24562629 Grandcase Presentation Intestinal Parasite With Erratic Migration Pneumonia

8/8/2019 24562629 Grandcase Presentation Intestinal Parasite With Erratic Migration Pneumonia

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ntestinalarasitismith Erratic

;igrationPneumonia


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randcasepresentation


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Presented:y-SN 3 A-SN 3 A-SN 3 A


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General Objective:

Within 4 hours of General CasePresentation, we will be able to convey

an accurate picture of a 2 year oldpediatric client diagnosed withIntestinal Parasitism with Erratic

Migration; Pneumonia, and thecorresponding medical-surgicalmanagement and nursing interventions

for identified priority nursing


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Specific Objectives:

1.To provide comprehensive informationregarding the medical diagnosis.

2.To present the nursing history, which is

reflective of the clients background datae.g. baseline, present history of illness,past medical history, lifestyle, nutrition,

and socioeconomic status.3.To justify physical assessment findings asmanifestations of the disease process

4.To correlate laboratory tests or diagnosticstudies done with corresponding medical-


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5.To present administered medications

throughout the course of the therapy andtheir corresponding drug actions.6.To present the pathophysiology of the

disease process through comparison withthe normal anatomy and physiology ofinvolved body systems.

7.To identify priority nursing diagnoses based

on defining cues.8.To identify nursing interventions appropriate

for each respective nursing diagnosis.

9.To evaluate the effectiveness of the nursing


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10. To provide an in depth rationalization of

suggested activities of daily living,nutrition, personal hygiene, medications,special treatments, and follow up visitswith the prepared discharge plan.


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SpotMap


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Legend:

Household

Clients House

Tree

Car

Main Road


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Legend:

Household

Clients House

Tree

Car

Main Road

Jaro Plaza

LHS

Bridge

Ricefield

Jaro Plaza

Land Heights Subd

Track


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Brgy.Balabago,

Jaro,Iloilo City

Jaro Plaza

LHS


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NursingHealth

History


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Biographic Data

Name: A.D.Age: 2 years old

Sex: FemaleAddress: Zone 4 Balabago, Jaro,Iloilo City

Date of Birth: May 7, 2006Nationality: Filipino

Religion: Roman Catholic


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Date of admission: November 5, 2008

Time of Admission: 10:00 pm

Attending physician: Dr. J.B.

Chief complaint: Vomiting and

abdominal painDiagnosis: Intestinal parasitism with

erratic migration; pneumonia


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Prenatal HistoryMrs. R.A.D. had her first menstruation

when she was 12 years old. She has a regularmenstrual cycle with an average of 28 days. Shecan consume 3-4 pads a day but she prefers not

to use a sanitary napkin because she feels morecomfortable when her menstruation drains orflows out directly. On August 31,2005, she

noticed that her menses was delayed. She was23 years old when she got pregnant on her thirdbaby. On her first month of pregnancy, sheexperienced nausea and vomiting upon waking upin the morning. She also had cravings for


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She slept more frequent and longer than the

usual sleeping habit. When R.A.D was pregnant,she would sleep at 8pm and wake up at 7am.What she experienced what not that unusual to

her because it is her third time to be pregnant.


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She had two prenatal check-ups, first whenshe was three months pregnant and the second

was when she was five months pregnant. Bothcheck-ups were done in their health centerfacilitated by the midwife. As relayed to her bythe midwife, the baby was in cephalicpresentation and in good condition. She did nothave a shot of tetanus toxoid during her prenatalvisits. She received tetanus toxoid injection when

she was about to deliver her baby in the hospitalwhich is the same with her past pregnancies. Thedoctor in the health center prescribed ferrous

sulfate 325mg per capsule daily because she was


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She consumed a total of 1 stub containing10 capsules taken irregularly.

She had not experienced any serious illnessor complication on her pregnancy except for

fever which lasted for 1 day when she was 4months pregnant. She said she felt warm andhot. She also had cough and runny nose whenshe was 6 months pregnant and lasted for aweek. She did not take any medicines to remedythe above mentioned rather she drank morewater.


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Natal History

Mrs. R.A.D. delivered her baby atWestern Visayas Medical Center,Mandurriao, Iloilo City facilitated by the

resident doctor on duty (name not recalled)on May 7, 2006 at about 8 am. The babywas delivered in a Normal Spontaneous

Vaginal Delivery (NSVD) in cephalicpresentation after the bag of water hasruptured. She had difficulty in delivering

the baby but there was no complications


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Neonatal HistoryAfter delivery, baby A.D. is

pinkish in color and covered withminimal amount of whitish cheesy

substance (vernix caseosa). She alsonoticed the fine downy hairs sparselydistributed on the neonates body.She weighed 6.2 lbs. while the lengthcould not be recalled by the mother.

The baby cried loudly and


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Postnatal History

Due to exhaustion, she fell asleep aftergiving birth. The baby had good suckingreflex during breastfeeding. The vernix

caseosa gradually diminished as they bathethe baby. They also noticed the bluish spotson her right buttocks and right thigh(mongolian spots). As relayed by the mother,the baby first defecated 12 hours afterdelivery. The stool (meconium) was greenishand minimal in amount. They stayed in thehos ital for one da . Mrs. RAD was ha


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Nutritional History

The mother started to breastfeed her babyright after giving birth until one and a half yearold. She breastfed her baby 8-10 times a day.She has not bottlefed her child with any othermilk products. She started to give su-am orrice am, about 150 ml per feeding, when A.D.was 6 months old. She can consume 5-6 bottles

of it daily. At 5 months, A.D. started to eatsoft foods like lugaw or porridge and mashedbanana. At 1 and a half years old, she noticed

her child eating more frequently. At same age,


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The mother prepares their food butsometimes they would buy cooked food in the

market. A.D. has her own serving of foodeats 3 times a day. Her usual diet includes:rice, powdered milk and adobong kangkong for

breakfast. For lunch, rice, laswa and an 9-ounce softdrink, and for dinner, they wouldeat egg, dried fish and rice. A.D. also likes to

eat cheese curls, lollipop and drink mountaindew. Her food preference is utan and friedchicken. The familys usual food is utan and

rice. She could drink as much as 12 glasses of


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Her mother supplements A.D. with tiki-tiki0.6ml once a dayat 2 months old, but they

stopped giving it when they noticed that A.D.was gaining weight by about 3 months old.

l


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Growth and Development

A.D. has a birth weight of 6.2 lbs andcurrently she weighs 10 lbs and stands 81 cm.In terms of her developmental milestone, duringthe first 2 months, A.D. was exhibiting the

following reflexes like grasp reflex and mororeflex. At 5 months, her first 2 lower incisorserupted and for the following month, her 2 upper

incisors erupted. During her 6th month, shebegan to crawl. At 7th month, she started tospeak her first words like aa and baba. Also,during this month, she was able to sit alonewithout su ort and b 11 months she was able


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With regards to her elimination pattern, shetells her mother that she wanted to urinate or

defecate and this started when she was at her 1year and 3 months of age. However, until now,she is unable to defecate or urinate by herselfand she still asks her mother to accompany her.Due to her separation anxiety, she is scaredwhen left with someone she doesnt know or notacquainted to. Currently, she can utter 4-6

words in a sentence. She loves to playhousekeeping toys plastic cooking utensils. Whenshe is playing, most of the time her mother

caught her eating leaves and places her dirty


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They sourced out their water used fordrinking and cooking from a jetmatic pump situated

almost 2 meters right in front of their house. Itis connected to a deep well 20 meters away fromtheir house. The well is chlorinated but notroutinely examined. They then store the water in

a covered blue container right there in thejetmaticpump. Next to their source of water is amuddy canal filled with black, foul smelling muck.

