case study intestinal parasitism, intestinal parasitism
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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.
Transcript
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 nurseThis 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 patientThis 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 SymptomsGastrointestinal 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.
II. BIOGRAPHIC DATA
NAME: Child X
AGE: 4 yrs. old
BIRTHDAY: June 25, 2005
GENDER: female
CIVIL STATUS: child
ADDRESS: Tala, Caloocan City
EDUCATIONAL LEVEL: Pre-school
RELIGION: Catholic
o CHIEF COMPLAINT: Vomiting
o MEDICAL DIAGNOSIS: Intestinal Parasitism Dehydration secondary to Vomiting and Malnutrition
III. NURSING HISTORYA. 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.
IV. ACTIVITIES OF DAILY LIVING
ADL Before hospitalization
Actual hospitalization
Interpretation and analysis
Nutrition eat her meal 3x a day
Only eat 2x a day -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 Urinate 15x a day regularly and defecate once a day regularly.
Urinate 18x a day and defecate 4x a day, she also experiencing vomiting
-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
Activity Always playing outside barefooted.
Always lying on bed. -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 parasitism.Reference: NANDA
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.
She doesn’t take bath regularly.
-Before 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.
-Prior to admission the client has poor hygiene that’s why she adopt microorganism that cause parasitism.Reference: NANDA
Substance use No medication taken
She was currently taking Diphenhydramine, Pyrantel Pamoate, Ampicillin, Gentamicin drugs.
-Before hospitalization the client did not take any medication while during hospitalization she was taking the drugs prescribed by doctor.
Sleep and rest She was able to consume normal 8-hour sleeping time.
She was experiencing difficulty of sleeping.
-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
V. PHYSICAL ASSESSMENT
Normal Actual findings Interpretation and analysis
1. General Appearance
Mood and affect
Posture
Hygiene and grooming
Types of clothing
Quantity and quality of speech
Relevance and organization of thought.
-Normally calm
-Relaxed and coordinated movement
-Well cleaned, presentable
-Accurate to the environment
-Having a good quality of speech
-Well good, having good decisions
-Irritable, signs of fatigue, restlessness
-Highly active movement (sign of angered action)
-She has unpleasant odor and has no underwear, uncut nails, and uncombed hair.
-She wears loose shirts without pants.
-she was screaming out loud.
-She was not participating and slightly disoriented.
-Check IV site carefully for signs of thrombosis or drug reaction
-Do not give IM injections in the same site.
- administer oral drug on an empty stomach, 1 hr. before or 2 hr. after meals with a full glass of water; do not give with fruit juce or softdrinks.
-avoid long-term therapies because of increased risk of toxicities
-ensure adequate hydration of patient before and during theraphy
IVFPLR
D5 0.3 Nacl
D5 IMB
Isotonic
Hypotonic
Hypertonic
1L
1L
500cc
30gtts/min
21gtts/min
30gtts/min
None
None
AmoxicillinGentamicin
Check IV order Explain/Teach pt.
Keep record of amt. Infused
Record: Type, Amount, Rate, Site
Calculate drop rate and check frequently
IX. PRIORITIZATION
NSG Problem Cues Justification
1. Deficient Fluid Volume
2. Diarrhea
3. Malnutrition
4. Hygiene
“Nanghihina siya” As verbalized by the mother.
“Nagtatae siya” As verbalized by the mother.
“Wala siyang ganang kumain” As verbalized by the mother.
“Hindi madalas napapaliguan” 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.
Self-Care Deficit r/t weakness as evidenced by untidy body.
Weakness↓
Impaired Mobility
↓Poor
Hygiene↓
Self-Care Deficit
LTG:After 72hrs of nsg intervention the patient will be able to:
1.Demonstrate behaviors, lifestyle changes to regain or maintain appropriate weight.
STG:
After 8 hrs. of nsg. Intervention, the pt. will be able to demonstrate changes to meet self-care needs:
1. Note causative factors
2. Assist in dealing the deficit
caffeinated beverages, chocolate, orange juice.
1.1Encourage the client to choose food and have family member bring foods that seem appealing,
1.2Promote adequate or timely fluid intake, limit fluids 1hr prior to meal.
1.1 Note the age of the pt.
1.2 Assess barriers to participation in regimen
2.1 Provide for communication among those who are involved in caring
1.1Stimulate appetite.
1.2To reduce possibility of early satiety.
1.1 To assess ability of pt. to meet own needs
1.2 To gain and enhance cooperation
2.1 Enhances coordination and continuity of care
After 72hrs of nsg intervention the patient was able to:
1. Acheived optimum weight.
After 8 hrs. of nsg. Intervention, the pt. was able to:
1. Causative factors noted and studied
2.Patient assisted on dealing the deficit
3. Promote wellness on pt.
LTG:
1. Assist in change in lifestyle
for/assisting the client
2.2 Encourage food and fluid choices reflecting individuals likes
3.1 Review safety concern
3.2 Give family information about care.
1.1 Provide proper health teaching/hygiene teaching in the pt.
2.2 To meet nutritional needs
3.1 To reduce risk of injury
3.2 Allow them to realize the situation of the pt. and make lifestyle change as appropriate
3. Wellness promoted
1. Assisted changes on lifestyle.
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.
