INTRODUCTION
Amoebiasis is due to invasion of the intestinal wall by the protozoan parasite Entemoeba
histolytica. Amoebic colitis results from ulcerating mucosal lesions caused by the release of
parasite-derived hyaluronidases and proteases. It refers to infection of man by Entamoeba
hystolytica initially involving the colon but which may spread to other soft tissues organs by
contiguity or by hematogenous or lymphatic dissemination most commonly to the liver and lungs.
It is a worldwide parasitic disease. It creates many medical and surgical problems. About
15 to 20 per cent of Indians are affected by the parasite. It can be acute and chronic and can have
intestinal and extra-intestinal manifestations. The causative organism is a protozoa which remains
in the large intestine and can be transmitted to other organs like liver, lungs, brain, spleen and skin
etc. It is transmitted through contaminated food, water and infected human feaces.
Amoebiasis can occur at any age. There is no gender or racial difference in the occurrence
of the disease. It is a household infection and the human being is responsible for spreading the
disease. Most of the infected people remain asymptomatic (without symptoms) and are called as
healthy carriers. If one person in a family gets infected with the parasite, other family members are
at the great risk of infection. The human carrier can discharge up to 1.5x107 cysts per day.
Amoebic Colitis
- characterized by periods of constipation and diarrhea and episodes of abdominal discomfort
frequently stimulating appendicitis
History of Discovery
Human infections of the parasite are not a recent phenomenon. The earliest record of
symptoms of the disease—bloody, mucose diarrhea—was from the Sankskrit document Brigu-
samhita, written at around 1000BC. Assyrian and Babylonian texts also have references to the
diseases, with descriptions of blood in the feces, thus suggesting that amoebiasis occurred in the
Tigris-Euphrates basin before the sixth century BC. Later records were able to distinguish bacterial
infections with those of amoebic origin: epidemics of dysentery by itself are more likely to result
from bacterial infections, while dysentery that is associated with disease of the liver is more likely
to be caused by amoeba. Thus, around the second century AD, there was clearer understanding of
the association between liver abscesses and amoebas.
Around the 16th century, amoebiasis became more widespread in the developed world, mostly due
to the growth of European colonies and increased world trade. There had been many clear
descriptions of the hepatic and intestinal forms of amoebiasis, considered as the cause of a “bloody
flux” spreading through Europe, Asia, Persia, and Greece. The first accurate description of both
forms of the disease came from the book Researches into the Causes, Nature and Treatment of the
More Prevalent Diseases of India and of Warm Climates Generally by James Annersley, written in
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the 19th
century.
Considering their small size, protozoans were difficult to identify before the invention of
the microscope in the 17th century. The causal agent, Entamoeba histolytica, was discovered in
Russia in 1873 by Friedrich Losch. His early observations came from the case of a young farmer
who had from been suffering chronic dysentery. In his diagnosis, Losch found large numbers of of
amoeba in his feces and associated the amoebas to be the cause of the dysentery.
Causative Agent
Entamoeba histolytica
The active (trophozoite) stage exists only in the host and in fresh loose feces; cysts survive
outside the host in water, soils and on foods, especially under moist conditions on the latter. The
cysts are readily killed by heat and by freezing temperatures, and survive for only a few months
outside of the host.[1] When cysts are swallowed they cause infections by excysting (releasing the
trophozoite stage) in the digestive tract. The trophozoite stage is readily killed in the environment
and cannot survive passage through the acidic stomach to cause infection.
Trophozoites are amorphous and range from 20-40um in diameter, and contain one
nucleus. They use a well-defined pseudopodium for their rapid, gliding locomotion. This
pseudopodium is often extended greatly, such that there is no conspicuous differentiation between
ecto- and endoplasm. It was originally thought to lack mitochondria, but recent evidence of
nuclear-encoded mitochondrial genes and a remnant organelle proves otherwise.
The cyst, which is capable of surviving in harsh environments as well as in the human
stomach and small intestine; thus it is the cyst form that transmits the disease
The trophozoite, which is involved in the actual infection of the host by invading the host
epithelial cells
Infection begins through fecal-oral contamination. Initially, a person ingests fecallly contaminated
food or water that contains the E. histolytica cysts. The cysts then pass through the stomach and
small intestine (if any trophozoites were ingested, they would die from the acidic gastric juices of
the stomach) and travel to the bowel lumen, where they excyst (with the help of the enzyme
trypsin). Thus, the potentially invasive trophozoite form is released into a safer environment in
which they can exist and cause infection. A total of four trophozoites emerge from each cyst.
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Most
asymptomatic
colonization (90% of all infections) arise because the trophozites end up aggregating in the
intestinal mucin layer and form new cysts, thus leading to a self-limited and asymptomatic
infection. But in some cases (which accounts for the 10% of those who are both infected and
symptomatic), the trophozoites adhere to and lyse the colonic epithelium, mediated by the GalNAc
lectin that initiates invasion of the colon. Further damage at the site of invasion is caused by the
presence of neutrophils that comes in as a response to the invasion. In the process of invasion in
the large intestine, the trophozoites also interact with enteric bacteria, adapt to the changing
oxygen environment, and ingest erythrocytes. Once the trophozoites have invaded the intestinal
epithelium, they may pass through damaged blood vessels and travel extraintestinally to invade the
peritoneum, liver, lung, brain, and other sites.
