a case study on ameobiasis

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Pamantasan ng Cabuyao Banay-banay, Cabuyao, Laguna
COLLEGE OF NURSING

A CASE STUDY on

Duodenal Amoebiasis
Members: Cagalawan, Ma. Sydney Casil, Gerlyn Kay Ebron, John Don Intong, Marjorie Lopez, Khyra Gem Nocos, Sharmain Mae Palisoc, Arvin John

LEARNING OBJECTIVES

General objective To gain knowledge and to further understand the nature and extent of the disease so as to prepare and arm ourselves with knowledge whenever we encounter same case in the future. And also to have a clear and better understanding about duodenal amoebiasis particularly on its disease process, treatment, diagnostic exam, preventive measure and nursing management. Specific objectives • • • To describe physiologic changes that may occur in patient. Formulate nursing diagnosis related to physiologic transition of patient. Plan nursing care related to the needs of the patient.

INTRODUCTION

INTESTINAL AMOEBIASIS Amoebiasis, or Amebiasis, refers to infection caused by the amoeba Entamoeba histolytica. The term Entamoebiasis is occasionally seen but is no longer in use it refers to the same infection. A gastrointestinal infection that may or may not be symptomatic and can remain latent in an infected person for several years, amoebiasis is estimated to cause 70,000 deaths per year world wide. Symptoms can range from mild diarrhea to dysentery with blood and mucus in the stool. E. histolytica is usually a commensal organism. Severe amoebiasis infections (known as invasive or fulminant amoebiasis) occur in two major forms. Invasion of the intestinal lining causes amoebic dysentery or amoebic colitis. If the parasite reaches the bloodstream it can spread through the body, most frequently ending up in the liver where it causes amoebic liver abscesses. Liver abscesses can occur without previous development of amoebic dysentery. When no symptoms are present, the infected individual is still a carrier, able to spread the parasite to others through poor hygienic practices. While symptoms at onset can be similar to bacillary dysentery, amoebiasis is not bacteriological in origin and treatments differ, although both infections can be prevented by good sanitary practices. Most infected people, about 90%, are asymptomatic, but this disease has the potential to make the sufferer dangerously ill. It is estimated that about 40,000 to 100,000 people worldwide die annually due to amoebiasis. Infections can sometimes last for years. Symptoms take from a few days to a few weeks to develop and manifest themselves, but usually it is about two to four weeks. Symptoms can range from mild diarrhea to severe dysentery with blood and mucus. The blood comes from lesions formed by the amoebae invading the lining of the large intestine. In about 10% of invasive cases the amoebae enter the bloodstream and may travel to other organs in the body. Most commonly this means the liver, as this is where blood from the intestine reaches first, but they can end up almost anywhere in the body. Onset time is highly variable and the average asymptomatic infection persists for over a year. It is theorised that the absence of symptoms or their intensity may vary with such factors as strain of amoeba, immune response of the host, and perhaps associated bacteria and viruses. In asymptomatic infections the amoeba lives by eating and digesting bacteria and food particles in the gut, a part of the gastrointestinal tract.. It does not usually come in contact with the intestine itself due to the protective layer of mucus that lines the gut. Disease occurs when amoeba comes in contact with the cells lining the intestine. It then secretes the same substances it uses to digest bacteria, which include enzymes that destroy cell membranes and proteins. This process can lead to penetration and digestion of human tissues, resulting first in flask-shaped ulcers in the intestine. Entamoeba histolytica ingests the destroyed cells by phagocytosis and is often seen with red blood cells (a process known

as erythrophagocytosis) inside when viewed in stool samples. Especially in Latin America, a granulomatous mass (known as an amoeboma) may form in the wall of the ascending colon or rectum due to long-lasting immunological cellular response, and is sometimes confused with cancer. "Theoretically, the ingestion of one viable cyst can cause an infection. Amoebiasis is an infection caused by the amoeba Entamoeba histolytica Likewise amoebiasis is sometimes incorrectly used to refer to infection with other amoebae, but strictly speaking it should be reserved for Entamoeba histolytica infection. Other amoebae infecting humans include: • Parasites o o o o o o o Dientamoeba fragilis, which causes Dientamoebiasis Entamoeba dispar Entamoeba hartmanni Entamoeba coli Entamoeba moshkovskii Endolimax nana and Iodamoeba butschlii.

