serve as a baseline data for future comparison.
DONE
Start venoclysis with PNSS 1L at 120cc/o
Serves as a route for IVTT medications and replaces fluid and electrolyte losses due to frequent loose bowel movement
DONE
Meds:
1. Paracetamol (Alvedon) 500mg 1 tab TID
2. Salbutamol + Guaifenesin (Ventolin) 1 tab BID
3. Celecoxib 200mg 1 tab OD
- Antipyretic, nonopiod analgesic; Indicated for fever.
- Bronchodilator; Indicated for Productive Cough?
- NSAID; Management of acute pain.
DONE
Monitor I & O every shift
To determine if the patient’s intake is closely equal to his output
DONE
Hydration rounds every 6 hours
Monitor the intake and output of the patient with an additional task of instructing them to replace the loss fluids with exactly the same amount of water by ,means of drinking
DONE
Refer for any unusualities Referral is done to correct unusualities as soon as possible and to inform the attending
DONE
physician of the patient's condition.
1:40 pm - Stool Exam ASAP <3 specimen
- Losartan 100mg 1 tab now then OD
- Incorporate 30 meqs KCL with present IVF and run @ 120cc/o
To analyze the condition of a person's digestive tract in general
- Antihypertensive; Management for hypertension.
- To return Potassium levels to normal
DONE
04/28/09 IVF to follow with PNSS 1L + KCL 30 meqs to run @ 120 cc/o
- PNSS is an isotonic solution. This is to provide the patient with essential electrolytes and nutrients in the body. It will also maintain an access to the circulating system for the intermittent administration of scheduled medications.
DONE
6:30 pm - Start Metronidazole 500mg 1 tab TID PO
- IV to follow: PLR 1L @ 120cc/o
- Anti-infectives; indicated to intraabdominal infection, management of amoebic dysentery.
- Is an isotonic with blood and intended for intravenous administration.
DONE
1pm Xenoflox 500mg 1 tab now then 1 tab every 12 (7-7)
Anti-infevtives; Indicated for infectious diarrhea and intra-abdominal infections.
DONE
04/28/09
9:40pm
150/100 x 2 takes captopril 25mg 1 tab for sublingual
- To increase the effectiveness of the drug (anthypertensive)
DONE
04/29/09
10:45 am
SE with occult blood - To detect blood in the feces. Occult blood usually indicates gastrointestinal bleeding.
DONE
6:40pm IVF to follow: PLR @120 cc/o - Plain Lactated Ringer’s Solution (PLR) is an isotonic solution which is commonly used to replace fluid loss resulting from bleeding, and dehydration for diarrhea. It will also maintain an access to the circulating system for the intermittent administration of scheduled medications.
DONE
7pm Discontinue Ciprofloxacin shift to Tetracycline 250mg 2 caps BID after meals
-Anti-infectives; Prevention of exacerbations of bronchitis.
DONE
04/29/09
IVF to follow with PLR 1L @ 120cc/o
- Plain Lactated Ringer’s Solution (PLR) is an isotonic solution which is commonly used to replace fluid loss resulting from bleeding, and dehydration for diarrhea. It will also maintain an access to the circulating system for the intermittent administration of scheduled medications.
DONE
04/30/09
2:30pm
- Rounds with Dr. Durban
- For follow-up assessment and evaluation.
DONE
04/30/09
7:30pm
180/100
↓
160/100
Captopril 25mg now -Antihypertensive; indicated for treatment of hypertension
DONE
DIANOSTIC EXAMS
HEMATOLOGY
Date: April 27, 2009
Parameter Results Units Lower
limitsUpper limits
Hemoglobin
- To identify the amount of oxygen carrying protein contained within the RBC.
177 g/L 135 180
Hematocrit
-to identify the percentage of the blood volume occupied by red blood cells.
-decreased HCT indicates blood loss, anemia, blood replacement therapy, and fluid balance, and screens red blood cells status
0.49 0.40 0.54
RBC
-to know the amount of RBC in the blood.
-a decreased count may indicate anemia, fluid overload, or severe bleeding
5.92 10ˆ 12/L
5.5 6.5
WBC
-to determine infection or inflammation in the body and monitor its responses to specific therapies.
-a leukocyte count is elevated in infectious diseases of the heart (e.g., acute bacterial endocarditis)
-increases because large number of white cells are necessary to dispose of the necrotic tissue resulting from the infarction.
10.34 10 ˆ 9/L
5 10
Neutrophil
-active phagocytes; number increases rapidly during short-term or acute infections.
- increases in localized tissue death (ischemia) due to heart attack, burns, carcinoma.
0.90 0.55 0.65
Lymphocyte
-part of immune system; one group (B lymphocytes) produces antibodies; other group (T lymphocytes) involved in graft rejection, fighting tumors and viruses, and activating B lymphocytes
- decreased by severe debilitating illness such as heart failure, renal failure, and advanced TB
0.05 0.25 0.35
Monocyte
-active phagocytes that become macrophages in the tissues; long-term “clean-up team”
-an increase may respond to corticosteroid, with pus conditions, hemorrhage.
0.05 0.03 0.06
Eosinophil
-kills parasitic worms; might pathocyte antigen-antibody complexes and inactive inflammatory chemicals.
0.00 0.02 0.04
Basophil
- granules contain histamine (vasodilator chemical), which is discharged at sites of inflammation
0.00 0 0.01
Platelet count
-is the number of platelets in a given volume of blood.
-responsible for beginning the process of coagulation, or forming a clot, whenever a blood vessel is broken
-both increase and decrease can point to abnormal conditions of excess bleeding or clotting.