Trophozoites are often carried in feces along with mucous and red blood cells. But what
continues the cycle of infection from human to human is that most of the trophozoites encyst
(convert into the cyst form) at the end of the large intestine and are passed through feces and
contaminate soil, grass, fruits and vegetables, dirty hands, water and food. Since the cysts can
survive the harsh environment outside, they go on to spread the infection. Through all these
sources, the cyst can once again enter the digestive tract and continue the infectious cycle. The
amoeba goes through asexual reproduction by binary fission
Mode of Transmission
Fecal-Oral Route
Since E. histolytica can exist in two forms, both forms are present in contaminated food and
drinks:
• Trophozoites (free amoeba)
• Infective cysts (which are surrounded by a protected wall
Ingesting the trophozoite form is not harmful—the trophozoites usually die in the acidic
stomach of a person. However, the cysts form are quite resistant to various environmental
conditions, and are thus able to survive in the acidic contents of the stomach and go on to cause
infection. When the cysts reach the intestine, the trophozoite forms are released in this safer
environment where it can invade the epithelial cells of the large intestine, causing flask-shaped
ulcers. Trophozoites can also penetrate the intestinal mucous layer and lead to colitis. The
intestinal mucous layer serves an important role in providing a barrier to invasion by blocking
amoebic adherence to the underlying epithelium and also by slowing motility of trophozoites.
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Thus, the
trophozoites
gain a strong advantage for infection when it is able to invade this layer. It does this by killing
epithelial cells, neutrophils and lymphocytes—thus limiting the immune system’s response. It can
also invade the venous system of the intestine and spread to other organs, including the liver, lungs
and brain. When it reaches end of the large intestine, most of the trophozoites are converted back
to its cyst form and released into the environment through passage of stool, and a new cycle of
infection begins.
It is important to note that although amoebic dysentery may not demonstrate any symptoms
for long periods of time (months, even years), the infected individuals still excrete cysts and, in
thus, infect their surroundings and aid in the spread of the disease.
The motile trophozoile is not an infected form whereas non-motile cyst is the infected one.
The infection is transmitted by cyst through ingestion. People discharge cyst in the stool. The cyst
remains live outside the body for days to weeks. It will die quickly if it is not kept cool and moist.
So the infection is transmitted from one person to another through contaminated water. Food
handlers are also the immediate source of infection, if they are the healthy carriers. While handling
the food, they transmit the cyst in the food.
Incubation period
After infection, it may take from a few days up to two to four weeks before developing
overt symptoms. However, some people may carry the parasite for several months or even years
before they become ill. Thus, due to the slight variations in incubation period, tracing the cause of
the illness requires that one knows what he/she ate and drank and the places traveled in the
weeks/months before becoming ill.
Risk factors
• Eating contaminated food.
• Anal or directly from person to person contact.
• Eating Non-veggie foods.
• Unhygienic conditions and Poor sanitation areas.
• Eating vegetables and fruits which have been contaminated by the harmful bacteria.
The most common symptoms of amoebiasis are diarrhoea, stomach cramps and fever. Rarely,
amoebiasis can cause an abscess in the liver. Entamoeba histolytica parasites are only found in
humans. After infection, it may take a few days, several months or even years before you become
ill but it is usually about two or four weeks.
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Signs and
symptoms
• Abdominal cramps.
• Nausea.
• Painful passage of stools.
• Loss of Weight.
• Severe stomach pain.
• Loss of Appetite.
• Profuse diarrhoea.
Treatment for carriers: idoquinot 650 mg x eight times a day for 20 days; furamide 500
mg x eight times a day for 10 days; and paromomycin 25-30 mg/kg/day in divided three doses for
seven days.
Prevention
2. Control of flies: Flies should be controlled at living places. The flies must be eradicated from
the house as they are responsible to transmit the disease from one place to another. Foods and
eatables should be covered and properly cooked before eating.
3. Safe drinking water: Drinking water should be boiled. If one can afford, water filter should be
used.
4. Hand washing: Hand washing practices are also very helpful to control the infection. Hands
should be properly washed with soap and water after defecation. Especially before eating and
preparing the food, hands should be washed properly.
5. Washing of vegetables: Ground grown vegetables like carrot, turnip, radish, should be washed
thoroughly by running water. During infection, these vegetables should be avoided because these
may be contaminated with human feaces.
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ANATOMY
AND PHYSIOLOGY
Digestion is the breaking down of food in the body, into a form that can be absorbed. It is
also the process by which the body breaks down food into smaller components that can be
absorbed by the blood stream. In mammals, preparation for digestion begins with the cephalic
phase in which saliva is produced in the mouth and digestive enzymes are produced in the
stomach. Mechanical and chemical digestion begin in the mouth where food is chewed, and mixed
with saliva to break down starches. The stomach continues to break food down mechanically and
chemically through the churning of the stomach and mixing with enzymes. Absorption occurs in
the stomach and gastrointestinal tract, and the process finishes with excretion.
Digestion is usually divided into mechanical processing to reduce the size of food particles and
chemical action to further reduce the size of particles and prepare them for absorption. In most
vertebrates, digestion is a multi-stage process in the digestive system, following ingestion of the
raw materials, most often other organisms. The process of ingestion usually involves some type of
mechanical and chemical processing. Digestion is separated into four separate processes:
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1. Ingesti
on:
The first activity of the digestive system is to take in food through the mouth. This process
has to take place before anything else can happen.
2. Mechanical Digestion: The large pieces of food that are ingested have to be broken into
smaller particles that can be acted upon by various enzymes. This is mechanical digestion,
which begins in the mouth with chewing or mastication and continues with churning and
mixing actions in the stomach.