Except for Dientamoeba, the parasites above are not thought to cause disease. • Free living amoebas. These species are often described as "opportunistic free-living amoebas" as human infection is not an obligate part of their life cycle. o Naegleria fowleri, which causes Primary amoebic meningoencephalitis o o o Acanthamoeba, which causes Cutaneous amoebiasis and Acanthamoeba keratitis Balamuthia mandrillaris, which causes Granulomatous amoebic encephalitis and Primary amoebic meningoencephalitis Sappinia diploidea

Transmission Amoebiasis is usually transmitted by the fecal-oral route, but it can also be transmitted indirectly through contact with dirty hands or objects as well as by anal-oral contact. Infection is spread through ingestion of the cyst form of the parasite, a semi-dormant and hardy structure found in feces. Any non-encysted amoebae, or trophozoites, die quickly after leaving the body but may also be present in stool: these are rarely the source of new infections. Since amoebiasis is transmitted through contaminated food and water, it is often endemic in regions of the world with limited modern sanitation systems, including México, Central America, western South America, South Asia, and western and southern Africa. Amoebic dysentery is often confused with "traveler's diarrhea" because of its prevalence in developing nations. In fact, most traveler's diarrhea is bacterial or viral in origin. Diagnosis Immature E. histolytica/E. dispar cyst in a concentrated wet mount stained with iodine. This early cyst has only one nucleus and a glycogen mass is visible (brown stain). From CDC’s Division of Parasitic Diseases Asymptomatic human infections are usually diagnosed by finding cysts shed in the stool. Various flotation or sedimentation procedures have been developed to recover the cysts from fecal matter and stains help to visualize the isolated cysts for microscopic examination. Since cysts are not shed constantly, a minimum of three stools should be examined. In symptomatic infections, the motile form (the trophozoite) can often be seen in fresh feces. Serological tests exist and most individuals (whether with symptoms or not) will test positive for the presence of antibodies. The levels of antibody are much higher in individuals with liver abscesses. Serology only becomes positive about two weeks after infection. More recent developments include a kit that detects the presence of amoeba proteins in the feces and another that detects ameba DNA in feces. These tests are not in widespread use due to their expense. Amoebae in a colon biopsy from a case of amoebic dysentery. Microscopy is still by far the most widespread method of diagnosis around the world. However it is not as sensitive or accurate in diagnosis as the other tests available. It is important to distinguish the E. histolytica cyst from the cysts of nonpathogenic intestinal protozoa such as Entamoeba coli by its appearance. E. histolytica cysts have a maximum of four nuclei, while the commensal Entamoeba coli cyst has up to 8 nuclei. Additionally, in E. histolytica, the endosome is centrally located in the nucleus, while it is usually off-center in Entamoeba coli. Finally, chromatoidal bodies in E. histolytica cysts are rounded, while they are jagged in Entamoeba coli. However, other species, Entamoeba dispar and E. moshkovskii, are also commensals and cannot be distinguished from E. histolytica under the microscope. As E. dispar is much more common than E. histolytica in most parts of the world this means that there is a lot of incorrect diagnosis of E. histolytica infection taking place. The WHO

recommends that infections diagnosed by microscopy alone should not be treated if they are asymptomatic and there is no other reason to suspect that the infection is actually E. histolytica. Typically, the organism can no longer be found in the feces once the disease goes extra-intestinal. Serological tests are useful in detecting infection by E. histolytica if the organism goes extra-intestinal and in excluding the organism from the diagnosis of other disorders. An Ova & Parasite (O&P) test or an E. histolytica fecal antigen assay is the proper assay for intestinal infections. Since antibodies may persist for years after clinical cure, a positive serological result may not necessarily indicate an active infection. A negative serological result however can be equally important in excluding suspected tissue invasion by E. histolytica. Prevention Amoebic Ulcer Intestine To help prevent the spread of amoebiasis around the home : • Wash hands thoroughly with soap and hot running water for at least 10 seconds after using the toilet or changing a baby's diaper, and before handling food. • • Clean bathrooms and toilets often; pay particular attention to toilet seats and taps. Avoid sharing towels or face washers.

