I.

OBJECTIVES

a. General Objectives

To develop the essential Skills, Knowledge, and Attitude in the care of

management of patient with Fracture and to have a better insight and understanding

about the disease

b. Specific Objectives

Given adequate opportunity, the students are expected to:

• Define “Amoebiasis”.

• Identify clinical manifestations.

• Apply knowledge and skills that are significant or necessary prevention for

the so called disease.

• Implement planned intervention.

• Apply the different nursing intervention applicable to the care of patient.

• Correlate the Laboratory findings on the patient current condition.

• Establish and maintain Nurse-Patient relationship.

Evaluate the effective care of what you implemented and rendered.

II. PATIENT'S PROFILE

NAME: Mrs. Namwahir

AGE: 47 yrs old

SEX: Female

CIVIL SATUS: Married

BIRTHDATE: January 06, 1963

ADDRESS: Perez St. San Juan Batangas

NATIONALITY: Filipino

RELIGION: Roman Catholic

NAME OF SPOUSE: Mr. Namwahir

ROOM NO: Diamond

DATE OF ADMISSION: July 09, 2010

TIME OF ADMISSION: 10:29 pm

DATE OF DISCHARGED: July 15, 2010

ATTENDING PHYSICIAN: Agelito Reyes M.D

III. HISTORY

a. Nursing History

I. Chief Complaint: abdominal pain, LBM, Back pain.

II. Admitting Diagnosis: T/C AGE with mild to moderate DHN T/C thoracic

strain.

III. Final Diagnosis: Intestinal Amoebiasis, Myofacsial pain syndrome.

b. Present Health History

4 days PTA, While lifting a pail of water had pain on thoracic spine, 3

days PTA had febrile episode, 2 days PTA had LBM 5x per day associated with

abdominal pain then consult.

c. Past Medical History

(-)DM (-)HTN (-)ALLERGY, has been hospitalized at DOCTORS

HOSPITAL because of UTI, and again has been hospitalized at MMG because of UTI

again.
IV. NUTRITION

a. 24 hours food recall (PTA)

Breakfast - Adobo, balatong and rice

Lunch - Kalderetang Manok and rice

Dinner - none

b. Regular/Routine diet

- the client eat variety of foods, she said that there nothing that she does

not eat.

V. DISEASE ENTITY

a. Definition

Amoebiasis is a protozoal infection of bowel in the human beings. It initially

involves the colon, characterized by diarrhea, but may spread to soft tissues, most

commonly to the liver or lungs, by contiguity or hematogenous or lymphatic

dissemination.

b. etiology

It is caused by the amoeba Entamoeba histolytica that is prevalent in unsanitary

areas, common in warm climate, and acquired by swallowing. It is an intestinal

infection that may or may not be symptomatic and can be present in an infected person

for several years. When symptoms are present it is generally known as invasive

amoebiasis and occurs 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". 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.

c. Occurrence/Epidemiology

It is estimated that it causes 70,000 deaths per year world wide. Symptoms,

when present, can range from mild diarrhea to dysentery with blood and mucus in the
stool.

The disease can be passed from one person to another through fecal-oral

transmission but it can also be transmitted through direct contact, through sexual

contact by orogenital, oroanal, and proctogenital sexual activity. And through indirect

contact, the disease can infect humans by ingestion of food especially uncooked leafy

vegetables or foods contaminated with fecal materials containing E. histolytica cysts.

Foods or drinks may be contaminated by cysts through pollution of water supplies,

exposure to flies, use of night soil for fertilizing vegetables, and through unhygienic

practices of food handlers.

Modes of prevention of amoebiasis is by providing health teachings such as

washing 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 and pay particular attention to toilet seats and taps. And

avoid sharing towels or face washers. And in helping to prevent infection, avoid raw

vegetables when in endemic areas, as they may have been fertilized using human

feces. Boiling of water or treat with iodine tablets. And fly control because they can

serve as a vector.

Life Cycle of Entamoeba Histolytica

 d. ANATOMY AND PHYSIOLOGY

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 SYSTEM 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

excreter into the anus

VI. PATHOPHYSIOLOGY

When cyst is swallowed, it passes through the stomach unharmed and shows no

activity while in an acidic environment. When it reaches the alkaline medium of the

intestine, the metacyst begins to move within the cyst wall, which rapidly weakens and

tears. The quadrinucleate amoeba emerges and divides into amebulas that are swept

down into the cecum. This is the first opportunity of the organism to colonize, and its

success depends on one or more metacystic trophozoites making contact with the

mucosa.

Mature cyst in the large intestines leaves the host in great numbers (the host remains

asymptomatic). The cyst can remain viable and infective in moist and cool environment

for at least 12 days, and in water for 30 days. The cysts are resistant to levels of

chlorine normally used for water purification. They are rapidly killed by purification,

desiccation and temperatures below 5 and above 40 degrees.