They do not boil the water they use for drinking.Their food preparation includes washing of cookingutensils, raw vegetables, and meat with tap water.

Their toilet is classified as an antipolo type, with


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They burn their garbage including dry leaves,waste and plastic materials 10 meters away

from their house everyday and sells used bottlesand cans.

R.D. has finished his 2nd year in high

school at Balasan National High School. Heworks as a driver of a track that is used in thedelivery of candies, automobiles fortransportation and earns 3000 php a month

utilized for their daily needs.His income is not enough for their daily

expenses so they would sometimes ask R.D.s

aunt who is a elementary public teacher for


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R.A.D. is an elementary graduate ofBalabago Elementary School at Jaro, Iloilo City

and a housewife. Their eldest child is 6 yearsold and currently in kinder 2. Second child is 5years old, while the third (A.D) and fourth childis 2 and 1 year old respectively. They do not

own the land where they live and rents for it for10php per month. They are in good terms withtheir neighbors who are also their relatives.

A.D. usually sleeps at 8:00 in the evening andwakes up at 6:00 in the morning. A.D.sometimes takes a nap for 3 hours or spends the

whole afternoon playing with her playmates


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A.D. sometimes joins her grandfather indrinking coffee for breakfast. They do not have

electricity at home for almost 1 year alreadybecause they lack money to pay their electricbill instead, they use oil lamp. A.D. would

sometimes watch television in their neighborshouse.

They do not hear Sunday mass regularly

but they would usually attend the weekly serviceat the chapel presided by a Baptist pastorevery Sunday at 2 to 4 oclock in the afternoon.

If they would go to church, they usually go to


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History of Present Illness

On November 3, 2008, Monday, 3 pm, BHWof the health center presented a scored tablet tothe mother as a dewormingmedicine. Specific

name of the drug was not mentioned by the BHWas verbalized by the mother. Knowing that herchild has intestinal parasites, R.A.D. allowed the

BHW to administer the tablet to A.D. At 10 pm,the child woke up and cried complaining itchinesson her throat as if something was moving. Themother soothed her childs throat by rubbing theneck.


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Dewormingtablet

presentedand given bythe BHW tothe mother


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The next day at 1 am, A.D. vomitedapproximately 3 cups of vomitusconsisting of the

her previous meal which includes rice and fish.She vomited twice until 2 am. After which shefell asleep and woke up at 7 am. Several minutesafter eating lugaw for breakfast, she vomitedagain of approximately 3 cups of vomitus. Thevomitus is greenish in color with 5-6 cylindrical,glistening, whitish worms about 5 cm in length.

Her father, R.D. gave lugaw again to A.D. butshe only ate 3 tablespoons of it.

non-specific abdominal pain Pain subsided after


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non-specific abdominal pain. Pain subsided afterseveral minutes. They observed body malaise,pale and dryness of lips. Her mother continued

to give her hydrite solution. By 7 pm, she atelugaw again. By 8:30, A.D. she defecated soft,brownish stool with 5-6 worms.

November 5, 2008 (Wednesday)Mr. R.D. gave again A.D. hydrite solution

(Oresol) but consumed only liter (500 ml). At 8am Mrs. R.A.D. cooked lugaw but A.D. refusedto eat. She has no appetite to eat any food, sothey just continue to give hydrite. By nighttime,

about 8:30 pm, they brought A.D. to her

A.D. rested and slept. She did not take herlunch so her father prepared hydrite solution(Oresol) and let her child drink. R.D. diluted 1tablet of hydrite to a pitcher of water about 1liter. She only consumed pitcher about 500

ml. By 2 pm, A.D. complained of non specificabdominal pain. The pain subsided after severalminutes. They observed body malaise, pale skin

and dryness of lips. Her parents continued togive hydrite solution. By 7 pm, she ate lugaw.By 8:30pm, A.D. defecated soft, brownish

stool, with 5-6 worms.


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On November 5, 2008, Mr. R.D. preparedagain hydrite solution (Oresol) 1 liter but she

only consumed 1 glass of it. At 8 am, Mrs.R.A.D cooked lugaw but A.D. refused to eat.She has no appetite to any food, so they just

continued to give hydrite. By night time about8:30 pm, A.D vomited again about 4 cups andwith a bolus of worms. They were so alarmed sothey brought her immediately to WVMCemergency department. They arrived to thehospital at 9 pm and admitted at 10 pm.

A.D. arrived at the WVMC emergency

department, cuddled by father with a chief


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She was diagnosed with acute gastroenteritiswith severe dehydration and intestinal

parasitism with erratic migration. An IVF of D50.3 NaCl 500cc x 62 cc/hr was inserted atright metacarpal vein.

Dr. B ordered administration of Ampicillin250 mg IVTT q6h ANST and laboratory testssuch as urinalysis, Fecalysis, Chest x-ray,

Hematolgy and Serum Na and K.


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Family Medical History

The heredo-familial diseases on the clients

paternal side are hypertension, diabetes mellitus,and heart disease. Her fathers uncle died dueto diabetes mellitus at the age of 42 years old.

At the age of 75, her grandmother died becauseof hypertension. Mr. R.D.s father died at theage of 54 due to heart disease. No other

immediate family member died of disease or itscomplication.On Mrs. R.A.D.s side, they do not have any

heredo-familial disease.

P t M di l Hi t


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Past Medical History

A.D has completed her immunizations however,

the mother could not recall the specific vaccinesgiven. Her yellow card was lost during the typhoonFrank. She has a scar on her right deltoid showing

the possibility that she had received BCG vaccine.She has experienced usual sickness like fever,cough and colds which usually lasted for not morethan one week. Mrs. R.A.D. would give A.D. over-

the-counter drugs like 1 tablespoon of Calpol every6 hours for fever and perform tepid sponge bath.She has no known allergies such as to food or

animal dander and other environmental agents. A.D.


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She was hospitalized once prior to her presentconfinement last April 2007 due to pneumonia

as relayed by the mother. A.D. experienceditching of her throat, rapid breathing, andvomiting. She vomited almost half the meal

she took with 3-4 whitish, long, cylindricalglistening worms. She was brought to theWestern Visayas Medical Center (WVMC)Mandurriao, Iloilo and was admitted for 2weeks. She received antibiotic therapy andIVF therapy, but Mrs. R.A.D. nor Mr. R.D.could not recall any specific medication given

to their child.