To help prevent infection: • • • Avoid raw vegetables when in endemic areas, as they may have been fertilized using human feces. Boil water or treat with iodine tablets. Avoid eating street foods especially in public places where others are sharing sauces in one container

Good sanitary practice, as well as responsible sewage disposal or treatment, are necessary for the prevention ofE.histolytica infection on an endemic level. E.histolytica cysts are usually resistant to chlorination, therefore sedimentation and filtration of water supplies are necessary to reduce the incidence of infection.

E. histolytica cysts may be recovered from contaminated food by methods similar to those used for recoveringGiardia lamblia cysts from feces. Filtration is probably the most practical method for recovery from drinking water and liquid foods. E. histolytica cysts must be distinguished from cysts of other parasitic (but nonpathogenic) protozoa and from cysts of free-living protozoa as discussed above. Recovery procedures are not very accurate; cysts are easily lost or damaged beyond recognition, which leads to many falsely negative results in recovery tests. Treatment E. histolytica infections occur in both the intestine and (in people with symptoms) in tissue of the intestine and/or liver. As a result, two different classes of drugs are needed to treat the infection, one for each location. Such anti-amoebic drugs are known as amoebicides. Prognosis In the majority of cases, amoebas remain in the gastrointestinal tract of the hosts. Severe ulceration of the gastrointestinal mucosal surfaces occurs in less than 16% of cases. In fewer cases, the parasite invades the soft tissues, most commonly the liver. Only rarely are masses formed (amoebomas) that lead to intestinal obstruction.(Mistaken for Ca caecum and appendicular mass) Other local complications include bloody diarrhea, pericolic and pericaecal abscess. Complications of hepatic amoebiasis includes subdiaphragmatic abscess, perforation of diaphgram to pericardium and pleural cavity, perforation to abdominal cavital (amoebic peritonitis) and perforation of skin (amoebic cutis). Pulmonary amoebiasis can occur from hepatic lesion by haemotagenous spread and also by perforation of pleural cavity and lung. It can cause lung abscess, pulmono pleural fistula, empyema lung and broncho pleural fistula. It can also reach brain through blood vessel and cause amoebic brain abscess and amoebic meningoencephalitis. Cutaneous amoebiasis can also occur in skin around sites of colostomy wound, perianal region, region overlying visceral lesion and at the site of drainage of liver abscess. Urogenital tract amoebiasis derived from intestinal lesion can cause amoebic vulvovaginitis (May's disease), rectovesicle fistula and rectovaginal fistula. Entamoeba histolytica infection is associated with malnutrition and stunting of growth.

CASE ABSTRACT

Case Abstract: Patient X rented a house at San Cristobal, Calamba , Laguna. He is 4 yrs old boy, Roman Catholic. They are two siblings in the family and he is the eldest. At January 13,2014 at around 4pm patient was rush by his mother at Ospital ng Cabuyao. Patient X was received at Emergency Department with the Chief Complaint of LBM with Temperature – 37 °C, Cardiac rate -122 bpm , and increased RR – 32 bpm with the present of body weakness, , č sign and symptoms of dehydration such as pale looking with capillary of 3 seconds . He was hook IV of D5 0.3 NaCl 500cc x 83.84 gtts/min. Patient X attend by Doctor B at the same day he was confined at pediaward. During his Second day of hospitalization Patient X experienced an elevated body Temperature 38°C. He was given paracetamol as PRN ordered. He also experienced poor appetite. At the next day as we go back to rendered nursing care the mother told us that she said Patient X vomit and deficated 7x. January 15, 2014 Patient X noted an improvement such as he can walk, has an increase appetite and as the mother verbalized if Patient X does not experience increased body temperature they can go home.

