Case Study Intestinal Parasitism

I.

INTRODUCTION Background Study

We, the group A2, have chosen to present a case of Intestinal Parasitism because we want to broaden our knowledge in this kind of disease and on how to prevent this in our own special way. Significance of the study ➢ As a student nurse This study will enable the students to understand better about Intestinal Parasitism and will explain the different risk factors for developing the disease, including consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation Since we are client-centered, we really should consider our patient’s comfort and this study will give the students sufficient knowledge that will help them to plan and implement nursing care plans that will satisfy patient’s needs. ➢ To the patient This study will enable the patient to recognize factors affecting her health status and be able to inform everything that will be helpful in the prevention of the disease. Scope and Limitations This study includes the collection of information specifically to the patient’s health condition. The study also includes the assessment of the physiological and psychological status, adequacy of support systems and care given by the family as well as the other health care provider. Goal and Objectives Goal: This study aims to convey familiarity and to provide an effective nursing care to a patient diagnosed with Intestinal Parasitism through understanding the patient history, disease process and management. Objectives: 1. To discuss the anatomy and physiology, pathophysiology of the patient’s condition, usual clinical manifestations and possible complications of this condition. 2. To have knowledge to the client medication and be familiar to that medication. 3. To formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to help the patient recover. Overview of Disease

Intestinal Parasitism- Infestation of the intestinal lumen and wall by nematodes, cestodes and immature trematodes.

Signs and Symptoms Gastrointestinal complaints such as pain, diarrhea, nausea, and perianal itching are common in many intestinal parasitic infestations. Parasites cause morbidity in humans in different ways, by: · affecting nutritional equilibrium · inducing intestinal bleeding · inducing malabsorption of nutrients · competing for absorption of micronutrients · reducing growth · reducing food intake · causing surgical complications such as obstruction, rectal prolapse and abscess · affecting cognitive development. The GI tract may be inhabited by many species of parasites. Their cycles may be direct, in which eggs and larvae are passed in the feces and stadial development occurs to the infective stage, which is then ingested by the final host. Alternatively, the immature stages may be ingested by an intermediate host (usually an invertebrate) in which further development occurs, and infection is acquired when the intermediate host or free-living stage shed by that host is ingested by the final host. Sometimes, there is no development in the intermediate host, in which case it is known as a transport or paratenic host, depending on whether the larvae are encapsulated or in the tissues. Clinical parasitism depends on the number and pathogenicity of the parasites, which depend on the biotic potential of the parasites or, when appropriate, their intermediate host and the climate and management practices. In the host, resistance, age, nutrition, and concomitant disease also influence the course of parasitic infection. Anatomy and Physiology of Affected Organ System DIGESTIVE SYSTEM The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste. Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas)

that produce or store digestive chemicals.

The Digestive Process: The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules). On the way to the stomach: the esophagus – After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down. In the stomach – The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.

In the small intestine – After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in

the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food. In the large intestine – After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon. The end of the process – Solid waste is then stored in the rectum until it is excreted via the anus. I.

BIOGRAPHIC DATA NAME:

Child X

AGE:

4 yrs. old

BIRTHDAY:

June 25, 2005

GENDER:

female

CIVIL STATUS: ADDRESS:

child Tala, Caloocan City

EDUCATIONAL LEVEL: RELIGION:

I.

Pre-school

Catholic

○

CHIEF COMPLAINT: Vomiting

○

MEDICAL DIAGNOSIS: secondary to Vomiting

Intestinal Parasitism Dehydration and Malnutrition

NURSING HISTORY A. Past Health History In past health history of the patient she completed all vaccines including 1 dose of BCG, 3 doses of OPV, DPT and Hep B and a dose of measles. And are all given at Rural Health Unit in their Barangay. Child X doesn’t have any record of accidents, surgeries, and allergies, but she was hospitalized last year with the same diagnosis. The patients haven’t taken any medication and herbal medicine. B. History of Present Illness The patient brought by her mother in Dr. Jose Rodriguez Memorial Hospital (Tala, Caloocan City) last August 27, 2009 with a chief