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PhysicalAssessment


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Date Performed:November 6, 2008

Pre- Physical

Assessment


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General survey

Generally weak, lying in crib, Height is 82.5cm, and weighs 10 kilograms, malnourished, bodymass index of 14.69, irritable, coordinatedmovement, animated facial expressions, foul body

odor, no halitosis noted, pale, cooperative, strongvoice when crying, poor appetite. Temperature is37.7 oC per axilla, slightly febrile cardiac rate of

110 beats per minute, respiratory rate of 22breaths per minute, and blood pressure of 90/70mmHg. With IVF of D50.3NaCl 500 cc x 62

mgtts/min at the level of 125 cc inserted at the

Ski


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Skin

Brown in color, generally uniform except for

the palms, soles and lips, which are pale. Bodyhair is thin and evenly distributed. Moisturenoted on the forehead, axilla, and back but

generally dry With profuse sweating noted, noedema noted, rough in texture, has variousinterruptions in skin integrity such as scar,crusts, ulcerations noted, particularly on thelower and upper extremities, presence of whitespots on the forehead, vary in size. Scar notedbelow the left elbow, on the lateral portion and

central portion of the right knee, on the


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Nails


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NailsConvex curvature, pale pink in color, smooth in

texture, pus noted on the nail root of the right

thumb, tissues surrounding other nails are intact,nails untrimmed and dirty, good capillary refill,returns to original color after 2 seconds

HeadNormocephalic and symmetrical with frontal,

parietal, and occipital prominences, smooth skull

contour 37.5 cm in circumference, scalp same coloras the facial skin, no flakes or infestation, hairbrownish in color, short, thin, dry, straight andevenly distributed, facial features symmetrical,

al ebral fissures e ual in size, s mmetrical

Eyes


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Eyes

Eyebrows symmetrically aligned and evenly

distributed, eyelashes slightly curved outward,eyelids intact and close symmetrically, noexcessive blinking, palpebral and bulbar

conjunctiva pale, slightly sunken eyeballs, sclera isanicteric with presence of pinpoint sized macule,dark brown in color at the right sclera. Cornea isshiny and smooth. Pupils black in color, equal insize (approximately 2 mm) and both reactive tolight and accommodation, can see objects at theperiphery, both eyes moves in unison, no

periorbital edema or tenderness over the lacrimal

Ears


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EarsSame color as the facial skin, symmetrical and

aligned with the outer cantus of the eye. Hair

follicles noted in the ear canal, presence of dry andyellowish cerumen in both ears, scant in amount.Auricles recoils immediately after it is folded, notenderness noted. Normal voice tones audible at 5meters, whispered words audible at the range of 6inches.

Nose and sinusesExternal nose straight and symmetrical, presence

of clear watery nasal discharge, scant in amount,uniform in color, non tender and no lesions noted. Both

nares patent, nasal mucosa pinkish in color, nasal

Mouth and Oropharynx


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Mouth and OropharynxLips has symmetrical contour, pale pink in color,

soft, dry, and smooth in texture. Able to purse lips,

facial nerve intact. Inner lips and mucosa uniform pink incolor, moist, smooth, glistening and elastic in texture,with 20 sets of teeth, yellowish in color, 4 upper incisorsnoted with presence of dental carries, gums pinkish, moist

and firm, tongue is in central position, no lesions, moist,appears rough and with thin whitish coating at thesurface. Papillae raised, tongue moves freely base of thetongue smooth. Soft palate is smooth and light pink incolor. Hard palate lighter pink in color and has irregulartexture. Uvula positioned at the midline, oropharynxpinkish and uniform in color. Tonsils pinkish and smooth,

no discharge and of normal size. Gag reflex present,


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Heart


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Heart

Apical pulse present on the 5th intercostals

space midclavicular line. Dullness heard uponpercussion, heart sounds heard on cardiaclandmarks, no thrills and murmurs heard upon

auscultation, Cardiac rate of 110 beats perminute, rhythm is regular.

BackNo redness, no mass and swelling, no bone

deformity, spine and posture is straight,

thoracic expansion is symmetrical, tactile


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The right and left inguinal lymph nodes


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The right and left inguinal lymph nodespalpable approximately 0.6 cm in diameter.Defecates 2 times a day to a yellowish, mucoidstool, with visible ascaris of 4-7 worms. Andvoids approximately 7 times a day with lightyellow urine, approximately 100 cc in amount per

voiding.

Extremities

Upper extremitiesNumerous skin lesions noted on arms,

shoulder, elbow, wrist and fingers, has full range

of motion, with quick capillary refill within 2

Lower extremities


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Lower extremities

Presence of lesions distributed all over the

legs and thigh, varicosities are absent in bothfeet. Knees and ankles have full range of motion.Knees can flex as well as the ankle. Both can

rotate without pain, toes can abduct and hyperextend. Popliteal, Dorsalis pedis, Posterior tibialpulses present.


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-Pathophysiology

Intestinal Parasitism with Erratic


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Intestinal Parasitism with ErraticMigration; Pneumonia

Precipitating Factors

vPoor hygienevImproper food preparations

vEnvironment

Predisposing Factor

vAge

(Children are more prone to acquire

the disease)

Ascarid eggs swallowed from contaminated raw

fruits or vegetables and soiled hands

Eggs pass through the stomach and arrive in the duodenum

Becomes a larvae after 18 days; depending on the

environmental condition


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Invades the blood vessels and

carried in the blood stream

Heart

Liver

Larvae burrow through

intestinal lining and into the

tissue underneath

of the bowel, abdominal discomfort

Hepatic damage (hepatitis)

Lungs


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Larvae matures for 10-14 days

Larvae penetrates alveolar walls

Inflammatory response

Minimal hemorrhage, hemoptysi

Accumulation of fluids in the lungsEdema, crackles

Ascaris

Pneumonia


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MEDICAL MANAGEMENT


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LABORATORIES

Laboratory examinations were ordered todetermine the cause of the disease. This

includes fecalysis, urinalysis, hematology andblood chemistry. The physician ordered forthe request of Serum Sodium and Potassium

to determine if the electrolyte level is belownormal.

FECALYSIS


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Fecalysis is also known as stoolanalysis. It refers to a series of laboratorytests done on fecal samples to analyze thecondition of a person's digestive tract ingeneral. It is also performed to check for

parasites, the presence of any reducingsubstances such as white blood cells (WBCs),sugars, or bile and signs of poor absorption.

This is done on the client to help the doctordetermine the presence of intestinal parasitethrough microscopic examination.

URINALYSIS


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Urinalysis is a diagnostic physical,chemical, and microscopic examination of aurine sample (specimen). It is done on theclient to determine various properties (color,specific gravity, ph, glucose, etc.) and

abnormal constituents as seen under amicroscope.

HEMATOLOGY

Hematology is the study of blood and itsdisorders. Hematologists, board-certifiedinternists, look specifically at blood

components such as blood count, and blood

This tests can help diagnose anemia.


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p gCommon hematological test includes whiteblood cell count, red blood cell count,platelet count, hematocrit red blood cellvolume, and hemoglobin concentration. Ablood test that shows you have an increased

number of a certain type of white blood cell(eosinophils) may indicate the presence of anintestinal parasite.

BLOOD CHEMISTRY

Blood chemistry measures the levels of anumber of chemical substances that are

The amounts of these chemicals in the blood


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may reflect abnormalities in the tissuessecreting them. On the clients case, the serum

sodium and serum potassium is measured todetermine possible dehydration.