PATIENT ASSESSMENT DATA BASE

PART I : PATIENT ASSESSMENT DATA BASE

Name of Patient: Age: Sex: Weight: Nationality: Civil Status: Religion: Source of Income: Rank in the Family: Address: Admission Date and Time: Attending Physician: Initial Diagnosis: Source of History: Chief Complaint:

Patient X 4 years old Male 23kg Filipino Child Roman Catholic Father Child Bel Flor Subdivision San Cristobal,Calamba City January 13, 2014/4:45pm Dr.B. Intestinal Amoebiasis Mother LBM

HEALTH HISTORY

HEALTH PERCEPTION PATTERN Present History One day prior to admission, the patient defecated three times with semi-formed stool and light brown in color. After an hour, he experienced a gastric pain and vomit three times. In this incident, the mother of the patient gave 500ml of Gatorade to drink. An hour prior to admission, the patient defecated and vomit seven times. The patient also felt body weakness, in this case the mother of the patient decided to rush him in hospital. Past History The patient completed his immunization. He doesn’t have any allergies on foods or drugs. He never experienced of having childhood illness like chickenpox, mumps or measles. According to his mother he was rush to JP Rizal in 2010 because he had a pneumonia and in 2011 because of having convulsion. Developmental Stage Developmental Stage Erikson’s Psychosocial Model Initiative vs. Guilt >Cooperate with others >Lack of self-confidence Piaget’s Cognitive Theory Pre-Conceptual Operation >Magical thinking >No cause and effect reasoning Normal Findings >Broaden his skill through active play Significant >Patient X able to broaden his skills through active play outside the house with his playmate according to his mother. > Patient X was able to cooperate with others especially when playing outside the house >Patient X has a lack of self-confident especially when talking to other people he didn’t know. >Patient X has no cause and effect regarding to reasoning to his mother when committing mistake. >Patient X used magical thinking in drawing different kinds of characters.

Freud’s Psychosexual Model Phallic Sullivan’s Interpersonal Model Juvenile

>Touching of genital >Learns to relate to peers >Competition, compromise and cooperation

>According to his mother, patient X used to touch his genital especially when he was curious about it. >Patient X like to play with other rather than playing alone. >Patient X used to compete, compromise and cooperate to his peers when talking about playing. >Patient X learned how to walk, he even run during playtime. >Patient X know how to control his elimination of body waste but because of diarrhea he didn’t control his elimination pattern. >Patient X learned to relate regarding parent relationship when his mother is getting mad at him.

Havighurst’s Developmental Task Infancy and Early Childhood

>Learning to walk >Learning to control the elimination of body waste >Learning to relate parent relationship

PHYSICAL ASSESSMENT

ANATOMY AND PHYSIOLOGY

The digestive system is a group of organs working together to convert food into energy and basic nutrients to feed the entire body. Food passes through a long tube inside the body known as the alimentary canal or the gastrointestinal tract (GI tract). The alimentary canal is made up of the oral cavity, pharynx, esophagus, stomach, small intestines, and large intestines. In addition to the alimentary canal, there are several important accessory organs that help your body to digest food but do not have food pass through them. Accessory organs of the digestive system include the teeth, tongue, salivary glands, liver, gallbladder, and pancreas. To achieve the goal of providing energy and nutrients to the body, six major functions take place in the digestive system:

Ingestion Secretion Mixing and movement Digestion Absorption Excretion Digestive System Anatomy