261 150 350
URINALYSIS
Date: April 27, 2009 2:17 pm
Macroscopic
Physical: Chemical:
Color: Dark Yellow specific Gravity: 1.030 Albumin: Trace
Appearance: cloudy Reaction (pH): acidic (6.0)
Sugar: negative
Microscopic
Cells:
Pus cells: 2-3/Hpf
Erythrocytes/RBC: 0-2/Hpf
FECALYSIS
Date: April 27, 2009 @ 2:02 pm
Macroscopic
Physical:
Color: Yellow
Consistency: Loose
Microscopic
Cells:
Pus cells: 0-1/Hpf
Erythrocytes/RBC: 0-1/Hpf
Yeast Cells: + (1 plus)
FECALYSIS
Date: April 27, 2009 @ 6:34 pmMacroscopic
Physical:
Color: Light Brown
Consistency: Loose
Microscopic
Cells:
Pus cells: 0-5/Hpf
Erythrocytes/RBC: 0-3/Hpf
Yeast Cells: + (1 plus)
FECALYSIS
Date: April 27, 2009 @ 10:49 pm
Macroscopic
Physical:
Color: Bloody
Consistency: Watery
Microscopic
Cells:
Pus cells: 0-1/Hpf
Erythrocytes/RBC: 0-3/Hpf
Yeast Cells: ++ (2 plus)
FECALYSIS
Date: April 28, 2009 @ 6:09 am
Macroscopic
Physical:
Color: Brown
Consistency: Watery
Microscopic
Cells:
Entamoeba Cyst: 0-1 (E.coli) /Hpf
Pus cells: 0-4/Hpf
Yeast Cells: few
FECALYSISDate: April 29, 2009 @ 4:21 pmMacroscopic
Physical: Chemical:
Color: Greenish Occult Blood: (-) negative
Consistency: Loose
Microscopic
Cells:
Entamoeba Cyst: 0-1/Hpf
Entamoeba Trophozoite: 0-1/Hpf
Pus Cells: 0-1/Hpf
Erythrocyte/RBC: 0-3/Hpf
Yeast Cells: few
CLINICAL CHEMISTRY
Date: April 27, 2009 @ 12:57 pm
Test
Result Ref. range
K+, substc 3.14 3,5-5,3
Na+, substc 137.5 135-148
SGPT, activity C 39.26 M: 0-41
Crea, substc 77,72 M: <50 y.o.: less than 115
>50 y.o.: less than 124
Date: April 28, 2009 @ 11:30 am
Test Result Ref. range SI units
Urate, substc 0, 23 M: 0, 21 – 0, 42 mmol/L
Cholesterol 4, 32 Up to 5,2 mmol/L
Triglycerides 0, 79 Up to 1,7 mmol/L
HDL 0, 84 More than 0, 91 mmol/L
LDL 3,12 Less than 3,5 mmol/L
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Mode of Action
Indication Contraindication
Dos
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Drug Interaction
Nursing Responsibilities
metronidazole
Flagyl
Anti-infectives, antiprotozoals, antiulcer agents
Disrupts DNA and protein synthesis susceptible organisms. Therapeutic effects: Bactericidal, trichomonacidal or amebicidal action. Spectrum: Most notable for avtivity against anaerobi
Amebecide in the management of amebic dysentery, amebic liver abscess and trichomoniasis: treatment of peptic ulcer disease caused by Helicobacter pylori.
Hypersensitivity. Use cautiously in: history in blood dyscrasias, History of seizures or neurologic problems and severe hepatic impairement.
500mg 1 tab, TID
CNS: Seizures, dizziness, headache.EENT: Tearing (topical only).GI: Abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste and vomiting.
Cimetidine may decrease metabolism of metronidazole. Phenobarbital and rifampin increases metabolism and may decrease effectiveness. Metronidazole increases the effects of phenytoin, lithium, and warfarin. Disulfiram-like reaction may occur with alcohol ingestion. May cause acute psychosis and confusion with disulfiram.
Adiminister on empty stomach or may administer with food or milk to minimize GI irritation.- Instruct patient to take medication exactly as directed with evenly spaced times between doses, even if feeling better.- Advised patient to not skip doses or double up on missed doses.- Inform patient that medication can cause metallic taste.- Advise patient that frequent mouth rinses, good oral hygiene and sugarless gum or candy may minimize dry mouth.- Inform patient that medication may cause urine to turn dark.- Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue or foul-smelling stools) develop
c bacteria including: Bacteroides, clostridium. In addition is active against: Trichomonas vaginalis, entamoeba histolytica, giardia lamdia, H. pylori and clostridium difficile.
Hemat: LeukopeniaNeuro: Peripheral neuropathy
Increased risk of leucopenia with fluorourousel or azathioprine.
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Dos
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Adverse reactionsDrug Interaction
Nursing Responsibilities
ciprofloxacin
Cipro
antibiotic
Bactericidal drugs, meaning that they kill bacteria. These antibiotic drugs inhibit the bacterial DNA gyrase enzyme which is necessary for DNA replication. Since a
Complicated Intra-Abdominal Infections (used in combination with metronidazole) caused by Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, or Bacteroides fragilis.
Ciprofloxacin hydrochloride is contraindicated in persons with a history of hypersensitivity to Ciprofloxacin, any member of the quinolone class of antimicrobial agents, or any of the product components. Body as a Whole: headache, abdominal pain/discomfor
500mg 1 tab, every 12 hours
Cardiovascular: palpitation, atrial flutter, ventricular ectopy, syncope, hypertension, angina pectoris, myocardial infarction, cardiopulmonary arrest, cerebral thrombosis, phlebitis, tachycardia, migraine, hypotension- Central Nervous System: restlessness, dizziness,
When Ciprofloxacin tablets are given concomitantly with food, there is a delay in the absorption of the drug, resulting in peak concentrations that occur closer to 2 hours after dosing rather than 1 hour. The overall absorption of
- Advise to contact healthcare provider if they experience pain, swelling, or inflammation of a tendon, or weakness; discontinue Ciprofloxacin treatment.- Advise patient that antibacterial drugs including Ciprofloxacin tablets should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). –Tell patient not to skip or or discontinue even if feeling better.- Ciprofloxacin may be taken with or without meals and to drink fluids liberally. As with other quinolones, concurrent administration of Ciprofloxacin with magnesium/aluminum antacids, or sucralfate, didanosine chewable/buffered tablets or pediatric powder, other highly buffered drugs or with other products containing calcium, iron or - Tell that Ciprofloxacin may be associated with hypersensitivity reactions, even following a
copy of DNA must be made each time a cell divides, interfering with replication makes it difficult for bacteria to multiply.