3. Chemical Digestion: The complex molecules of carbohydrates, proteins, and fats are
transformed by chemical digestion into smaller molecules that can be absorbed and utilized
by the cells. Chemical digestion, through a process called hydrolysis, uses water and
digestive enzymes to break down the complex molecules. Digestive enzymes speed up the
hydrolysis process, which is otherwise very slow.
4. Movements: After ingestion and mastication, the food particles move from the mouth into
the pharynx, then into the esophagus. This movement is deglutition, or swallowing. Mixing
movements occur in the stomach as a result of smooth muscle contraction. These repetitive
contractions usually occur in small segments of the digestive tract and mix the food
particles with enzymes and other fluids. The movements that propel the food particles
through the digestive tract are called peristalsis. These are rhythmic waves of contractions
that move the food particles through the various regions in which mechanical and chemical
digestion takes place.
5. Absorption: movement of nutrients from the digestive system to the circulatory and
lymphatic capillaries through osmosis, active transport, and diffusion
6. Elimination: The food molecules that cannot be digested or absorbed need to be
eliminated from the body. The removal of indigestible wastes through the anus, in the form
of feces, is defecation or elimination
Underlying the process is muscle movement throughout the system, swallowing and peristalsis.
• Cephalic phase - This phase occurs before food enters the stomach and involves
preparation of the body for eating and digestion. Sight and thought stimulate the cerebral
cortex. Taste and smell stimulus is sent to the hypothalamus and medulla oblongata. After
this it is routed through the vagus nerve and release of acetylcholine. Gastric secretion at
this phase rises to 40% of maximum rate. Acidity in the stomach is not buffered by food at
this point and thus acts to inhibit parietal (secretes acid) and G cell (secretes gastrin)
activity via D cell secretion of somatostatin.
• Gastric phase - This phase takes 3 to 4 hours. It is stimulated by distention of the stomach,
presence of food in stomach and increase in pH. Distention activates long and myentric
reflexes. This activates the release of acetylcholine which stimulates the release of more
gastric juices. As protein enters the stomach, it binds to hydrogen ions, which raises the pH
of the stomach to around pH 6. Inhibition of gastrin and HCl secretion is lifted. This
triggers G cells to release gastrin, which in turn stimulates parietal cells to secrete HCl.
HCl release is also triggered by acetylcholine and histamine.
• Intestinal phase - This phase has 2 parts, the excitatory and the inhibitory. Partially-
digested food fills the duodenum. This triggers intestinal gastrin to be released.
Enterogastric reflex inhibits vagal nuclei, activating sympathetic fibers causing the pyloric
sphincter to tighten to prevent more food from entering, and inhibits local reflexes.
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The
digestive
system includes the digestive tract and its accessory organs, which process food into molecules
that can be absorbed and utilized by the cells of the body. Food is broken down, bit by bit, until the
molecules are small enough to be absorbed and the waste products are eliminated. The digestive
tract, also called the alimentary canal or gastrointestinal (GI) tract, consists of a long continuous
tube that extends from the mouth to the anus. It includes the mouth, pharynx, esophagus, stomach,
small intestine, and large intestine. The tongue and teeth are accessory structures located in the
mouth. The salivary glands, liver, gallbladder, and pancreas are major accessory organs that have a
role in digestion. These organs secrete fluids into the digestive tract
Digestion begins in the oral cavity where food is chewed. Saliva is secreted in large
amounts (1-1.5 litre/day) by three pairs of exocrine salivary glands (parotid, submandibular, and
sublingual) in the oral cavity, and is mixed with the chewed food by the tongue. There are two
types of saliva. One is a thin, watery secretion, and its purpose is to wet the food. The other is a
thick, mucous secretion, and it acts as a lubricant and causes food particles to stick together and
form a bolus. The saliva serves to clean the oral cavity and moisten the food, and contains
digestive enzymes such as salivary amylase, which aids in the chemical breakdown of
polysaccharides such as starch into disaccharides such as maltose. It also contains mucin, a
glycoprotein which helps soften the food into a bolus. the tongue which tastes and manipulates the
food
Swallowing transports the chewed food into the esophagus, passing through the oropharynx
and hypopharynx. The mechanism for swallowing is coordinated by the swallowing center in the
medulla oblongata and pons. The reflex is initiated by touch receptors in the pharynx as the bolus
of food is pushed to the back of the mouth.
Pharynx, leads to both the trachea and the esophagus. The Esophagus, a narrow, muscular tube
about 25 centimeters (11 inches) long, starts at the pharynx, passes through the larynx and
diaphragm, and ends at the cardiac orifice of the stomach. The wall of the Esophagus is made up of
two layers of smooth muscles, which form a continuous layer from the Esophagus to the oten and
contract slowly, over long periods of time. The inner layer of muscles is arranged circularly in a
series of descending rings, while the outer layer is arranged longitudinally. At the top of the
Esophagus, is a flap of tissue called the epiglottis that closes during swallowing to prevent food
from entering the trachea (windpipe) while. The uvula blocks off the nose. The chewed food is
pushed down the Esophagus to the stomach through peristaltic contraction of these muscles. It
takes only seconds for food to pass through the Esophagus, and little digestion actually takes place.