Mouth Food begins its journey through the digestive system in the mouth, also known as the oral cavity. Inside the mouth are many accessory organs that aid in the digestion of food—the tongue, teeth, and salivary glands. Teeth chop food into small pieces, which are moistened by saliva before the tongue and other muscles push the food into the pharynx. Teeth. The teeth are 32 small, hard organs found along the anterior and lateral edges of the mouth. Each tooth is made of a bone-like substance called dentin and covered in a layer of enamel—the hardest substance in the body. Teeth are living organs and contain blood vessels and nerves under the dentin in a soft region known as the pulp. The teeth are designed for cutting and grinding food into smaller pieces. Tongue. The tongue is located on the inferior portion of the mouth just posterior and medial to the teeth. It is a small organ made up of several pairs of muscles covered in a thin, bumpy, skin-like layer. The outside of the tongue contains many rough papillae for gripping food as it is moved by the tongue’s muscles. The taste buds on the surface of the tongue detect taste molecules in food and connect to nerves in the tongue to send taste information to the brain. The tongue also helps to push food toward the posterior part of the mouth for swallowing. Salivary Glands. Surrounding the mouth are 3 sets of salivary glands. The salivary glands are accessory organs that produce a watery secretion known as saliva. Saliva helps to moisten food and begins the digestion of carbohydrates. The body also uses saliva to lubricate food as it passes through the mouth, pharynx, and esophagus. Pharynx The pharynx, or throat, is a funnel-shaped tube connected to the posterior end of the mouth. The pharynx is responsible for the passing of masses of chewed food from the mouth to the esophagus. The pharynx also plays an important role in the respiratory system, as air from the nasal cavity passes through the pharynx on its way to the larynx and eventually the lungs. Because the pharynx serves two different functions, it contains a flap of tissue known as the epiglottis that acts as a switch to route food to the esophagus and air to the larynx. Esophagus The esophagus is a muscular tube connecting the pharynx to the stomach that is part of the upper gastrointestinal tract. It carries swallowed masses of chewed food along its length. At the inferior end of the esophagus is a muscular ring called the lower esophageal sphincter or cardiac sphincter. The function of this sphincter is to close of the end of the esophagus and trap food in the stomach.

Stomach The stomach is a muscular sac that is located on the left side of the abdominal cavity, just inferior to the diaphragm. In an average person, the stomach is about the size of their two fists placed next to each other. This major organ acts as a storage tank for food so that the body has time to digest large meals properly. The stomach also contains hydrochloric acid and digestive enzymes that continue the digestion of food that began in the mouth. Small Intestine The small intestine is a long, thin tube about 1 inch in diameter and about 10 feet long that is part of the lower gastrointestinal tract. It is located just inferior to the stomach and takes up most of the space in the abdominal cavity. The entire small intestine is coiled like a hose and the inside surface is full of many ridges and folds. These folds are used to maximize the digestion of food and absorption of nutrients. By the time food leaves the small intestine, around 90% of all nutrients have been extracted from the food that entered it. Liver and Gallbladder The liver is a roughly triangular accessory organ of the digestive system located to the right of the stomach, just inferior to the diaphragm and superior to the small intestine. The liver weighs about 3 pounds and is the second largest organ in the body. The liver has many different functions in the body, but the main function of the liver in digestion is the production of bile and its secretion into the small intestine. The gallbladder is a small, pear-shaped organ located just posterior to the liver. The gallbladder is used to store and recycle excess bile from the small intestine so that it can be reused for the digestion of subsequent meals. Pancreas The pancreas is a large gland located just inferior and posterior to the stomach. It is about 6 inches long and shaped like short, lumpy snake with its ―head‖ connected to the duodenum and its ―tail‖ pointing to the left wall of the abdominal cavity. The pancreas secretes digestive enzymes into the small intestine to complete the chemical digestion of foods.

Large Intestine The large intestine is a long, thick tube about 2 ½ inches in diameter and about 5 feet long. It is located just inferior to the stomach and wraps around the superior and lateral border of the small intestine. The large intestine absorbs water and contains many symbiotic bacteria that aid in the breaking down of wastes to extract some small amounts of nutrients. Feces in the large intestine exit the body through the anal canal.