complaint of watery stool accompanied by vomiting and headache. Two days prior to admission the mother of the patient noticed that her daughter Child X was not feeling well as evidenced by sudden loss of energy, paleness and dryness of skin. The mother observed also that there is a change in Child X bowel habit and form of bowel. The symptoms revealed and got worse that’s why the mother decided to brought Child X in the hospital to seek consultation. The diagnosis was Intestinal Parasitism Dehydration secondary to Vomiting and Malnutrition as supported by laboratory findings and diagnostic procedure done. C. Family History According to the mother of Child X, they have no history of any disease like TB, heart disease, Syphilis, Diabetes, etc. They are six in the family including her husband which is a construction worker, her four children (15, 14, 4, and 1 yr. of age) and her. The mother stated also that since her husband has no stable job, their meals daily was not stable also, there are times that they eat 2 times a day or it also happened that they eat only once a day. D. Pediatric Health History The mother of the patient verbalized that she delivered all their children in their house by a ‘Hilot’. And she breastfeed all her children though Child X started solid foods like lugaw when she was six mo. old. I.

ACTIVITIES OF DAILY LIVING

ADL Nutrition

Before hospitalization eat her meal 3x a day

Actual hospitalization Only eat 2x a day

Interpretation and analysis -Before hospitalization, the client takes her meal 3x a day while during hospitalization she only eats 2x a day. -The client experiencing loss of appetite that’s why she only takes twice a day for her meal. Reference: Fundamentals of Nursing by Kozier, Chapter 47 pg. 1238

Elimination

Activity

Urinate 15x a day regularly and defecate once a day regularly.

Always playing outside barefooted.

Urinate 18x a day and defecate 4x a day, she also experiencing vomiting

Always lying on bed.

-The client urinate 4x a day regularly and defecate once a day daily while during hospitalization the client urinate 3x a day and defecate 4x a day, she also experiencing vomiting. -The client always demands for water because she was experiencing severe thirst that’s why she urinates frequently. And regarding her fecal elimination, the client is experiencing loose watery stool. Reference: Fundamentals of Nursing by Kozier, Chapter 48 -Before hospitalization the client was always playing outside while during hospitalization she was always lying on bed. - Prior to admission the client always play barefooted that’s why she adopt microorganism that cause

Hygiene

She was not taking a bath regularly; she only took 4 times a week. She also frequently eats with her bare hands and sometimes forgot to wash hands before and after meals.

parasitism. Reference: NANDA She doesn’t take -Before bath regularly. hospitalization the client was not taking a bath regularly; she only took 4 times a week. She also frequently eats with her bare hands and sometimes forgot to wash hands before and after meals while during hospitalization the number of days taking a bath was lessen.

Substance use No medication taken

She was currently taking Diphenhydramin e, Pyrantel Pamoate, Ampicillin, Gentamicin drugs.

Sleep and rest

She was experiencing difficulty of sleeping.

She was able to consume normal 8-hour sleeping time.

-Prior to admission the client has poor hygiene that’s why she adopt microorganism that cause parasitism. Reference: NANDA -Before hospitalization the client did not take any medication while during hospitalization she was taking the drugs prescribed by doctor. -Before hospitalization she sleeps normally while during hospitalization she was experiencing difficulty of

sleeping. -The client experienced difficulty of sleeping because of gastric irritability due to her diagnosis. Reference: Fundamentals of Nursing by Kozier, Chapter 45 II.

PHYSICAL ASSESSMENT

Normal 1. General Appearance • Mood and affect -Normally calm

•

Posture

•

Hygiene and grooming

•

•

•

Types of clothing

Quantity and quality of speech Relevance and organization of thought.

-Relaxed and coordinated movement -Well cleaned, presentable

-Accurate to the environment -Having a good quality of speech -Well good, having good decisions

Actual findings

Interpretation and analysis

-Irritable, signs of fatigue, restlessness

-The patient feels uncomfortable , undesirable actions.

-Highly active movement (sign of angered action)

-The patient has a good posture.

-She has unpleasant odor and has no underwear, uncut nails, and uncombed hair.