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii 1, Shigella dysenteriae, Shigella flexneri or Shigella sonnei1 when antibacterial therapy is indicated.
t, foot pain, pain, pain in extremities, injection site reaction (Ciprofloxacin intravenous)
lightheadedness, insomnia, nightmares, hallucinations, manic reaction, irritability, tremor, ataxia, convulsive seizures, lethargy, drowsiness, weakness, malaise, anorexia, phobia, depersonalization, depression, paresthesia, abnormal gait, grand mal convulsion- Gastrointestinal: painful oral mucosa, oral candidiasis, dysphagia, intestinal perforation, gastrointestinal bleeding, cholestatic jaundice, hepatitis
Ciprofloxacin tablets, however, is not substantially affected. Concurrent administration of antacids containing magnesium hydroxide or aluminum hydroxide may reduce the bioavailability of Ciprofloxacin by as much as 90%.Patients should be advised:
single dose, and to discontinue the drug at the first sign of a skin rash or other allergic reaction.- Instruct patient that peripheral neuropathies have been associated with Ciprofloxacin use. If symptoms of peripheral neuropathy including pain, burning, tingling, numbness and/or weakness develop, they should discontinue treatment and contact their physicians.- Advise patient that Ciprofloxacin may cause dizziness and lightheadedness; therefore, patients should know how they react to this drug before engaging in activities requiring mental alertness or coordination.- Tell patient that convulsions have been reported in patients receiving Ciprofloxacin.
Metabolic/Nutritional: amylase increase, lipase increase-Skin/Hypersensitivity: allergic reaction, pruritus, urticaria, photosensitivity/phototoxicity reaction, flushing, fever, chills, angioedema, edema of the face, neck, lips, conjunctivae or hands, cutaneous candidiasis, hyperpigmentation, erythema nodosum, sweating
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Mode of Action
Indi
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Contraindication
Dos
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Adverse reactions
Drug Interaction
Nursing Responsibilities
ca
Ca
An
Captopril is an ACE inhibitor
Hypertensi
Contraindicated in patients who are
25 mg 1
- Renal: About one of 100
- Agents Having - Patients should be advised to
ptopril
poten
tihypertensive
which prevents the conversion of Ang.I to Ang.II resulting in peripheral vasodilatation and reducing peripheral resistance and after load and the reduction of aldosterone secretion promoting sodium excretion and potassium retention. It also reduces the angiotensin-mediated vasopressin release resulting in protection from volume overload with reduction of
on: captopril tablets, USP is indicated for the treatment of hypertension.
hypersensitive to this product or any other angiotensin-converting enzyme inhibitor (e.g., a patient who has experienced angioedema during therapy with any other ACE inhibitor).
tab patients developed proteinuria- Hematologic: Neutropenia/agranulocytosis has occurred. Cases of anemia, thrombocytopenia, and pancytopenia have been reported.- Dermatologic: Rash, often with pruritus, and sometimes with fever, arthralgia, and eosinophilia, occurred in about 4 to 7 (depending on renal status and dose) of 100 patients, usually during the first four weeks of therapy. It is usually maculopapular,
Vasodilator Activity: Data on the effect of concomitant use of other vasodilators in patients receiving CAPOTEN; nitroglycerin or other nitrates (as used for management ofangina) or other drugs having vasodilator activity should, if possible, be discontinued before starting Capoten. - Agents Increasing Serum Potassium; Potassium-
immediately report any signs or symptoms suggesting angioedema (e.g., swelling of face, eyes, lips, tongue, larynx and extremities; difficulty in swallowing or breathing; hoarseness) and to discontinue therapy- Patients should be told to report promptly any indication of infection (e.g., sore throat, fever), which may be a sign of neutropenia, or of progressive edema which might be related to proteinuria and nephrotic syndrome- Patient should be cautioned that excessive perspiration and dehydration may lead to an excessive fall in blood pressure because of reduction in fluid volume. Other causes of volume depletion such as vomiting or diarrhea may also lead to a fall in blood pressure; patients should be advised to consult with the physician.- Patients should be advised not to use potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes without consulting their physician- Patients should be informed that CAPOTEN should be taken one hour before meals.
pre - load. The above action is of value in control of heart failure.The inhibition of ACE, promotes accumulation of bradykinin with its vasodilator properties
and rarely urticarial. The rash is usually mild and disappears within a few days of dosage reduction, short-term treatment with an antihista-minic agent, and/or discontinuing therapy; remission may occur even if captopril is continued. Flushing or pallor.
sparing diuretics such as spironolactone, triamterene, or amiloride, or potassium supplements should be given only for documented hypokalemia
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tet
Sum
Tetracycline is an
It works by inhibiting
Tetracycline's primary
250mg 2 caps,
This medication may cause stomach upset, diarrhea,
Tetracycline should not be taken at the same
racycline
ycin
antibiotic with a broad spectrum, that is, it is active against many different bacteria.
action of theprokaryotic 30s ribosome, by binding the 16S rRNA thereby blocking the aminoacyl-tRNA. However, bacterial strains can acquire resistance against tetracycline and its derivates by encoding a resistance operon.