Chest X-RayIt is a projection radiograph of the thorax

which is used to diagnose problems with thatarea. A chest x-ray may be ordered when aperson's symptoms include a persistent cough,coughing up blood, chest pain, a chest injury, ordifficulty in breathing. The test is also used when

tuberculosis, lun cancer, or other chest or lun


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INTRAVEOUS FLUID THERAPY

The doctor ordered IV fluids such as D5 0.3NaCl 500cc to run at 62-63 cc/hr or 15-16gtts/min x 6 hours, then the next day it wasD5 0.3 NaCl 500cc + 10 mEqs of KCl at 62-

63 cc/hr x 8 hours. In case of Gastro-intestinal loss, the doctor ordered to replaceit volume/volume of PLNSS to avoid

dehydration.


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This is usually ordered by the physicianto maintain or replace body stores of water,electrolytes, vitamins, protein, calories, andnitrogen in the client who cannot maintainadequate intake by mouth, restore acid base

balance, replenish blood volume and provideavenues for keeping the vein open for easyadministration of drugs whenever the condition

becomes severe or the client cannot able totake medications orally, it is given through IVfor the medications to take effect as rapidly as

possible.

1 D5 0 3 NaCl 500cc x 62 63 cc/hr


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1.D5 0.3 NaCl 500cc x 62-63 cc/hr

D5 0.3% NaCl is typically thechoice for maintenance fluid for pediapatients. Dextrose and sodium chloride

solutions are used as sources ofelectrolytes, calories and water forhydration. Sodium and chloride ions are

responsible for regulating the acid-base balance of the body.

Dextrose is a source of calories. It is


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readily metabolized and helps to

decrease losses of body protein andnitrogen. It also promotes glycogendeposition and decreases or prevents

ketosis.2.D5 0.3 NaCl + 10 mEq KCl x 62-63cc/hr

Potassium chloride is used in thetreatment of hypokalemia and associated

3 D5 IMB (hypertonic solution) 500 cc x 41-


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3.D5 IMB (hypertonic solution) 500 cc x 4142 cc/hr

Hypertonic solution has higher osmoticpressure than that of plasma drawing fluid intothe cell. It is also used in repairing electrolyte

and acid/base imbalances, and also include totaland partial parenteral nutrition solutions.

4. Plain NSS

It is an effective method of supplying fluidsdirectly into the intravenous compartments. It

MEDICATIONS


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For the medications, the doctor ordered for

Ampicillin 250 mg IVTT q6h and a go homemedication which is the Cotrimoxazole 80mg/5ml to prevent infection.

NUTRITIONAL SUPPORT

For the nutrition of the client, the doctor

ordered Diet as Tolerated with Strict AspirationPrecaution to maintain the nourishment of theclient and to prevent aspiration pneumonia.


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Nursing Management


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Nursing Management

vWhen the client was admitted, the nurseadministered D5 0.3 NaCl 500 cc + 10 mEqKCl x 62-63 cc/hr as ordered

vVital signs were checked every 4 hours.

vCareful intake and output monitoring for theclient was done.

vStool and vomiting count was made and a

sheet was placed on the bedside.vOrdered medications were given.

vAfter 3 days, the IVF was changed to D5

IMB re ulated at 41-42 cc/hr as ordered

vHealth Teachings was given to the folks to


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create awareness about the disease and toprevent reinfection. Proper handwashing ofhands before and after eating wasemphasized.


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LaboratoryResults andDiagnostic

Tests

URINALYSIS


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URINALYSIS

Definition: Urinalysis is a diagnostic testused as screening because it can help

detect substances or cellular material inthe urine associated with differentmetabolic and kidney disorders. It is

ordered widely and routinely to detectany abnormalities that should be followedupon.

Preparation: The specimen can be


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Preparation The specimen can becollected anytime of the day. Collect

midstream clean catch urine specimenin a clean, dry, wide mouth plastic cupor container. Collected specimen must

not be less than 30ml. Bring it to thelaboratory immediately aftercollection. Label the specimen cup withthe clients name, and ward/roomnumber.

Result Normal ValuesSignificance


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Physical

PropertiesColor Palestraw

Pale straw Normal

Transparency Slightlyhazy

Clear toslightly hazy

Normal

Reaction Acidic Acidic Normal

SpecificGravity

1.012 1.010-1.025 Normal



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Chemical

testSugar Negative Absence ofsugar

Normal

Protein Negative Absence ofprotein

Normal

Result NormalV l

Significance


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ValuesMicroscopic

RBC 0-1 Veryoccasional

Normal

Pus 0-1 None Indicates early

infection in thegenitourinarytract

Cast None None Normal

NormalCrystal

Few None to few Normal

Result NormalV l

Significance


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ValuesMicroscopic

Squamousepithelial cells

Few few Normal

Round

epithelial cells

None None Normal

Bacteria Few None tofew

Normal; presence offew bacteria may be

possible due toimproper handling ofspecimen and dirtycontainer.

Result Normal Significance


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ValuesMicroscopic

Mucousthreads

None None to few Normal

Yeast cells None None Normal

Parasite None None normal


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Interpretation: From the results of the

urinalysis indicated above, AD does notsuffer from any urinary tract or renaldisorder. There is a very slight deviationfrom the normal values as in the presence offew bacteria which is due to improperhandling of specimen.

FECALYSIS (Direct fecal smear)


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( )

Name: A.D Received: 11-6-08

Age: 2 y.o Ward/Room No.: Pedia Apex

Sex: Female Lab No.: 2-7

Requesting Physician: Dr. B.

Definition: Stool analysis is used to determinethe various constituents of the stool for

diagnostic purposes such as diseases of thegastrointestinal tract. It is done to makeadequate, gross and microscopic examination.

Purpose: Its purposes are to detect the


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p p ppresence of parasites and identify certaintypes of bacteria that can cause disease. Itdetermines the cause of symptoms affectingthe digestive tract, including prolongeddiarrhea, bloody diarrhea, an increased

amount of gas, nausea, vomiting, loss ofappetite, bloating, abdominal pain andcramping, and fever.

Preparation: The specimen can be collected


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anytime of the day. Place the fecal matter

in a clean, dry, wide mouth plastic cup orcontainer. The fecal specimen must be atleast the size of the thumb. Bring it to thelaboratory immediately after collection,

preferably one hour after defecating. Labelthe specimen cup with the clients name, andward/room number.


Ph l


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PhysicalProperties

Color Brown Brown Normal; due tobacterialdegradation ofbile pigments

to stercobilin.

Consistency Mucoid Soft; Formed Abnormal; dueto increased

gastric motilityand presenceof bacteria

MICROSCOPICEXAM

Result NormalV l

Significance


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EXAM Values

Ascarislumbricoides

More than12ova/slide

none Indicatesintestinalparasitism;ascariasis

Hookworm none none Normal

Trichuristrichiura

0-1ova/slide

noneIntestinalparasitism;trichuriasis

Trichomonashominis

few none Indicates intestinalparasitism


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hominis parasitism

Entamoebacoli

5 ova/slide none Indicates intestinalparasitism;amoebiasis

Entamoebahistolytica

More than 12cyst/slide

none Indicates intestinalparasitism;

amoebiasisRBC 2-4/hpf none Increased; due to

GI tractinflammation

Pus cells 0-1/hpf none Presence indicatesbacterial infection

Ascaris


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Ascarislumbricoides

Trichuris trichura


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Trichuristrichura

Trichomonashominis


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Entamoeba coli


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Entamoebacoli

Entamoebahistolytica


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Interpretation: From the results of stool

analysis indicated above, it showed thatA.D. experiences severe intestinal parasitismwith the presence of the following parasitesand helminthes: ascaris lumbricoides,trichuris trichiura, trichomonas hominis.Results also showed intestinal amoebiasis dueto the presence of Entamoeba hystolytica.

