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]

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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.

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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

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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

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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

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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.

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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

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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.

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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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effects/ Adverse reactions

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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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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Indi

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Contraindication

Dos

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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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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.