use is for the treatment of acne vulgaris and rosacea.It is first-line therapy for Rocky Mountain Spotted Fever (Rickettsia), Q Fever (Coxiella) Psittacosis and Lymphogranuloma venereum (Chalydia), and to erradicate nasal carriage of meningococci
BID nausea, headache or vomiting. If these symptoms persist or worsen, notify your doctor. Very unlikely, but report promptly: stomach pain, yellowing eyes or skin, vision problems, mental changes. Tetracyclines increase sensitivity to sunlight.Use of this medication for prolonged or repeated periods may result in a secondary infection like sore throat while taking this medication. In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention. Symptoms of an allergic reaction include: rash,
time as aluminum, magnesium, or calcium-based antacids [for example, aluminum with magnesium hydroxide-oral (Mylanta, Maalox), calcium carbonate (Tums, Rolaids)]; iron supplements;bismuth subsalicylate (Pepto-Bismol), and dairy products. These agents bind tetracycline in the intestine and reduce its absorption into the body.Tetracycline may enhance the activity of the blood thinner, warfarin (Coumadin), and result in excessive "thinning" of the
itching, swelling, dizziness, trouble breathing.
blood, necessitating a reduction in the dose of warfarin. Phenytoin (Dilantin), carbamazepine (Tegretol), and barbiturates (such as phenobarbital) may enhance the elimination of tetracycline. Tetracycline may reduce the effectiveness of oral contraceptives.
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celecoxib
Celebrex
Celecoxib is a nonsteroidal antiinflammatory drug (NSAID) that is used to treat arthritis, pain, menstrual cramps, and colonic polyps.
Celecoxib blocks the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling
Acute PainContraindicated in patients who are hypersensitive to any component of this product.
200mg 1 tab, OD
Headache, abdominal pain, dyspepsia, diarrhea, nausea, flatulence, and insomnia. Other side effects include fainting, kidney failure, heart failure, aggravation of hypertension, chest pain, ringing in the ears, deafness, stomach and intestinal ulcers, bleeding, blurred vision, anxiety, photosensitivity, weight gain,
- Concomitant use of celecoxib with aspirin or other NSAIDs may increase the occurrence of stomach and intestinal ulcers. - Fluconazole (Diflucan) increases the concentration of celecoxib in the body by preventing the elimination of celecoxib in the liver. - Celecoxib increases the concentration of lithium (Eskalith) in the blood by 17% and may promote lithium toxicity. - Persons taking the anticoagulant (blood
and tenderness are reduced. Celecoxib differs from other NSAIDs in that it causes less inflammation and ulceration of the stomach and intestine (at least with short-term use) and does not interfere with the clotting of blood
water retention, flu-like symptoms, drowsiness and weakness.
thinner) warfarin (Coumadin) should have their blood tested when initiating or changing celecoxib treatment, particularly in the first few days, for any changes in the effects of the anticoagulant.
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Dos
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Losartan
Lifexar
Losartan an angiotensin II receptor antagonist drug used mainly to treat high blood pressure (hypertension).
Losartan is a selective, competitive Angiotensin II receptor type 1 (AT1) receptor antagonist, reducing the end organ responses to angiotensin II. Losartan administration results in a decrease in total peripheral resistance (afterload) and cardiac venous return
Hypertension
Contraindicated in patients who are hypersensitive to any component of this product.
100mg 1 tab
Dizziness, lightheadedness, blurred vision, or a stuffy nose as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Fainting, decreased sexual ability. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: change in the
Digoxin, fluconazole, lithium, certain non-steroidal anti-inflammatory drugs (e.g., indomethacin), potassium-sparing "water pills" (diuretics such as amiloride, spironolactone, triamterene), "water pills" (diuretics such as furosemide), potassium supplements (e.g., potassium chloride) or salt substitutes, rifampin.
Do not take any new medication during therapy unless approved by prescriber.- Do not use potassium supplement or salt substitutes without consulting prescriber.- Take exactly as directed and do not discontinue without consulting prescriber. Preferable to take on an empty stomach, 1 hour before or 2 hours after meals. - May cause dizziness, fainting, or lightheadedness (use caution when driving or engaging in tasks that require alertness until response to drug is known); postural hypotension (use caution when rising from lying or sitting position or climbing stairs);
(preload) All of the physiological effects of angiotensin II, including stimulation of release of aldosterone, are antagonized in the presence of losartan. Reduction in blood pressure occurs independently of the status of the renin-angiotensin system. As a result of losartan dosing, plasma renin activity increases due to removal of the angiotensin II feedback.
amount of urine, stomach/abdominal pain, severe nausea, yellowing eyes or skin, dark urine, unusual fatigue, muscle pain. An allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: rash, itching, swelling (especially of the face, lips, tongue, or throat), severe dizziness, trouble breathing.
diarrhea (boiled milk, buttermilk, or yogurt may help). - Observe for symptomatic hypotension and tachycardia especially in patients with CHF; hyponatremia, high-dose diuretics, or severe volume depletion
Gen
eric
N
ame
Bra
nd
Nam
eC
lass
ific
-ati
on
Mode of Action
Indication Contraindication
Dos
age Side effects/
Adverse reactionsDrug Interaction Nursing Responsibilities
paracetamol
Biogesic
Analgesic (pain reliever) and antipyretic (fever reducer).
Inhibits cyclooxygenase (COX),an enzyme responsible for the production of prostaglandins, which are important mediators of inflammation, pain and fever.
Paracetamol is a suitable substitute for aspirin, especially in patients where excessive gastric acid secretion or prolongation of bleeding time may be a concern. While paracetamol has analgesic and antipyretic properties comparable to those of aspirin, its anti-inflammatory effects are weak.