Because of the reaction to bacterialinfection, it ensued to an increased level ofRBC and WBC.

ROENTGENOLOGICAL REPORT


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Case No: 19596-cj Date: 11-5-2008

Name: D. A. Age: 2 y.o.Examination: Chest APL Sex: FemaleDepartment: APEX

Requesting Physician: Dr. B.Findings:

Chest APL shows parachilar and peribronchial

haziness.Heart is not enlarged.Trachea is at midline.

Hemidiaphragm and costrophrenic angles


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BLOOD CHEMISTRY


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Name: A. D. C.S.: SingleWard: Pedia Apex Age: 2Examinationdesired: Na+, K+ Sex: FemalePhysician: Dr. R. B. Date:11-07-08

HospitalNo: 45174 Lab No: 5-27Results Normal Values

Electrolytes

Serum Sodium(Na+)

140.1 135.143 mmol/L

Serum Potassium(K+)

4.19 3.5-6.3 mmol/L


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SIGNIFICANCE:

Results shows that sodium-potassiumlevel is within the normal range, no

indication of electrolyte imbalance.


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Results NormalValues

Significance


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ValuesNeutrophils

Segmenters

0.63

0.63

0.59-0.68

0.32-0.62

Slightly

increased,indicatesinflammatorydisease

Lymphocytes 0.37 0.25 0.33 Increased; inresponse topresence of

microorganisms, possibleinfection


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Significance: Based on thefindings, A.D. manifestsinflammatory disease and infection

as evidenced by slight increase ofantigen presenting cells such assegmenters and lymphocytes.


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DrugStudy

Name of Classification

Indication Action


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Drug

GenericName:Ampicillin

BrandName:

Principen

Antibiotic For GITinfection

Inhibitscell wallsynthesisduringmicroorganism

multiplication.


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Adverse Reactions andSide Effects

Dosage


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Side Effects

SE:Vein irritation, nauseaand vomiting, diarrhea

AR:Thrombophlebitis,thrombocytopenia,

urticaria,hypersensityivityreaction, anaphylaxis

250 mg IVTT q6h ANST

(-)6-12-6-12

Availability:Capsule: 250mg, 500 mgInfusion: 500mg, 1g, 2g

Injection: 25mg, 250mg,500mg, 1g, 2gOral suspension:125mg/5ml,

Nursing ResponsibilitiesObserve 10 Rights in giving medications


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Observe 10 Rights in giving medications.Obtain history of patients infection before

therapy.Ask patient or folks about previous allergicreaction to penicillin

Perform skin test before giving the medication.Be alert for adverse reactions and druginteractions.Monitor hydration status.Give at least 2 hour before bacteriostaticantibiotic.Stop drug immediately if anaphylaxis occurs.

Name ofDrug

Classification

Indica-tion

Action


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GenericName:PotassiumChloride(KCl)

PotassiumSupplement

Forprevention ofhypoka-lemia

Aids intransmittingnerve impulses,contractingcardiac andskeletal muscle,and maintaining

intracellularmetabolism, acidbase balance,

and normal renal


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Dosage


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Side Effects

SE:Paresthesia, listlessness,confusion, n/v,abdominal pain,diarrhea, cold skin,oliguria

AR:Arrhythmias, heartblock, cardiac arrest,

GI ulcerations and

DosageKCl 6 mEq incorporated to300 cc D5 0.3 NaCl x62-63 mgtts/min

Availability:Capsule: 8mEqs, 10mEqs

Injection: 0.5meqs/ml,2meqs/mlOral liquid: 20meqs/15mlPowder: 15meqs/packet,

Nursing ResponsibilitiesObserve 10 Rights in giving medications


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Observe 10 Rights in giving medications.Assess patients condition before start of therapy.Be alert for adverse reactionsMonitor fluid input and output, creatinine and BUNlevels.

Give cautiously because different potassiumsupplements deliver varying amounts of potassium.Drug is commonly given with potassium-wastingdiuretics to maintain pottasium levels.Advise to eat potassium rich foods.Dont give postoperatively until urine flow isestablished.

Name ofD

Classification

Indication Action


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Drug

GenericName:Cotrimoxazole

Antibiotic Forsusceptiblemicroorganisms

Sulfamethoxazole inhibitsformation ofdihydrofolic

acid fromPABA;trimethopriminhibits

dihydrofolatereductase.Both decreasebacterial folicacid synthesis

Special Precautions Contraindications


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Use with caution andreduce dose in clientwith hepatic

impairment, CrCl of15-30 ml/min, severeallergy or asthma,

G6PD deficiency, orblood dyscrasia

Contraindicated in clientswith megaloblastic anemiacaused by folate

deficiency, severe renalimpairment, orhypersensitivity of the

drug


Dosage andAvailability


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Side Effects Availability

SE:Headache, abdominalpain, diarrhea, anorexia,muscle weaknessAR:Thrombocytopenia,leukopenia, anaphylaxis,

hepatic necrosis

Dosage:

80mg/5ml

Nursing ResponsibilitiesObserve 10 Rights in giving medications.


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Observe 0 R ghts n g v ng med cat ons.Assess clients infection before and after

therapy.Before giving first dose, obtain specimen forculture and sensitivity tests. Begin therapy

pending results.If adverse GI reactions occur, monitor hydrationstatus.Monitor MIO. Ensure urine output is at least 1.5L daily. Inadequate urine output leads tocrystalluria.For full absorption, give with a full glass of


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NursingCare Plan

List of Priority Nursing


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y g

Diagnosis

Fluid volume deficitAltered Nutrition, less than

body requirementsHyperthermiaImpaired skin integrity

NURSING DIAGNOSIS


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Fluid volume deficit related to activefluid loss as evidenced by 5 episodes ofvomiting with approximately 100cc of semi-solid vomitus which contains previously taken

foods; defecated 2 times a day with ayellowish, mucoid stool, skin warm to touch,dryness of skin in palms and sole of the feet,

skin turgor of 4 seconds, dryness of lips, palebulbar and palpebral conjunctiva, temp= 37.7degrees celcius, slightly sunken eyeballs and

profuse sweating Mrs RAD verbalized that


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GOAL

Within 4 hours of effectivenursing intervention, client will

display improvement onhydration status to a functional

level such as good skin turgorand stable vital signs.

NURSINGINTERVENTIONS

RATIONALE


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INTERVENTIONS

INDEPENDENT:

1. Monitor vital signs

every 4 hours includingthe intake and outputand note the strengthof peripheral pulses.