The stomach is a pear shaped pouch and it is also described as a thick walled elastic bag. The
food enters the stomach after passing through the cardiac orifice. In the stomach, food is further
broken apart, and thoroughly mixed with gastric acid and digestive enzymes that break down
proteins. The acid itself does not break down food molecules; rather, the acid provides an optimum
pH for the reaction of the enzyme pepsin. The parietal cells of the stomach also secrete a
glycoprotein called intrinsic factor which enables the absorption of vitamin B-12. Other small
molecules such as alcohol are absorbed in the stomach as well by passing through the membrane
of the stomach and entering the circulatory system directly. The form of the food in the stomach is
in semi-liquid form.
The transverse section of the alimentary canal reveals four distinct and well developed layers
called serosa, muscular coat, submucosa and mucosa. Serosa: It is the outermost thin layer of
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single cells
called
mesothelial cells. Muscular coat: It is very well developed for churning of food. It has outer
longitudinal, middle smooth and inner oblique muscles. Submucosa: It has connective tissue
containing lymph vessels, blood vessels and nerves. Mucosa: It contains large folds filled with
connective tissue. The gastric glands have a packing of lamina propria. Gastric glands may be
simple or branched tubular secreting mucus, hydrochloric acid, pepsinogen and renin. The cardiac
sphincter which closes off the top end of the stomach and the pyloric sphincter, which closes off
the bottom.
Small intestine which has a length of about 6 m. The surface of the small intestine is wrinkled
and convoluted to produce a greater surface area for absorption. the sections of the small intestine
include the duodenum, jejunum, ileum.
After being processed in the stomach, food is passed to the small intestine via the Pyloric
sphincter. The majority of digestion and absorption occurs here as chyme enters the duodenum.
Here it is further mixed with three different liquids:
1. bile, which emulsifies fats to allow absorption, neutralizes the chyme, and is used to
excrete waste products such as bilin and bile acids (which has other uses as well). It is not
an enzyme, however. The bile juice is stored in a small organ called the gall bladder.
2. pancreatic juice made by the pancreas.
3. intestinal enzymes of the alkaline mucosal membranes. The enzymes include: maltase,
lactase and sucrase, to process sugars; trypsin and chymotrypsin are also added in the small
intestine.
Most nutrient absorption takes place in the small intestine. As the acid level changes in the
small intestines, more enzymes are activated to split apart the molecular structure of the various
nutrients so they may be absorbed into the circulatory or lymphatic systems. Nutrients pass
through the small intestine's wall, which contains small, finger-like structures called villi, each of
which is covered with even smaller hair-like structures called microvilli. The blood, which has
absorbed nutrients, is carried away from the small intestine via the hepatic portal vein and goes to
the liver for filtering, removal of toxins, and nutrient processing.
The small intestine and remainder of the digestive tract undergoes peristalsis to transport food
from the stomach to the rectum and allow food to be mixed with the digestive juices and absorbed.
The circular muscles and longitudinal muscles are antagonistic muscles, with one contracting as
the other relaxes. When the circular muscles contract, the lumen becomes narrower and longer and
the food is squeezed and pushed forward. When the longitudinal muscles contract, the circular
muscles relax and the gut dilates to become wider and shorter to allow food to enter. In the
stomach there is another phase that is called Mucus which promotes easy movement of food by
wetting the food. It also nullifies the effect of HCl on the stomach by wetting the walls of the
stomach as HCl has the capacity to digest the stomach. If the form of food in the stomach is semi-
liquid form, the form of food in the small intestine is liquid form. It is in the small intestine where
the digestion of food is completed.
After the food has been passed through the small intestine, the food enters the large intestine.
The large intestine is roughly 1.5 meters long, with three parts: the cecum at the junction with the
small intestine, the colon, and the rectum. The colon itself has four parts: the ascending colon, the
transverse colon, the descending colon, and the sigmoid colon. The large intestine absorbs water
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the rectum is the terminal portion of the large intestine and functions for storage of the feces,
the wastes of the digestive tract, until these are eliminated. The external opening at the end of the
rectum is called the anus. The anus has two sphincters, one voluntary and one involuntary. The
pressure of the feces on the involuntary sphincter causes the urge to defecate and the voluntary
sphincter controls whether a person defecates or not.
Carbohydrate digestion
Carbohydrates are formed in growing plants and are found in grains, leafy vegetables, and
other edible plant foods. The molecular structure of these plants is complex, or a polysaccharide;
poly is a prefix meaning many. Plants form carbohydrate chains during growth by trapping carbon
from the atmosphere, initially carbon dioxide (CO2). Carbon is stored within the plant along with
water (H2O) to form a complex starch containing a combination of carbon-hydrogen-oxygen in a
fixed ratio of 1:2:1 respectively.
Plants with a high sugar content and table sugar represent a less complex structure and are
called disaccharides, or two sugar molecules bonded. Once digestion of either of these forms of
carbohydrates are complete, the result is a single sugar structure, a monosaccharide. These
monosaccharides can be absorbed into the blood and used by individual cells to produce the
energy compound adenosine triphosphate (ATP).
The digestive system starts the process of breaking down polysaccharides in the mouth
through the introduction of amylase, a digestive enzyme in saliva. The high acid content of the
stomach inhibits the enzyme activity, so carbohydrate digestion is suspended in the stomach. Upon
emptying into the small intestines, potential hydrogen (pH) changes dramatically from a strong
acid to an alkaline content. The pancreas secretes bicarbonate to neutralize the acid from the
stomach, and the mucus secreted in the tissue lining the intestines is alkaline which promotes
digestive enzyme activity. Amylase is secreted by the pancreas into the small intestines and works
with other enzymes to complete the breakdown of carbohydrate into a monosaccharide which is
absorbed into the surrounding capillaries of the villi.