Paracetamol should not be used in hypersensitivity to the preparation and in severe liver diseases.
500mg 1 tab, every 4 hours
In rare cases hypersensitivity reactions, predominantly skin allergy (itching and rash), may appear. Long-term treatment with high doses may cause a toxic hepatitis with following initial symptoms: nausea, vomiting, sweating, and discomfort. Occasionally a gastrointestinal discomfort may be seen.
- May need to adjust your usual dose of anticoagulants (eg warfarin) if you take paracetamol regularly. Check with your anticoagulation clinic. Otherwise there are no serious interactions between paracetamol and other drugs.
Gen
eric
N
ame
Bra
nd
Nam
eC
lass
ific
-ati
on
Mode of Action
Indication Contraindication
Dos
age Side
effects/ Adverse reactions
Drug Interaction Nursing Responsibilities
salbutamol
Ventolin
Bronchodilator
Salbutamol produces bronchodilation through stimulation of beta2-adrenergic receptors in bronchial smooth muscle, thereby causing relaxation of bronchial muscle fibres.
-Relief of severe bronchospasm associated with acute exacerbations of chronic bronchitis and bronchial asthma- Treatment of status asthmaticus- In patients refractory to salbutamol respiratory solution
Patients with a hypersensitivity to any of the ingredients and in patients with tachyarrhythmias.
-TremorPalpitationTachycardiaHeadachePeripheral Vasodilataion Feelng of Tension
Beta-blockers: Beta-adrenergic blocking drugs, especially the noncardioselective ones, may effectively antagonize the action of salbutamol, and therefore, salbutamol and nonselective beta-blocking drugs, such as propranolol, should not usually be prescribed together.
- Ensure the patient has no allergy to it, and there are no contra-indications with other medications or conditions. - Once administered the nurse should observe for any reactions the patient has to the medication, and take appropriate observations of the patient.
NURSING THEORIES
Theorist Theory Application to the Patient
Faye Glenn
Abdellah
Abdellah's theory of nursing stated that
it was the “determination of the nature
and extent of nursing problem
presented by the individual patients or
families receiving nursing care”. She
says a nursing problem presented by a
client is a condition faced by the client
or client's family that the nurse,
through the performance of
professional functions, can assist them
to meet. Abdellah's use of term
“nursing problems” is more consistent
with nursing functions or nursing goals
than with those client-centered
problems. The apparent contradiction
can be explained by her desire to move
away from the disease-centered
orientation. In her attempt to bring
nursing practice into its proper
relationship with restorative and
preventive measures for meeting total
client needs, her model seems to swing
the pendulum to the opposite pole,
from the disease orientation to nursing
orientation, while leaving the client
somewhere in the middle.
This theory is very applicable in
the way care was given to Mr.
Mamugz. During Mr. Mamugz’s
stay in the hospital, he exhibited
symptoms that fall under
Abdellah’s 21 nursing problems.
To name a few, his diarrhea
connected to #8 – “To facilitate
the maintenance of fluid and
electrolyte balance,” and his
complaining behavior towards his
food matched with #12 – “To
identify and accept positive and
negative expressions, feelings and
reactions.” With these problems in
mind, Abdellah’s theory was able
to aid the student nurses in
prioritizing the interventions
given.
As the theory emphasizes the
client-centered approach, the
student nurses were able to focus
in caring for Mr. Mamugz in his
physical, biological and socio-
psychological needs.
Theorist Theory Application to the Patient
Lydia Hall Core, Care and Cure Theory
Hall's theory emphasizes the
importance of individuals as unique,
capable of growth and learning, and
requiring a total person approach.
Her definition of health can be
inferred to a state of self-awareness
with conscious selection of
behaviors that are optimal for that
individual. Hall stresses the need to
help the person explore the meaning
of his or her behavior to identify and
overcome problems through
developing self-identity and
maturity. The concept of society or
environment is dealt with in relation
to the individual. Hall's theory of
nursing involves three interlocking
circles, each one of it represents one
aspect of nursing. The same aspect
represents intimate bodily care of
the patient. The core aspect deals
with the innermost feeling and
motivations of the patient and family
through the medical aspects of care.
Care is the sole function of nurses,
During our exposure the student
nurse assigned to Mr. Mamugz was
able to accomplished the task
assigned to him such as tepid
sponge bath, giving P.O. medicines,
taking vital signs, monitor intake
and output and providing comfort
as part of the task assigned to him.
Core involves the cooperation of the
patient for his recovery. Mr.
Mamugz was able to cooperate in all
the nursing interventions (above)
performed for him.
Cure is the willingness of the patient
to comply all treatment regimen.
According to the student nurse
assigned to Mr. mamugz that day,
Mr. mamugz showed eagerness
towards getting himself better and
examples are that he complained
about the food given to him that it
should not have contained oil
because he is aware that the ordered
diet is low salt and low fat diet.
Theorist Theory Application to the Patient
Ida Jean
Orlando
Theory: Nursing Process Theory
Orlando’s theory was developed in the
late 1950s from observations she recorded
between a nurse and patient. Despite her efforts
she was able to categorize the records as “good”
or “bad” nursing. It then dawned on her that
both formulations of “good” and “bad” nursing
were contained in the records. From these
observations she formulated the deliberative
nursing process. The role of the nurse is to find
out and meet the patient’s immediate needs for
help. The patient’s presenting behavior maybe a
plea for help, however, the help needed may not
be what it appears to be. Therefore, nurses need
to use their perception, thoughts about the
perception or the feelings engendered from their
thoughts to explore with patients the meaning of
their behavior. This process helps the nurse
finds out the nature of the distress and what help
the patient needs. Orlando ’s theory remains one
of the most effective practice theories available.