-Vital signs serve as

patients baselinedata. Monitoring fluidintake and outputenables us to evaluatethe degree of fluidvolume deficit.

2. Estimate proceduralfl l

-To note the volumef l fl


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fluid losses and

possible route ofinsensible fluid losses.

of insensible fluid

losses for properreplacement.

3. Note clientsf

-This will help inh l


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preferences concerning

foods with high fluidcontent such as papayaand jelly ace.

4. Encourage theparents to increaseclients fluid intake

approximately 2-3liters per day astolerated.

encouraging the client

to increase her fluidintake.

-Increasing fluidintake will replace

fluid losses and helpmaintain fluid volumeat functional level.

5. Instruct theparents to secure

-This is a preparation ifthe client will crave for


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parents to secure

available drinkingwater at the bedside.

6. Give crackers or

ice chips to theclient.

the client will crave for

water. The availabilityof fluids is a good wayto respond immediatelyto the physiologicalneeds of the client.

-This is a non-

pharmacologicmanagement to reducenausea.

Dependent:


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1.Administermedications asorderedAmpicillin 250 mg

IVTT q6h6am-12nn-6pm-12pm

-Ampicillin is a broadspectrum antibiotic thatkills parasites byinterfering their ability

to form cell walls, thusthey will break up anddie.

2.Infuse IV fluids asordered and regulate

-this is given tocounteract hypotonic


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ordered and regulateat prescribed rate:D5 0.3% NaCl 500 ccx 62 63 cc/hr

Collaborative1. Monitor laboratorydata such as

hematocrit,electrolytes andspecific gravity of

urine

counteract hypotonicdehydration and tomaintain the balance influids and electrolytes inthe clients system.

-to note if there areprogress in clients

condition as to her fluidvolume.

E


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EVALUATION Goal met. A.Dwas able toimprove her hydration status to afunctional level after 4 hours of

effective nursing interventions asevidenced by good skin turgor of 2seconds and stable vital signs.

NursingDiagnosis

Altered Nutrition, less than the body requirementsrelated to Inability to Absorb Nutrients due to Biological


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y gFactors (Intestinal Parasites) as evidenced by BMI of

14.69 (malnourished), persistent vomiting approximately5 times prior to admission from November 3 toNovember 5, 2008 approximately 100cc per episode ofvomiting, dryness of lips, pale palpebraland bulbarconjunctiva with slightly sunken eyeballs, hair is brownin color, thin and dry, pallor, protuberant and distendedstomach, weakness, ,presence of intestinal parasites as

laboratory results revealed, presence of Ascarislumbricoides (more than 12 ova per slide), Trichuristrichuria (0-1 ova per slide), Trichomonas hominis (few),Entamoeba coli (5 ova per slide), Entamoeba histolytica

(more than 12 cyst per slide) RBC 2 4hph presence of

Goal


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GoalWithin 14 days of

effective nursing interventions,

client will demonstrateprogressive weight gain from

4-7 kilograms to achievenormal Body Mass Index of20-24.

Nursing InterventionsRationale

Independent:

1. Assess age, body Helps to determine


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1. Assess age, bodybuild, activity and restlevel.

2. Reassess weight.

Assess BMI.3. Establish a minimumweight goal with the

client of approximately4-7 kilograms withintime span.

pnutritional needs.

To establish baseline

parameter.- Provides comparativebaseline data for

effectiveness of therapy.Improved nutritionalstatus enhances activitytolerance and physiologic

4. Review the nutritionalhistory including quality of

- Identify thedeficiencies and


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food taken and meal eaten

per day.

5. Weigh regularly andrecord results.

6. Identify and manageunderlying causative factors

such as food preparations,proper hygiene andenvironmental sanitationincluding the present

suggest proper daily

intake.To monitoreffectiveness of

nursing interventions.

- To determine theamount that should be

added in the diet andmonitor the foodpreferences of the

client

7. Evaluate the totaldaily food intake

Reveal possible causeof malnutrition and


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daily food intake

including caloric intake,patterns and time ofeating.

8. Provide smallfrequent meals andsupplemental snacks

like boiled kamotewhich is readilyavailable in the clients

back ard

of malnutrition and

changes that could bedone to be made inclients intake.

- Gastric dilation canoccur and if refeedingis too rapid and canlead to gastric reflux.

9. Use flavoring agentsminimal in amount such

- To enhance foodsatisfaction and


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minimal in amount such

as salt, pepper andother herbs in food aspreferred.

10. Ensure minimalintake of foods thatcause intolerances suchas foods that are gasforming and avoid toohot/cold or spicyaccording to clients

satisfaction and

stimulate appetite.

Increase gastricmotility leading toreflux and diarrhea

11. Promote adequateand timely fluid intake astolerated by the client

Replace fluid loss dueto diarrhea and


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tolerated by the client

preferably 2-3L. Limitfluids 1 hour as possibleprior to meal.

12. Recommend eatingin upright position.

13. Minimize unpleasantodors or sight includingscent of spoiled and raw

vomiting. Limiting fluid

intake prior to mealprevents early satiety.

May enhance intakeand reduce sensation ofabdominal fullness.

To promote pleasantatmosphere that canincrease and stimulateintake.

14. Schedule activitieswith adequate rest

Conserve energy andreduces caloric needs


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with adequate rest

periods and promoterelaxation technique.

15. Monitor laboratory

results

reduces caloric needs

To monitor the

condition of the clientand any alterationsassociated to clients

status like presence ofintestinal parasites.

Dependent

P id t l


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Administer IVF of D5

0.3% NaCl 500cc x 62-63 cc/hr as ordered.

Interdependent:Refer to dietician forspecific meal plan.

Provide parenteral

nutrition and replace GIloses.

- To meet proper daily

nutritional needs.

2. Refer to physicianf

To eliminate parasites


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prescription of

antihelmenthic drugs.

in the GI tract.Parasites such asentamoeba hystolyticaand ascaris lumbricoides

competes with thenutrition acquired bythe client causing not

enough nutrition beingacquired by the body.

Evaluation


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Goal met. Within 14days of effective nursinginterventions, client was ableto gain weight of 4kg withBMI of 20.56.


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Goal

Within one hour ofnursing effective nursing

interventions, client will beable to maintain coretemperature of 36-37.5 oCof per axilla.

NursingInterventions

Rationale


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Interventions

Independent:

Monitor clients

temperature prior totherapy.

2.Monitor vital signsevery 15 minutes.

- To provide comparative

baseline data.

-To note any alterations

in the current conditionand monitor effectivityof nursing interventions.

3. Perform tepidsponge bath

Promotes heat lossthrough the process of


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sponge bath.

4. Limit bed linens.

5. Instruct folks tolet client wear loose-

through the process of

conduction andevaporation.

- Number of linens

should be minimized tomaintain near bodytemperature by allowing

heat loss.

-Tight clothes trapmoisture coming from


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Goal


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Within 5 days of nursinginterventions, the client will be

able to achieve timely healing oflesions without complications.

Nursing Interventions Rationale

Independent


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p

1.Identify theunderlying conditions,the cause and the

nature of the skinlesions, ulcerations andscars.

2.Instruct mother toclean the lesions withsoap and water.