Nutrients in the blood are transported to the liver via the hepatic portal circuit, or loop,
where final carbohydrate digestion is accomplished in the liver. The liver accomplishes
carbohydrate digestion in response to the hormones insulin and glucagon. As blood glucose levels
increase following digestion of a meal, the pancreas secretes insulin causing the liver to transform
glucose to glycogen, which is stored in the liver, adipose tissue, and in muscle cells, preventing
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hyperglycemia
. A few hours
following a meal, blood glucose will drop due to muscle activity, and the pancreas will now
secrete glucagon which causes glycogen to be converted into glucose to prevent hypoglycemia.
Note: In the discussion of digestion of carbohydrates; nouns ending in the suffix -ose
usually indicate a sugar, such as lactose. Nouns ending in the suffix -ase indicates the enzyme that
will break down the sugar, such as lactase. Enzymes usually begin with the substrate (substance)
they are breaking down. For example: maltose, a disaccharide, is broken down by the enzyme
maltase (by the process of hydrolysis), resulting in a two glucose molecules, a monosaccharide.
Fat digestion
The presence of fat in the small intestine produces hormones which stimulate the release of lipase
from the pancreas and bile from the gallbladder. The lipase (activated by acid) breaks down the fat
into monoglycerides and fatty acids. The bile emulsifies the fatty acids so they may be easily
absorbed.
Short- and medium chain fatty acids are absorbed directly into the blood via intestine capillaries
and travel through the portal vein just as other absorbed nutrients do. However, long chain fatty
acids are too large to be directly released into the tiny intestinal capillaries. Instead they are
absorbed into the fatty walls of the intestine villi and reassembled again into triglycerides. The
triglycerides are coated with cholesterol and protein (protein coat) into a compound called a
chylomicron.
Within the villi, the chylomicron enters a lymphatic capillary called a lacteal, which
merges into larger lymphatic vessels. It is transported via the lymphatic system and the thoracic
duct up to a location near the heart (where the arteries and veins are larger). The thoracic duct
empties the chylomicrons into the bloodstream via the left subclavian vein. At this point the
chylomicrons can transport the triglycerides to where they are needed.
Digestive hormones
There are at least four hormones that aid and regulate the digestive system:
• Gastrin - is in the stomach and stimulates the gastric glands to secrete pepsinogen(an
inactive form of the enzyme pepsin) and hydrochloric acid. Secretion of gastrin is
stimulated by food arriving in stomach. The secretion is inhibited by low pH .
• Secretin - is in the duodenum and signals the secretion of sodium bicarbonate in the
pancreas and it stimulates the bile secretion in the liver. This hormone responds to the
acidity of the chyme.
• Cholecystokinin (CCK) - is in the duodenum and stimulates the release of digestive
enzymes in the pancreas and stimulates the emptying of bile in the gall bladder. This
hormone is secreted in response to fat in chyme.
• Gastric inhibitory peptide (GIP) - is in the duodenum and decreases the stomach churning
in turn slowing the emptying in the stomach. Another function is to induce insulin
secretion.
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Significance
of pH
in digestion
pH in the stomach is very acidic and inhibits the breakdown of carbohydrates while there. The
strong acid content of the stomach provides two benefits, both serving to denature proteins for
further digestion in the small intestines, as well as providing non-specific immunity, retarding or
eliminating various pathogens.
In the small intestines, the duodenum provides critical pH balancing to activate digestive
enzymes. The liver secretes bile into the duodenum to neutralise the acidic conditions from the
stomach. Also the pancreatic duct empties into the duodenum, adding bicarbonate to neutralize the
acidic chyme, thus creating a neutral environment. The mucosal tissue of the small intestines is
alkaline, creating a pH of about 8.5, thus enabling absorption in a mild alkaline in the environment.
The colon is approximately 4.5 feet long, 2.5 inches wide, and is a muscular tube
composed of lymphatic tissue, blood vessels, connective tissue, and specialized muscles for
carrying out the tasks of water absorption and waste removal. The tough outer covering of the
colon protects the inner layer of the colon with circular muscles for propelling waste out of the
body in an action called peristalsis. Under the outer muscular layer is a sub-mucous coat
containing the lymphatic tissue, blood vessels, and connective tissue. The innermost lining is
highly moist and sensitive, and contains the villi- or tiny structures providing blood to the colon.
The location of the parts of the colon is either in the abdominal cavity or behind it in the
retroperitoneum. The colon in those areas is fixed in location.
The colon is actually just another name for the large intestine. The shorter of the two
intestinal groups, the large intestine, consists of parts with various responsibilities. The names of
these parts are: the transverse colon, ascending colon, appendix, descending colon, sigmoid colon,
and the rectum and anus.
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PARTS OF
THE COLON
Several parts make up the continuous tube of the colon. Each part contributes to the
movement of materials and the formation of stools. The parts include:
Illeocecal Valve:
The illeocecal valve is a fold of mucus membrane at the entry way to the colon. It is
located where the small intestine meets the colon. Materials from the small intestine pass into the
colon through this valve.
Vermiform Appendix:
The appendix is attached to the bottom of the cecum. This is a twisted coiled tube that is
about 3 inches long. The function of the appendix is not known.
Cecum:
It is located below the illeocecal valve at the base of the colon. The upper part of the
cecum is open to the colon. The muscles of the cecum and the colon advance feces upward out of
the cecum.