The use of her theory keeps the nurses to focus
on their patients. The strength of the theory is
that it is clear, concise and easy to use. While
providing the overall framework for nursing, the
use of her theory does not exclude nurses from
using other theories while caring for the patient.
Student nurse is
finding out the problem
and meeting the patient's
immediate needs.
The student nurse
assigned to Mr. Mamugz
was able to assess the
patient well therefore he
is able to come up a
good plan of care for
identified problems such
as fever, hypertension
and pain. The student
nurse was able to meet
the patient's immediate
need.
Date / Time
Cues Needs Nursing Diagnosisw/ Rationale
Objective of Care
Nursing Interventionw/ Rationale
Evaluation
August 27, 2009
4:00 pm
Subjective:> “Naa pa ba ko’y tambal nga pain reliever? Sakit man gud ang akuang likod.” [pain scale: 6]>”Dugay dugay na pud ning back pain nako.”> “Katong 40 years old pa ko nagsakit ang akong tangkurog, nagpa-BP ko sa university physician. Unya, ingon niya sa ako, hypertensive daw ko.”
Objective:> Grimacing> Age: 59 y.o.> Hypertensive
Vital Signs:
BP - 150/80 mmHgPR - 98 bpmRR - 20 cpmTemp. – 38.8ºC
COGNITIVE-PERCEPTUAL
PATTERN
Chronic Pain r/t muscle strain secondary to hypertension and old age
R: Muscle strength deteriorates with age and can cause pain with prolonged use; this is worsened by hypertension as the increased blood pressure directly affects the affected muscles.
Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania
Within 7 hours span of care, my patient will experience relief from pain as evidenced by decreased grimacing and verbalization of decreased pain with the use of a pain scale.
1. Encourage to get adequate rest and sleep® Pain is minimized when relaxed or asleep
2. Teach how to do deep breathing exercises® Helps relax the body
3. Assist in guided imagery® To help divert attention
4. Establish and enumerate preferred attention-diverting activities® To decrease pain levels by diverting attention away from pain stimulus by putting more focus on a non-painful stimulus
5. Encourage to participate in massage therapy® To decrease pain by decreasing muscle tension
6. Encourage to have an exercise program® To help in strengthening muscles
7. Reposition in bed as preferred® To help in relaxation of muscles
8. Apply warm compress to affected areas® To vasodilate blood vessels thus helping in getting rid of any lactic acid accumulation.
9. Administer analgesics as prescribed® To relieve pain
10. Administer antihypertensive drugs as prescribed® To decreases blood pressure; helps in lowering pain levels
Goal met:
August 27, 20099:00 pm
> Patient was able to verbalize a pain level of 2.
>Patient was not observed to be grimacing
Date / Time
Cues Needs Nursing Diagnosisw/ Rationale
Objective of Care
Nursing Interventionw/ Rationale
Evaluation
August 27, 2009
4:00 pm
Subjective: (none)Objective:> Skin warm to touch> Sweating> Chills
Vital Signs:
BP - 150/80 mmHgPR - 98 bpmRR - 20 cpmTemp. – 38.8ºC
NUTRITIONAL-
METABOLIC
PATTERN
Hyperthermia related to release of endogenous pyrogens secondary to underlying disease
R: An underlying disease, such as an infection, triggers the inflammatory response of the body thus increasing the body’s temperature due to the release of endogenous pyrogens.
Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania
Within 7 hours span of care, my patient will be free from fever as evidenced by a temperature reading of lower than 37.5ºC
1. Encourage increase in oral fluid intake® To decrease the body temperature by excretion in urination and will prevent dehydration2. Instruct temporary removal of clothing and top sheets® To prevent the insulation of body heat3. Apply tepid sponge bath® To lower body temperature by process of absorption and evaporation4. Turn to sides frequently® To prevent insulation of the body heat at the back
5. Instruct to call the attention of nurse once chills develop® For immediate interventions to be applied
6. Teach watcher how to do tepid sponge bath® For continuous care
7. Encourage watcher to occasionally fan patient® To cool down the body temperature
8. Get laboratory results from laboratory technician® To determine if there is an evident cause of the fever (e.g. infection)
9. Administer paracetamol as ordered® To lower the body temperature
10. Administer antibiotics as ordered® To eliminate the underlying bacteria that cause the inflammatory response.
Goal met:
August 27, 20099:00 pm
- After 6 hours, temperature was 37.4ºC
Date / Time
Cues Needs Nursing Diagnosisw/ Rationale
Objective of Care
Nursing Interventionw/ Rationale
Evaluation
August 27, 2009
4:00 pm
Subjective:>“Murag lima ka beses na ko naka libang kaganinang buntag.”>“Dili gahi ang akuang tae… Daghan pud ug tubig.”
Objective:> Hyperactive bowel sounds: 21 sounds in one minute.
Vital Signs:
BP - 150/80 mmHgPR - 98 bpmRR - 20 cpmTemp. – 38.8ºC
ELI
MINATION
PATTERN
Diarrhea related to malabsorption in intestines secondary to amoebiasis
R: Amoebas secrete enzymes that digest chyme; digested chyme does not get digested by small intestine and this gets excreted from the body unformed.
Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania
Within 3 days span of care, my patient will reestablish and maintain normal pattern of bowel functioning as evidenced by passing of formed stools and decreased number of loose bowel movements
1. Reduce intake of solid foods® To allow for reduced intestinal workload
2. Limit foods that contain caffeine and high amounts of fiber® To prevent aggravation of condition
3. Assist in walking towards bathroom during episodes of loose bowel movement® To prevent rushing, accidents and injury
4. Encourage to increase oral fluid intake® To replace lost fluids and prevent dehydration
5. Provide for changes in dietary intake® To avoid foods that precipitate diarrhea
6. Promote use of relaxation techniques® To reduce stress and anxiety which can precipitate bowel movement
7. Provide a bed pan as necessary® To provide quick access
8. Teach patient that episodes of diarrhea may last longer than usual® To avoid going back and forth from bed to bathroom in a short period of time
9. Administer antidiarrheal drugs as ordered® To decrease episodes of diarrhea
10. Administer antibiotics as ordered® To rid body of underlying cause of diarrhea
Goal partially met:
April 30, 20094:00pm
> Patient verbalized that he has had bowel movements with formed stools already but he still has an average of 5 episodes of bowel movements during daytime.