Digestive System Physiology
The digestive system is responsible for taking whole foods and turning them into energy and nutrients to allow the body to function, grow, and repair itself. The six primary processes of the digestive system include: Ingestion of food Secretion of fluids and digestive enzymes Mixing and movement of food and wastes through the body Digestion of food into smaller pieces Absorption of nutrients Excretion of wastes Ingestion The first function of the digestive system is ingestion, or the intake of food. The mouth is responsible for this function, as it is the orifice through which all food enters the body. The mouth and stomach are also responsible for the storage of food as it is waiting to be digested. This storage capacity allows the body to eat only a few times each day and to ingest more food than it can process at one time. Secretion In the course of a day, the digestive system secretes around 7 liters of fluids. These fluids include saliva, mucus, hydrochloric acid, enzymes, and bile. Saliva moistens dry food and contains salivary amylase, a digestive enzyme that begins the digestion of carbohydrates. Mucus serves as a

protective barrier and lubricant inside of the GI tract. Hydrochloric acid helps to digest food chemically and protects the body by killing bacteria present in our food. Enzymes are like tiny biochemical machines that disassemble large macromolecules like proteins, carbohydrates, and lipids into their smaller components. Finally, bile is used to emulsify large masses of lipids into tiny globules for easy digestion. Mixing and Movement The digestive system uses 3 main processes to move and mix food: Swallowing. Swallowing is the process of using smooth and skeletal muscles in the mouth, tongue, and pharynx to push food out of the mouth, through the pharynx, and into the esophagus. Peristalsis. Peristalsis is a muscular wave that travels the length of the GI tract, moving partially digested food a short distance down the tract. It takes many waves of peristalsis for food to travel from the esophagus, through the stomach and intestines, and reach the end of the GI tract. Segmentation. Segmentation occurs only in the small intestine as short segments of intestine contract like hands squeezing a toothpaste tube. Segmentation helps to increase the absorption of nutrients by mixing food and increasing its contact with the walls of the intestine. Digestion Digestion is the process of turning large pieces of food into its component chemicals. Mechanical digestion is the physical breakdown of large pieces of food into smaller pieces. This mode of digestion begins with the chewing of food by the teeth and is continued through the muscular mixing of food by the stomach and intestines. Bile produced by the liver is also used to mechanically break fats into smaller globules. While food is being mechanically digested it is also being chemically digested as larger and more complex molecules are being broken down into smaller molecules that are easier to absorb. Chemical digestion begins in the mouth with salivary amylase in saliva splitting complex carbohydrates into simple carbohydrates. The enzymes and acid in the stomach continue chemical digestion, but the bulk of chemical digestion takes place in the small intestine thanks to the action of the pancreas. The pancreas secretes an incredibly strong digestive cocktail known as pancreatic juice, which is capable of digesting lipids, carbohydrates, proteins and nucleic acids. By the time food has left the duodenum, it has been reduced to its chemical building blocks—fatty acids, amino acids, monosaccharides, and nucleotides.

Absorption Once food has been reduced to its building blocks, it is ready for the body to absorb. Absorption begins in the stomach with simple molecules like water and alcohol being absorbed directly into the bloodstream. Most absorption takes place in the walls of the small intestine, which are densely folded to maximize the surface area in contact with digested food. Small blood and lymphatic vessels in the intestinal wall pick up the molecules and carry them to the rest of the body. The large intestine is also involved in the absorption of water and vitamins B and K before feces leave the body. Excretion The final function of the digestive system is the excretion of waste in a process known as defecation. Defecation removes indigestible substances from the body so that they do not accumulate inside the gut. The timing of defecation is controlled voluntarily by the conscious part of the brain, but must be accomplished on a regular basis to prevent a backup of indigestible materials.