Ascending Colon:
The ascending colon is located on the right side of the abdomen above the cecum. Here,
most of the water is absorbed from the feces as it moves upward through the ascending colon. The
ascending colon “ends” at the hepatic flexure where the colon bends to the left and connects to the
transverse colon.
Transverse Colon:
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
The
transverse
colon runs laterally across the abdomen below the belly button. As feces move across the
transverse colon, stools begin to take form. The transverse colon “ends” at the splenic flexure
where the colon bends again and connects to the descending colon which heads down the left side.
Descending Colon:
The descending colon runs down the left side of the abdomen. Stools move down the
descending colon. Stools are now more solid in form. Here, stools may be stored for a time. The
descending colon “ends” where it continues into the sigmoid colon.
Sigmoid Colon:
The sigmoid colon angles to the right, curving down and inward to about the midline, then
it curves slightly upward where it connects to the top of rectum. Stools continue their descent as
they move through sigmoid colon. Stools may also be stored here for a time before they are moved
into the rectum.
The colon has no villi (multiple, minute projections of the intestinal mucous layer which serve to
absorb fluids and nutrients) as compared to the small intestine and produces no digestive enzymes.
It is like a tube of circular muscle lined with a layer of moist mucous cells that lubricate the
contents. The smooth folds of the colon are speckled with glands that resemble skin pores.
These glands extract the fluids and electrolytes from the passing food residue. Between 1/3 -1 liter
of water (which is recycled and eventually filtered and excreted by the kidneys as urine),
electrolytes, and some vitamins, are absorbed daily through the colon. If colon bacteria are normal,
vitamins B-1, B-2, B-12 and K are produced by them, and all with the possible exception of B-12
are absorbed and used by the body traveling first to the liver via the portal circulation.
Absorption and storing fecal material are the colon's two main functions.
The colon does secrete mucus to help the digested food along and hold the fecal material together.
It also plays a role in protecting the walls of the colon from bacterial activity and neutralizes some
of the fecal acids.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
After
processed
matter from the small intestine enters the colon much absorption occurs in the cecum and
ascending colon. Mixing movements called haustrations occur every few minutes and last about
one minute apiece.
They roll and mix the matter to expose most of it to the colon’s surface for absorption. Over 80%
of the material reaching the colon is reabsorbed.
There are no peristaltic waves in the colon but a few times daily (usually after meals) a segment of
the colon usually eight inches long will constrict (usually in the transverse or descending colon) to
force the fecal material along. Our Feces are usually 75% water, 7-8% dead bacteria, 2-7% fat, .5-
10% protein, 5-10% roughage, byproducts, digestive juices, etc.
Once the stool moves out of the sigmoid colon into the rectum, a parasympathetic reflex is set up
and the brain gets the signal that nature is calling, and so we go.
The external sphincter is under voluntary control and we can mentally overcome this reflex and
prevent defecation if we desire to.
Of all the vital organs in the body, the one that suffers the most abuse from modern dietary habits
is the colon.
Mucosal layer on the surface is made up simple columnar cells and a mucosal muscularis on the deep
side .
Submucosa contains fibrous connective tissue and blood vessels.
The muscularis externa is made up of a circular and a longitudinal muscle layer with a myenteric plexus
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
in between the
layers.
A very thin layer of Serosa is also present .
Aided by enzymes and muscular action, the mouth, stomach and small intestine perform
their individuated jobs of breaking down and absorbing nutrients. The liquid that these organs
generate is called chyme. However, when it passes to the colon, the liquid that is leftover is mostly
waste matter. This liquid waste matter is called feces. It is passed to the colon for further
processing and elimination. In the colon, instead of the enzymatic action that occurs in other
organs of the G.I. tract, further breakdown of fecal matter and the production of substances occur
by way of bacterial fermentation. Cellular exchanges, bacteria, and muscular actions all play a part
in processing the feces as it passes through the colon:
Fluid Absorption:
The colon lining contains epithelial cells that absorb fluids and other substances such as
vitamins and electrolytes. It is the absorption of fluids and bacterial processing that transforms the
soupy fecal matter into a stool.
Secretion of Mucus:
The colon lining contains epithelial cells that secrete mucus. This mucus moisturizes and
lubricates the colon lining. This lining protects the colon wall and nerve tissues.
Bacterial Growth:
Bacteria live and grow along the colon lining. Using the fluids and foods you intake,
bacteria actually manufacture the nutrients that sustain their environment and their food supply.
Production of Lubrication:
Bacteria ferment soluble fiber into a lubricating gel that is incorporated into the stool mass
as it is formed. This gel helps to make stools soft and flexible. Some of this gel also coats the
exterior of the stools and is used by the colon to moisturize the colon lining. This lubrication helps
to ease stool passage through the colon.
Stool Formation:
To form stools, muscles in the colon churn the soupy liquid fecal matter as fluids are
extracted until the particles have the consistency to form a stool.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
PATHOPHYSIOLOGY OF AMOEBIASIS
Predisposing Factors
Precipitating Factors
Developing countries
Unsanitary food handling
Tropical and subtropical
Ingestion of contaminated food and
countries
drinks
Urban areas
Poor environmental sanitation
Socioeconomic status
Crowded areas
Etiologic Agent
Entamoeba histolytica
Mode of Transmission
Fecal-Oral route
Enters the
stomach
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Excsytation occurs
Emergence of trophozoites
Trophozoites multiply by
means of binary fission
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Diarrhea
Abdominal pain
Dehydration
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Formation of lesions
Increase vascular Chemotaxis Activation of
permeability occurs prostaglandin
Flask shaped
Swelling Mobilization of Stimulates the ulceration
leukocytes and goblets cells in
macrophages the colon
Irritation of the
intestine
Hematochezia Ulcerative
Colitis
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
PATHOPHYSIOLOGY OF AMOEBEASIS
Normally human intestinal flora protects the bowel from colonization of pathogens;
however, the intestinal flora can be disrupted by harmful bacteria and viruses that cause tissue
damage and inflammation or depressed by antibiotic c therapy.