-Identifying thecondition, cause, andthe nature of the skinlesions will determineappropriate nursinginterventions.

-Washing the lesion sitewith antiseptic soap andwater cleanses it andprevents bacterial


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5. Instruct mother toprovide A.D. withVitamin C rich food

- Protein-rich foodfacilitates skinregeneration thus


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like calamansi and suha.

6. Instruct mother tofeed A.D. protein richfood such as fish and

legume, string beans,mongo and kadyos.

promoting healing.

-vit. C rich food booststhe immune system thus,preventing infections and

eventually maintaining goodskin integrity.

-Protein-rich foodfacilitates skinregeneration thuspromoting healing.

7. Instruct mother toapply herbal medicine

-This herbal medicinesare accessible available


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apply herbal medicine

such as guava leavesand found in theirvicinity.8. Instruct mother tohave her child wearappropriate footwear

like slippers withgarter.

are accessible, available

and DOH-recommendedfor wound healing.

-To protect the soles ofthe feet from injury.


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Evaluation


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EvaluationGoal partially met. Some

lesions were still noted on the

upper and lower extremitiesbut still on the stage ofhealing.


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A.D.


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Skin

Brown, generally uniform in color, body


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hair is thin and evenly distributed, skin is moist,no edema noted, rough in texture, has variousinterruptions in skin integrity such as scars,crusts, ulcerations particularly on the upper and

lower extremities with signs of healing in variousstages. Ulcerations noted on the left tarsal withevidence of healing process. Bluish discoloration

noted at the anterior portion of the buttocksand left gluteus medius (Mongolian spot),presence of pinpoint marks on the soles of the

f t Ski t t if ll th

Nails

Convex curvature, pinkish in color, smooth int xt tiss s ndin th n ils int ct


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texture, tissue surrounding the nails are intact.

Nails are untrimmed and dirty, good capillaryrefill, returns to original color after 2 seconds.

Head

Normocephalic and symmetrical with frontal,parietal, and occipital prominences, smooth skull contour37.5 cm in circumference, scalp same color as the facial

skin, no flakes or infestation, hair brownish in color,short, thin, dry, straight and evenly distributed, facialfeatures symmetrical, palpebral fissures equal in size,symmetrical nasolabial folds, no masses nor nodules


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Mouth and OropharynxLips has symmetrical contour, pink in color, soft,

moist, and smooth in texture. Able to purse lips, facial


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nerve intact. Inner lips and mucosa uniform pink incolor, moist, smooth, glistening and elastic in texture,with 20 sets of teeth, yellowish in color, 4 upperincisors noted with presence of dental carries, gums

pinkish, moist and firm, tongue is in central position, nolesions, moist, appears rough and with thin whitishcoating at the surface. Papillae raised, tongue movesfreely base of the tongue smooth. Soft palate is

smooth and light pink in color. Hard palate lighter pinkin color and has irregular texture. Uvula positioned atthe midline, oropharynx pinkish and uniform in color.

T il i ki h d th di h d f l

Neck

Neck muscles equal in size, head centered,


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m q , ,

head movement coordinated, with no discomfort,head flexes, hyperextends, flexes laterally androtates laterally, lymph nodes not palpable,

trachea placed at the midline of the neck.Thyroid isthmus rises when client swallow,thyroid gland not visible on inspection, smooth,nontender nonenlarge, lobes of thyroid glandcannot be palpated.


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Heart

Apical pulse present on the 5th intercostals


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p p p

space midclavicular line. Dullness uponperscussion. Heart sounds heard on cardiaclandmarks, no thrills and murmurs heard uponauscultation, Cardiac rate of 110 beats perminute, rhythm is regular.

Back

No redness, no mass and swelling, no bonedeformity, spine and posture is straight,thoracic expansion is symmetrical, tactile


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GenitalsNo unusual discharges, Perinuem intact,

wound marks noted absence of redness at the


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wound marks noted, absence of redness at the

anal opening. Presence of sticky clear dischargesnoted at the vaginal opening. Right and leftinguinal lymph nodes slightly palpable. Defecates

two times a day to a yellowish formed stoolwithout the presence of worms(ascaris) and voidsapproximately 7 times a day to a light yellow urineapproximately 100 cc in amount per voiding. The

right and left inguinal lymph nodes slightlypalpable.

Extremities Upper extremities


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Numerous skin lesions noted on arms,shoulder, elbow, wrist and fingers and on variousstages of healing, has full range of motion, with

quick capillary refill within 2 seconds.Lower extremities

Presence of lesions distributed all over the

legs and thigh, varicosities are absent in bothfeet. Knees and ankles have full range ofmotion. Knees can flex as well as the ankle.

B th t t ith t i t bd t


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DischargePlan

I. General Objectives:

To provide continuity of care at home in


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p y f m

the absence of a health care provider.

II. Specific Objectives

1. To discuss to the folks of the client someinformation about the clients illness,including its background, etiology,

epidemiology, and signs and symptoms.2. To help the folks assist the client in

dealing with her personal hygiene so as to

3. To guide the folks of the client byinstructing the ADLs listed and practice it sothat the client can avoid any complications


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y p

again and live normally as a child.4. To provide a list of nutritional foods that is

appropriate to the client and teach folks how to

prepare, store and cook it properly.5. To help the folks interpret and understand

the medications and herbal medicines listed.

6. To inform the folks when will be theappropriate time to return for follow-up checkup and repeat laboratory exams as requested.

III. Health Teachings

A)Knowledge about the Illness


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The intestinal parasitism is an endemicclinical condition that prevails in nations withthe population's severe imbalances social and

economic, where vast sectors they lack thebasic services of education, health, housing,and recreation.

Etiology

Among these parasites, the ascarislumbricoides is a nematode which is one of the

A lumbricoides is the most prevalent andthe largest of the intestinal nematodes thatinfect humans This illness is characterized by


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y

variable symptomatology ; it is generallyasymptomatic in the adult, and it is in childrenwhere we see the most florid clinical

presentation and the complications of thisillness.

As most of the intestinal parasite

infections, the ascariasis prevails and is endemicin areas lacking of sanitary infrastructure, withprecarious housings, poverty and ignorance. This

h l i thi i f ti i i d b th i ti

They ascend for the respiratory tree andthen continuing go up for later to be swallowedand arrive to the small intestine where they


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and arrive to the small intestine where they

become adults.

Epidemiology

The form of more frequent presentation isthe chronic infection, which mostly contributes tothe process that takes to the malnutrition. It can

happen to any age, being more frequent inchildren of school age and persisting in theadulthood. Every year, 60.000 deaths areattributed directly to this infection.

The clinical illness is restricted to subjectwith important load of parasites. This minorityrepresents from 1 2 to 2 million cases with


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represents from 1,2 to 2 million cases with

clinical manifestations in the world, beingconsidered around 50.000 deaths a year forsevere illness caused by ascaris lumbricoides.