-The patient lacks proper hygiene.

-She wears loose shirts without pants.

- not presentable

-she was screaming out loud. -She was not participating and slightly disoriented.

-She possesses signs of irritability. -She was

anxious.

2. Vital signs Body temp

36.5˚C-37.5˚C

36.5˚C

Within normal range of body temp.

Pulse rate

80-160bpm

70bpm

low pulse rate

Respiratory rate

30-60cpm

24cpm

low respiratory rate

Before: 13kgs. Current: 9kgs.

-Active weight loss that leads to malnutrition

Height Weight

Body Parts

Normal Findings

Actual Findings

Skin

-The skin is normally uniform, whitish pink or brown in color depending on the race of the patient.

-She has rough, and dry skin, has lesions in her left leg.

Head

Eyes

Ears

-The head should be normocephalic and symmetrical, normal skull is smooth, non tender and w/o masses and depressions. -The eyes are normally aligned; there should not be excessive discharge from the lacrimal duct. -The ear color should match the color of the rest of the body.

Interpretation and Analysis - Not normal, accdg. To Kozier it is signs of dehydration bec. Of active loss of body fluids.

-Normal

- Sunken eyeball -Not normal accdg. To Kozier, It is sign of dehydration, restlessness

-No discharges noted -Normal

Should be positioned centrally in proportion to the head.

Nose

Mouth

Chest

Abdomen

-It is located symmetrically in the middle of the face and must not have presence of lesions and masses. -The lips and membranes should be pink and moist and to show no evidence of lesions or inflammation -Antero-posterior diameter is equal to transverse diameter shape is

-No discharges noted

- Normal

- Dry mucous membrane

- Not normal, accdg. To Kozier it is a sign of dehydration

- Chest is symmetrical

-Normal

-Bloated

-Not normal, accdg. To Kozier, this sign is caused by decrease absorption of food bec. The GI tract are dysfunctional.

-Abdominal contour is flat and no abdominal pain

I.

Laboratory and diagnostic Examination result

Procedure

Normal Range

Result

RBC

3:50 : 5:50

4.13

HCT

38.0 : 48.0

L37.3

PLT

150 : 450

255

Interpretation and analysis Within normal range Below normal range, it may indicate anemia Within normal range

WBC

5.0 : 10.0

#17.2DE Above normal range, it may indicate a particular disorder

HGB

12.0 : 14.0

12.8 Within normal range

LYM %

25.0 : 40.0

L24.3 Within normal range

GRA % MID %

45.0 : 6.0 2.0 : 15.0

68.4 7.3

Above normal range, it may indicate Within normal range

II.

DRUG STUDY

Generic IVF/ Trade name

Dosage / Classification CLASSIFICATI BOTTLE#Indication FLOW Frequency ON RATE

Contraindica Side effects Nursing DRUG NSG RESPONSIBILITY tion Responsibi INCORPORATE lities D

Ampicillin PLR (AMPICIN)

TIVP 320 Antibiotic Isotonic 1L mg. Q8 Penicillin

Hypersensi None tivity to penicillins

D5 0.3 Nacl

Hypotonic

1L

Hypertonic

Treatment of 30gtts/mi infection n caused by Gr (+) and Gr 21gtts/mi (-) bacteria n

500cc

D5 IMB 30gtts/mi n

Gentamicin (PEDIATRIC GENTAMICIN SULFLATE)

TIVP 25mg q12

Aminoglyco side

Serious infections when causative organisms are not known (often conjunction with a penicillin or cephalospori n)

None

-CNS: • Check IV-Check order IV lethargy, site pt. • Explain/Teach hallucinations, carefully • Keep record of seizures. for signs amt. Infused -GI: glossitis, of

stomatitis, • Record: thrombos Type, gastritis, sore is or drug Amount, Rate, Amoxicillin reaction Site Gentamicin mouth, furry tongue, • black Calculate drop “hairy” rate and -Do not check tongue, frequently give IM nausea, injections vomiting, in the diarrhea, same abdominal site. pain, bloody diarrhea, enterocolitis, pseudomembr administe r oral anous colitis, drug on non-specific an empty hepatitis. stomach, -GU: nephritis 1 hr. before or -Hematologic: 2 hr. after Anemia, thrombocytop meals with a full enia, glass of leucopenia, water; do neutropenia, not give prolonged bleeding time. with fruit juce or softdrinks Hypersensitivi . ty: Rash, fever, wheezing, anaphylaxis.

contraindic ated with allergy to any aminoglyco iside

-Local: Pain, phlebitis, thrombosis at injection site (parenteral) -Other: Superinfection s, oral and rectal

IX.