Amoeba cause tissue damage and inflammation by releasing toxins (enterotoxins) that
stimulates the mucosal lining of the intestine, resulting greater secretion of water and electrolytes
into the intestinal lumen. The active secretion of chloride and bicarbonate ions in the small bowel
leads to inhibition of sodium reabsorption. To balance the excess sodium, large amounts of protein
rich fluids are secreted in the bowel, leading to diarrhea
The metacystic trophozoites or their progenies reach the cecum and those that cone contact
with cecal mucosa penetrate or invade the epithelium by the lytic digestion if condition is
favorable. The trophozoites burrow deeper with tendency to spread laterally by flask shape
ulcers. There may several points of penetration. From the primary site of invasion, secondary
lesions may be produced at the lower levels of the large intestines. Progenies of the initial colonies
are squeezed out of the neck of the ulcer and carried to the lower portion of the bowel, thus have
opportunity to invade and produce additional ulcers. Eventually the whole colon may be involved.
When the integrity of the GIT impaired its ability to carry out digestive and absorptive
functions can be affected as well as the sympathetic and parasympathetic afferent nerve will be
stimulated thru the vagus, glossopharyngeal, vestibular and splanhnic nerves, which is located at
the proximal duodenum, thus stimulates emetic center resulting to vomiting.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
BIOGRAPHICAL DATA
HOSPITAL DATA
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
FAMILY
BACKGROUND
Family Position Date of Age Sex Civil Place of Educational Occupation Salary
Members Birth Status Residence Attainment
Davao City High School Unemployed N/A
Mr. R.G Father 01/05/42 66 y/o Male Married Graduate
Binondo, Sta.
Mrs. D.G Mother 02/02/47 61 y/o Female Married Cruz, Manila High School House helper 3,500/
Graduate month
Ms. L.G Eldest 01/21/75 33 y/o Female Single San Dionosio, 2-yr. Store vendor 15,000/
(patient) sibling Paranaque Vocational month
City Course
Mrs. C.G Middle 09/04/78 30 y/o Female Married Davao City High School Unemployed N/A
sibling Graduate
20,000/
Mr. J.G Youngest 07/24/81 27 y/o Male Single Qatar College Factory month
sibling Undergraduate Worker
Currently, Ms. L.G is residing alone at San Dionisio, Paranaque City. She rents a small
house and has a sari-sari store as her means of income. Her father and middle sibling lives together
in Davao City together with their relatives. While her mother is a stay in house helper at Binondo,
Sta. Cruz, Manila. Ms. L.G’s youngest sibling works as a factory worker in Qatar.
Ms. L.G finished a 2-year vocational course in Bohol and had previously worked as a
sewer and dressmaker at Africa and Brunei for almost three years from 2003-2006. She went back
here in the Philippines last May 2006 since her contract to the agency she was employed already
expired. She then decided not to return again abroad to work and started to invest on a ‘sari-sari’
store which provided her with sufficient income. Her youngest sibling is a college undergraduate
and works as a factory worker in Qatar for almost two years.
SOCIO-ECONOMIC BACKGROUND
Ms. L.G lives in a typical urban community set-up situated at Lim Compound, San
Dionisio, Paranaque City. The surroundings in which her house is situated consists of compressed
households and was quite unsafe. Her mother verbalized, “ Medyo delikado nga dito sa lugar
namin, Minsan may mga gulo at nag-aaway pero kahit papaano ligtas naman, may mga barangay
tanod naman dito.” While transportation, public and commercial establishments are accessible
within her house. She lives alone in a small bungalow type of household which she rents every
month. But due to her recent health condition, her mother presently stays with her temporarily. The
household comprises of a single bedroom, comfort room and a small space that serves as their
living room and dining area. The space of the household is approximately enough for two to three
persons only. In front of the house is a space provided for Ms. L.G’s small ‘sari-sari’ store. The
structure of the house is of mixed type built with wood and cement and two medium size windows
as a means of ventilation. The cleanliness of the house is maintained by the client herself. Ms.
L.G’s water supply is from NAWASA. She pays for it monthly.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Ms.
L.G. has her
income through her small ‘sari-sari’ store. Her income every month comprises of about 15,000
pesos. This income supports her alone with her basic needs. However, part of it is given to her
nephews and niece to support them with their daily needs. The client verbalized, “ Sapat lang din
para sa akin yung kinikita ko sa tindahan pero sinusuportahan ko din yung mga pamangkin ko kasi
wala naman trabaho yung pangalawa kong kapatid, kaya talagang nagigipit din ako.” On the other
hand, the youngest sibling of Ms. L.G. works abroad earning 20,000 pesos a month which is given
to support their family needs. While Ms. L.G’s mother earns 3,500 a month as a house helper
which is also contributed to the family’s basic needs.
LIFESTYLE
The client’s usual daily activity is more on housekeeping and watching her ‘sari-sari’ store.