Signs and Symptoms

The infested patients could not have anysymptom, or to manifest low of weight, chronicabdominal colic pain, nausea, vomiting and theelimination of parasites by stools. Children couldhave retardation related growth and weight, and

Most of children have the antecedents ofascaris expulsion by rectum, and patients withintestinal obstruction is common to records


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parasites expulsion by mouth, which help as anelement to keep in mind for making a rightdiagnosis. The diagnosis is carried out by means

of the visualization of the eggs in the directexam of fecal matter. The mature females canalso be visualized in feces. In few cases thatthe infection is only for males, there are noteggs in the stools, and an abdomen x-ray allowsvisualizing the parasites in the intestine.

Erratic MigrationOne of the peculiarities that characterize

the massive infestation conditioned by these


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the massive infestation conditioned by theseworms is the enormous capacity that theypossess to invade spaces, organs, conduits andcavities of the human body where it is not

normal to find them, for what this extensivechapter has been denominated in theinternational literature as erratic or ectopic

ascariasis. As consequence of the erraticlocalizations, the presence of parasites has beendescribed in biliar ducts, nasal graves, hearings,

f ll i t b llbl dd th


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1. Sanitary disposal of human feces and goodpersonal hygiene.

2. Washing of hands before and after eating and


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after going to the comfort room, or handlingpets.

3. Keep fingernails short and clean becauseparasites can live for two months under thefingernails.

4. Keep environment neat and clean by doing ageneral cleaning thrice a week together with the

family.5. Do not walk barefoot on warm moist soil, or

while playing in the backyard because parasites


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C.) Activities of Daily Living

1.Eating:


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a)Before and after eating, make sure towash hands properly using a soap andclean water because proper hand

washing may prevent the spread ofmicroorganisms.

b)Encourage to avoid eating foods from

streets like fish balls, fried chicken,ice candy, and other foods which aresold on the nearby streets since we

These foods may not be cleanedproperly, or may be already

contaminated


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contaminated.c) Encourage to boil water at least

5-15 minutes if they use water from

the faucet in order to destroymicroorganisms present in the water.2. Bathing, Grooming, and Clothing:

a) Wearing of shoes or slippersproperly outside and inside of thehouse.

c) Counsel not to allow children to belicked or kissed by pets that are notdewormed regularly.


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g y

d) Discourage nail-biting and scratchingthe anal area.

e) Have children change into a clean

underwear each day to prevent infection.

3) Eliminating/ Toileting

a) It is necessary to wash hands aftertoileting for infection control and towipe perineum from front to back to

b) Encourage not to ignore the urge to void sothat the bacteria from the urinary tractwill be flushed out.


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c) It is also necessary to defecate in a day toremove toxins from the body.

Rationale: To guide the folks of theappropriate ADL that must be performedand practiced by the client daily.

D.) Nutritional Status

1.Wash thoroughly and cook foodparticularly fruits and vegetables.

3. Encourage to drink more clean water byboiling it 15-30 minutes or to boiling point.

4. Eat Vitamin C rich foods and high in protein


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and calories to replace weight loss likeoranges, and other citrus fruits, milk, meat,and fish.

5. Prepare food properly to enhance appetite ofthe child.6. Light soups, rice and eggs are good foods to

eat during recovery.7. Sugar and sweetened foods should be avoided

because parasites thrive on it.8. Take large doses of plant derivatives

Rationale: To take foods appropriately andavoid foods that is restricted.


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E.) Medication, Treatment and SpecialProcedures

1.Instruct the folks of the client tofollow physicians order take homemedications, correct dose, preparations

or for any laboratory exam likefecalysis.2.Let bowel rest by drinking only clear

3. Avoid taking OTC medications or other drugswithout asking a knowledgeable health careprovider regarding it.


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4. Comply with antibiotic medications.Cotrimoxazole 2.5 ml BID,(8am and 6pm) PO,for 7 days. Give with full glass of water, 1 to2 hours after meals.

5. Suggest herbal medicines.Preparation:Boil Star apple leaves for 10 minutes

Strain the extract and get rid of theleaves and residue

Cool the extract for 5 min

Rationale: To subject client for medicationsand special procedures to enhance health.


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F.) Follow-up VisitEncourage the folks of the client to return

for follow-up visit after 1 week after dischargeNovember 16, 2008, WVMC OPD 8:00 am tomonitor condition or health status or if neededor necessary.

Rationale: To inform the folks and the clientwent to go back to monitor the status and


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WardObservation

octor s r er S eetDr. B made the following orders:

please admit patient at pedia apex down


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please admit patient at pedia apex down- this is to monitor patient's condition andprovide necessary care and interventionsrelated to patient's diagnosis. Pedia apex

down is used for the admission of patientswith infectious diseases particularlygastrointestinal diseases

TPR every 4 hours and record- to monitor and note any alterations thatmay need or elicit prompt referral and

d

A w t SA- the patient is two years old and should berequired to be in SAP and because thepatient has experienced vomiting and should


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p p g

be cautioned for aspirationContinue Na K- A laboratory examination performed to

determine and correct fluid electrolyteimbalance caused by previous episodesvomiting and diarrhea

Fecalysis- a routine laboratory examination intendedto identify parasites present in thegastrointestinal tract and the extent of

Urinalysis- to provide information about the basicproperties of a urine sample and aid in diagnosis.Measures the pH and concentration check for


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Measures the pH and concentration, check forglucose, protein, the presence of bloodAPC chest x-ray right and left lung-to identify extent of damage to the lungs due to

erratic migration of the parasites to the organIVF D5 0.3 NaCl 500cc x 6h to run at 62-63cc/hr or 15-16 gtts/min; reassess at 4am

- an isotonic solution that can be used as initialfluid for hydration because it provides morewater than sodium; commonly used asmaintenance fluid

Medication: Ampicillin 250mg IVTT every 6hours ANST

-an antibiotic intended to fight the infection


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caused by the parasite invading the organsMIO every shift and record include stool andvomiting count at bedside

-to monitor GI losses in order to know howmuch is to be replaced based on the outputand to note characteristics of stool to

identify gastrointestinal function-

Replace GI loss volume/volume with PNSS

-to prevent hypovolemia and fluid and


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electrolyte imbalance)-Refer accordingly

- to prevent any complication or untoward

incidents that may need immediate medical orsurgical interventions


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7:30am Lips dry, dirty nails and untrimmed,good capillary refill, poor skin turgor,springs back after 4 seconds, pale


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p g p

bulbar and palpebral conjunctiva, noadventitious breath sounds, abdomendistended 53cm, normoactive bowel

sounds in all 4 quadrants with 7cycles/min., no abdominal pain uponpalpation, has not defecated since

after admission, separation anxietyevident, Mongolian spots on rightbuttocks and thigh about 5cm indiameter. Skin lesions on right knee and

8:00am8:15am

TSB done.Breakfast taken. Consumed 1/2 cupof rice bowl of chicken soup and


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8:30am

of rice, bowl of chicken soup andapproximately 240cc of chocolatedrink well-tolerated.Temperature rechecked. Temp. per

axilla=37.50C. TSB donecontinuously.

9:00am

9:15am

IVF consumed and followed withthe same IVF of D5 0.3 NaCl

500cc and regulated to the desiredrate.Wound dressing done.

9:30am Defecated in CR but the mother failedto get a stool specimen. Stool isformed, yellow in color with 4-6 white,

10:00am

Documents

24562629 Grandcase Presentation Intestinal Parasite With Erratic Migration Pneumonia