Date / Time
Cues Needs Nursing Diagnosisw/ Rationale
Objective of Care
Nursing Interventionw/ Rationale
Evaluation
August 27, 2009
4:00 pm
Subjective:
>“Dili kaayo ko makatulog kay pirminti lang ko momata para maglibang bisan kadlawon pa na.”
Objective:
>Sleeping during the afternoon>Awake during the evening
Vital Signs:
BP - 150/80 mmHgPR - 98 bpmRR - 20 cpmTemp. – 38.8ºC
SLEEP-REST
PATTERN
Disturbed sleep pattern related to loose bowel movement secondary to amoebiasis
R: Amoebas secrete enzymes that digest chyme; digested chyme does not get digested by small intestine and this needs to be excreted from the body no matter what time of day it is.
Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania
Within 3 days span of care, my patient will reestablish and maintain normal sleeping pattern as evidenced by reports of improvement in sleep pattern and feeling rested
1. Arrange care to provide for uninterrupted periods of rest® To maximize hours of sleep2. Restrict intake of food or drinks that contain caffeine especially before bedtime® To prevent prolonged periods of being awake3. Limit oral fluid intake before bedtime® To prevent occurence of nocturia4. Encourage to designate activities to be done only during the day® To prevent increased stress levels during bed time5. Recommend not to take naps during the afternoon® To prevent prolonged hours of being awake6. Suggest to accomplish as many tasks as possible during the daytime® To prevent sleeplessness due to an unaccomplished task7. Encourage to ambulate during daytime® To avoid increased energy levels during bedtime that will keep patient awake
8. Recommend bedtime snack® To avoid sleep interference from hunger/hypoglycemia
9. Administer antibiotics as ordered® To rid body of underlying cause of loose bowel movements
10. Administer analgesic as ordered [if possible, before bed time.® To relieve discomfort and take maximum advantage of sedative effect
Goal met:
April 30, 20094:00pm
> Patient verbalized that he was able to sleep 8 hours straight for the past 3 days
Date / Time
Cues Needs Nursing Diagnosisw/ Rationale
Objective of Care
Nursing Interventionw/ Rationale
Evaluation
August 27, 2009
4:00 pm
Subjective:>“Murag lima ka beses na ko naka libang kaganinang buntag.”>“Dili gahi ang akuang tae… Daghan pud ug tubig.”
Objective:> Good skin turgor
Vital Signs:
BP - 150/80 mmHgPR - 98 bpmRR - 20 cpmTemp. – 38.8ºC
NUTRITIONAL-
METABOLIC
PATTERN
Risk for deficient fluid volume related to loose bowel movement secondary to amoebiasis
R: Amoeba disrupts absorption of water in large intestine which results to passing of watery stools.
Source: Marilynn E. Doenges, APRN, BC, et. al. Nurse’s Pocket Guide, 10th ed. © 2006. F.A. Davis Company, Philadelphia, Pennsylvania
Within 3 days span of care, my patient will be free from dehydration as evidenced by good skin turgor, non-sunken eyes and maintained weight.
1. Weigh patient daily® To assess changes in weight which can determine extent of any fluid loss
2. Encourage to increase oral fluid intake® To reduce risk of hypovolemia and dehydration
3. Regulate IVF as ordered® To supplement water intake via intravenous route
4. Monitor intake and output® To ensure accurate knowledge of fluid status
5. Assess skin turgor and mucous membranes regularly® To be able to identify if early signs of deficient fluid volume are manifesting
6. Advise to include food that contain high amounts of water in daily meals (e.g. soup, watermelon, etc)® To maximize hydration of body
7. Control humidity and ambient air if possible® To reduce high fever and elevated metabolic rate
8. Teach patient signs of dehydration and advise to notify health care personnel as soon as they may manifest® To ensure timely interventions to be performed appropriately
Goal met:
April 30, 20094:00pm
>Patient did not have poor skin turgor and sunken eyes.
9. Keep patient well thermoregulated® To avoid excessive sweating
10. Administer antidiarrheals as ordered.® To treat the underlying cause {amoebiasis)
MEDICATION
Instruct the patient and family to follow the home medications as prescribed by
the physician.
R: Treatment regimen is important to have faster recovery.
Explain each purpose of the medication
R: Knowledge about what medications will make the client become aware of what he is
taking and for the family to participate more in the client’s treatment.
Instruct client not to take over-the-counter drugs without doctor’s knowledge.
R: Non-prescribed drugs may have an antagonistic effect or synergistic effect in any
drug therapy.
Explain the side effects or adverse reactions of each medication. Instruct the client
and family to watch out for it and to report it immediately as soon as possible to
the physician.
R: Explaining the side effects will let the client and family identify what harmful effects
to expect and for them to distinguish the adverse reaction to medication for them to report
it to their physician immediately.
Inculcate to the client to comply all the medications prescribed at the ordered
dosage, route and at the ordered time.
R: Taking the drugs at the ordered dose, route and time limits the chance for toxicity and
ensure its effectiveness.
Advice client to take medications with food if not contraindicated or to take
medicine one hour before meals or one hour after meals.
R: Some medications are irritating to the gastric mucosa.
Let patient complete the whole course of the drug therapy.