PRIORITIZATION NSG Problem

1. Deficient Fluid Volume

2. Diarrhea

3.

Malnutrition

4. Hygiene

IX.

Cues

Justification

“Nanghihina siya” As verbalized by the mother.

1. According to Maslow’s Hierarchy of needs, fluids are the 2nd important on physiological needs. 2. According to Maslow’s Hierarchy of needs, fluids are the 2nd important on physiological needs. 3. According to Maslow’s Hierarchy of needs, fluids are the 3rd most important need. 4. According to Henderson 14 fundamental needs, Hygiene is 8th most important needs.

“Nagtatae siya” As verbalized by the mother.

“Wala siyang ganang kumain” As verbalized by the mother.

“Hindi madalas napapaliguan” as verbalized by the mother.

NURSING CARE PLAN

ASSESSME NT S: “Nanghihin a siya” as verbalized by the mother. O: -dry skin restlessne ss -sunken eyeballs V/S: T: 36.4˚C PR: 70bpm RR: 24cpm

DIAGNOSI S

Deficient fluid volume r/t to Active fluid volume loss as manifeste d by diarrhea and vomiting.

INFERENC E

Active fluid volume loss ↓ Vomiting ↓ Abdomina l Irritability ↓ Intake of contamin ated of food and water ↓ Diarrhea ↓ Deficient fluid volume

PLANNING

INTERVENTIO N

RATIONA LE

STG: After 8hrs of nsg interventio n the patient will be able to:

1.Assess Precipitatin g factors

2.Evaluate degree of fluid deficit

1.1Determin e effects of age

2.1Assess vital signs: note strength of peripheral pulses

2.2Determin e customary and current weight

3.Correct/ replace lossess to reverse pathophysi

3.1Establish 24hr of fluid replacement

1.1Childr en have a relatively high percenta ge of total body water, are sensitive to loss, and are less able to control their fluid intake

2.1To obtain baseline data and to have a comparis on

EVALUTIO N

After 8hrs of nsg interventio n the goal was met as evidence by: 1. Assessed precipitati ng factors.

2.Evaluate d degree of fluid deficit.

2.2To assess the degree of dehydrat ion 3.Correcte d/

XI. DISCHARGE PLAN Patients with Intestinal Parasitism, watchers are instructed to take the following plan for discharge: E- Exercise should be promoted in a way by stretching hand and feet every morning and exercise burping every after meal. T- Treatment after discharge is expected for patients and watcher with Intestinal Parasitism to fully participate in continuous treatment. - Usually supportive, treatment consists of nutritional support and increase fluid intake. H- Health teaching for clients with Intestinal parasitism includes: promotion of personal hygiene should be encouraged such as, daily bathing and always wash hands w/ warm water and soap handling foods, esp. after using the bathroom. O- OPD such as regular follow-up check-ups should be greatly encouraged to client’s watcher with Intestinal Parasitism as ordered by physician to ensure the continuing management and treatment. D- Diet should be promoted, such as soft and bland diet that cannot irritate the GI tract.

Submitted to: Mr. Felix SP. Aquino, RN

Submitted by:

BSN 103-A/ Group A2 Flores, Ma. Fe Gabriel, Ivy Garcia, Kesselyn Garingo, Jeovina Gumasing, Mary Janine Gutierrez, Sunshine Hernandez, Baby Jane Lamurena, Jacquelyn Lopez, Christine Anne Lualhati, Richard Mapiscay, Ma. Richel Mendoza, Rosa Mia Nicolas, Jean Therese