PATHOPHYSIOLOGY

LABORATORY and DIAGNOSTIC PROCEDURES

HEMATOLOGY, January 14, 2014 RESULT NORMAL VALUES SIGNIFICANCE A Low hemoglobin level indicates anemia. Estimates of Hgb in each RBC are moderately important when determining the total blood Hgb. However, hemoglobin findings are even more dependent upon the total number of RBC's. In other words, for the diagnosis of anemia, the number of RBC's is as important as the hemoglobin level. If the Hct is abnormal, then the RBC count is possibly abnormal. If the RBC count turns out to be normal, then the average size of the RBC is probably too small. Shock, hemorrhage, dehydration, or excessive IV fluid administration can reduce the Hct. The RBC count is useful for determining such problems as anemia and hemorrhage. In combination with other hematology tests, it can be quite useful for diagnosis. This test can also give an indirect estimate of the hemoglobin levels in the blood. Presence of infection Within normal range

HEMOGLOBIN

112

M: 140-170 F:120-140

HEMATOCRIT

.33

0.44-0.48

RBC CT WBC CT LYMPHOCYTES

3.8 13.8 .32

M: 4.5-5.0 F:4.0-4.5 5.0-10.00 .20-.40

URINALYSIS, January 14, 2014 COLOR TRANSPARENCY PH SPC. GRAVITY ALBUMIN PUS CELLS RBC EPITH CELLS MUCOUS THREADES AMPORPHOUS URATES-PHOSPHATES RESULT Yellow Clear 6.0 (4.5 - 7.2 normal range) 1.020 (1.005 to 1.025) Negative 2.3 0.2 (Normal is 0-3 RBC's) Few Few Few SIGNIFICANCE Normal Normal Within normal range Within normal range Normal Normal Normal Normal Normal

FECALYSIS, January 13, 2014 CONSISTENCY AMOEBA: CYST AMOEBA: TROPHOZOITE COLOR PUS CELLS RBC BACTERIA BLOOD CHEMISTRY, JANURAY 14, 2014 TEST SODIUM POTASSIUM INTERPRETATION: The diagnostic results shows high WBC which signifies that the patient has infection, the fecalysis shows that patient x is positive of E.histo Cyst, the causative agent of ameobiasis which proves the diagnosis of the patient. Decrease values in Hemoglobin and RBC signifies possible bleeding, that may be caused by the destruction of the mucous lining and anemia which is also one of the symptoms of ameobiasis RESULT 134.5 (135-148 mmoL/L 5.0 (3.5-5.3 mmol/l) SIGNIFICANCE Within normal range Within normal range RESULT Watery E.histo Cyst: 0-3 E.histo Troph: 0-2 Light brown 5-10 0-2 Many

DRUG STUDY

NURSING CARE PLAN

DISCHARGE PLAN

M- Medication to take Instruct and explain the patient’s mother that the medication is very important to continue depending on the duration that the doctor ordered for the total recovery of the patient. E-Exercise Instruct the mother that eventually the patient can return to its normal activities of daily living and to let her child play but it should be limited. T-Treatments Advice patient to keep her baby relax in order to recover in his present condition and Instruct the mother to minimize the patient from exposure to a dirty environment to prevent risk factor of his condition. H-Health Teaching Encourage the mother and explain to the patient’s mother that it is important to maintain proper hygiene to prevent further infection. O-Out Patient follow up Regular consultation to the physician can be factor for recovery to assess and monitor the patient’s condition. D-Diet Diet as tolerated , meaning the patient can eat everything until he can. Diet plays a big role in fast recovery so that, instruct the mother to give nutritious foods

PROGNOSIS

PROGNOSIS Patient X has a good prognosis, in the first day of hospitalization the patient experienced a increased in body temperature and the patient vomits and defecated with watery stool in 7 times and patient has a bad appetite. After 3 days of nursing intervention the patient show an improvement, the patient have recovered and has a good appetite, and as his mother says ―nakakadumi na siya ng maayos at napipigilan na nya hanggang sa C.R.‖

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