R: This can help the patient alleviate the problem and be able to experience the full
therapeutic effect of the medication.
EXERCISE
Encourage early ambulation.
R: Walking is good exercise and could promote circulation, hence, proper healing.
Promote exercise to the client especially ROM.
R: This will promote good physical health.
Instruct client to avoid strenuous activities for at least a week or a month until
fully recovered.
R: Activities that require great muscle strength should be avoided to prevent injury and
muscle strain.
Advise patient to have adequate rest and sleep.
R: To gain back the lost strength and be able to return to its normal state thus allow ample
time for healing.
Practice deep breathing exercise.
R: This will help alleviate any pain or discomfort that patient will encounter
TREATMENT
Explain the need of treatment after discharge and must take it seriously so as to
prevent such complications to the patient
R: To make the client and family aware that the treatment does not only end at hospital but
needs to be continued at home to make the client responsible towards medication.
Explain to the family the condition of the patient and give them factual informa-
tion about the illness.
R: To have better understanding of the patient’s condition and to be able to know what
intervention they should give that could not alter the effect of the therapy.
HYGIENE
Encourage having proper hygiene like taking a bath, meticulous hand washing,
and brushing of teeth every after meal.
R: Hygiene promotes comfort and cleanliness to the patient. It also increases the sense of
wellness, which is very much needed in the therapeutic process.
Encourage patient to continue hygienic measures practiced at present such as
changing clothes everyday and changing of underwear as often as necessary,
keeping the nails neatly trimmed, maintaining own supplies/items for personal ne-
cessities.
R: Keeping all practiced measures is necessary in consistent maintenance of proper hygiene.
Owning personal accessories for hygiene purposes keep client away from contamination and
infectious diseases.
Provide a calm, clean, and accepting environment.
R: Calm, clean and non threatening environment may lessen the occurrence of
possible infection and would be a good place for healing.
OUTPATIENT ORDER
Inform the patient that follow-up check-up is important to have continuous moni-
toring and care even after attainment of the course medical therapy.
R: Through constant visits as out patient, the physician would still monitor the progress of
the therapeutic intervention availed by the patient.
Advice the client and the family to carry out follow-up diagnostic examinations
R: This is to evaluate the therapeutic response of the patient to the treatment.
Instruct the family to report any unusual signs and symptoms experienced by the
patient.
R: This will help detect early signs and symptoms of recurrence of the disease.
DIET
Encourage client to eat a variety of nutritious foods like fruits and vegetables once
instructed by the physician.
R: To maintain and promote a healthy body.
Instruct client to take vitamins as ordered.
R: To boost the body’s defense mechanism.
Encourage patient to increase oral fluid intake.
R: This hydrates the body for normal functioning and maintain acid-base balance.
Advise client not to skip meals and have a regular eating pattern/schedule.
R: Regular interval of meals is the basic principle of a good dietary plan.
Tell patient not to eat foods contraindicated by the physician.
R: To prevent the occurrence of complications.
Instruct patient to avoid drinking liquors and smoking
R: To also avoid illness to be triggered.
Prognosis
CategoryPoor
(1)
Fair
(2)
Good
(3)Justification
1. Duration of
Illness
It has been only 5 days since he has
been having diarrhea.
2. Onset of
Illness
Mr. Mamugz, 59 years old, is nearly a
geriatric patient. Getting sick with
amoebiasis poses a big threat to his
health.
3. Predisposing
Factors
Location predisposes Mr. Mamugz to
getting Amoebiasis
4. Precipitating
Factors
Practicing good cleaning of vegetables
would have been the key to avoid
getting amoebiasis.
5. Willingness
to take the
medications or
compliance to
treatment
regimen
Mr. Mamugz is very willing to take
his medications. He knows the good
effects of the drug and intravenous
therapy.
6. environment
Mr. Mamugz’s garden is near a canal
which can flood. Unless he moves his
garden elsewhere, it will mostly be
unclean and will always be suspected
of carrying amoeba.
7. family
support
The most number of family members
that were present in the ward was 3.
This number included every member
of his family.
Calculations4x1 =
4
0x2 =
03x3 = 9
4 + 0 + 9 = 13
13/7 = 1.85
Ranges:
1.0 – 1.5 = Poor
1.5 – 2.5 Fair
2.5 – 3.0 = Good
Mr. Mamugz has a FAIR prognosis.
His condition has only been short term and is very treatable and even curable. He is also
eager to get healthy again. Through this, our prognosis has come up to the fair category.
RECOMMENDATION
To the Student Nurses:
We have also evaluated ourselves and have agreed that we have to heed the
recommendations of our clinical instructor. Patient care is our ultimate goal and
continuous monitoring and application of nursing interventions is compulsory for the
patient’s recovery. Data gathering skills should also be honed for accurate presentation of
cases.
To the Patient and his family:
Religious taking of medicine was promoted as well as good general and oral
hygiene. Good family support can boost the morale of the patient and continuous holistic
care will improve his over-all health. He must also accept his condition and be aware of
it, so that he could discipline himself and follow the necessary interventions given.
To the Ateneo de Davao University – College of Nursing
The group is proud to belong to such a prestigious school. We recommend that
the Ateneo de Davao University’s College of Nursing keep up, or improve their
inculcation of morals and values to their student nurses. Aside from that, continuous
teaching and evaluating our skills will lead us to aim a higher standard of education.
To the readers:
The group recommends that you, the reader, broaden your knowledge and
continue reading other sources and not base anything on this case presentation alone. A
variety of sources make a good over-all understanding of a subject.
Steps can be taken to lower the chance to develop and to delay the possible
outcome of Amoebiasis. That’s why we recommend that everybody must take care of
themselves in preparing or eating foods. They must also establish new patterns of eating,
drinking, and lifestyle in order to prevent diseases from occurring.
Recommended