She is not smoking and drinks alcohol occasionally. The patient used to consider cleaning the
house as a form of exercise and spends 7-8 hours of sleep per day. She seldom watches TV
programs and prefers to read magazines and newspaper as well as listening to OPM music. She
seldom goes to malls and public places except when she needs to buy groceries for her ‘sari-sari’
store. Ms. L.G. goes to church regularly every Sunday morning. She is not involved to any
organizations or social institutions and spends a lot of her time at home.
The only recognized familial disease is hypertension, all other hereditary diseases (e.g.
diabetes mellitus, lung diseases, cancer etc.) was not traced back to the client’s family generation.
With her father side, both grandparents are still alive with no alteration in their health condition.
While her father is of good health status except that he smoked for almost 40 years from now and
denies any health problems. Hypertension is identified to the maternal side. As evident, the client’s
grandmother and mother were hypertensive and maintain a regular dose of antihypertensive drugs.
However, the client herself is not hypertensive in spite of having a family history of hypertension.
The family seeks medical consultation whenever they need to, but as for common health problems
such as flu, cough, fever and colds that are manageable, they practice self-medication.
Medical History
The patient had no previous medical records that are significant to her health condition
prior to her recently diagnosed disease. The patient was never been admitted to a hospital and
consider herself healthy prior to her sickness. She only consults medical advice for purposes of
going abroad as a requirement since the client previously worked outside the country. The client
verbalized, “Hindi pa naman ako na-ospital dati, ngayon lang talaga nung nagkasakit ako. Nung
umpisa pa nga, ayoko din talaga magpa confine, kaso hindi ko na din talaga kaya. Nagpupunta
lang ako sa ospital kapag magpapa- medical kasi kailangan kapag mag-aabroad ako.” The patient
had no surgical procedures done from the past. The client seldom take a dose of multivitamins and
ascorbic acid. Uses Paracetamol (Biogesic) for fever, analgesic (Alaxan) for muscle or body pain,
Diphenhydramine HCL (Neozep) for common colds and to relieve symptoms of flu, and
Guaifenessin (Robitussin) for coughs and colds.
The patient acquired chicken pox and measles during her childhood years. No other
communicable disease noted from the past. The patient also have no allergic reactions to any
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
chemicals,
foods or
medications.
The patient had an injury during an earthquake attack on 1991 when she accidentally fell
off the ground due to the intensity of the earthquake and obtained a fracture in the wrist. Medical
consultation was sought after the incident and was treated appropriately through anti inflammatory
medications and X-ray imaging. No complications was noted and complete bone healing was
achieved.
The patient had an Oral Polio vaccination during her childhood. Other immunizations were
not remembered by the client.
Patient was in usual state of good health until April 2008 prior to confinement at the
Metropolitan Medical Center. Four months prior to confinement, the patient had experienced mild
abdominal pain and loose bowel movement. She had 3-6 times of bowel movement per day
characterized with mucoid consistency, brownish yellow in color and about 1 to ½ cup per bout.
The onset of these symptoms begun after the client ate from a usual ‘carinderia’ near her place.
The client verbalized, “ Pagkatapos ko kumain ng kaldereta dun sa karinderya malapit sa amin,
sumama na yung timpla ng tiyan ko. Tapos nagsimula na akong magtae, maaaring sa tubig din na
ininum ko dun sa karinderya kaya sumama yung timpla ng tiyan ko.” After which, the client
experienced persistent loose bowel movement and a gradual increase in the abdominal pain for
consecutive days. Due to above symptoms, the client took an over the counter medication. She
took ‘Imodium’ 1 tablet which offers a quite relief to her loose bowel movement. Eventually, 1
month after the onset of the symptoms, the client continuously experienced loose bowel movement
for 3-4 times per day with absence of the abdominal pain. She continues to take ‘Imodium’ as
needed and still offers relief to her condition. In this time, the consistency of her feces is still of
mucoid, foul odor, brownish yellow with blood streaked. This prompted the client to seek for
medical consultation. Since the client is alone while experiencing the above signs and symptoms,
she contacts her mother to accompany her to the hospital for consultation.
By late of May 2008, the client went to San Juan de Dios Medical Center as an out patient.
She was attended by Dr. Mariano and was prescribed for a fecalysis immediately during the time
they consulted. Based on the result of the fecalysis, the attending medical doctor diagnosed that the
client has an Amoebiasis. She was then prescribed to take a daily dose of Flagyl for 7 days 750mg
as a treatment regimen. After the consultation, the treatment that was given to the client offered a
great relief as compared to her recent condition prior to medical consult. She had a frequency of 2-
3 bowel movements per day but with same characteristics except with the presence of blood streak
and amounts for about ½- 1 cup per bout. Still symptoms persist but with decrease in severity.
However, by early June 2008, the client experienced severe abdominal cramping and
aggravated loose bowel movements with a frequency of 3-5 times per day still with mucoid
consistency, foul odor, brownish yellow with blood streak, 1 ½ -2 cups per bout. This onset of
aggravated symptoms was attributed when the client had stopped taking her medication after
experiencing a relief from her previous conditions. Due to persistent above signs and symptoms,
the client once again consulted for a medical advice and was rushed to the emergency room of
Makati Medical Center. Upon the client’s confinement on the ER, she was again prescribed to
have fecalysis as well as CBC and urine analysis. She was also given another set of antibiotics and
advised to resume taking Flagyl for 7 days 750mg. Once result of fecalysis was done, the client
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
was still
diagnosed
with Amoebiasis and was advised to continue medications. The client was not admitted to the
hospital since they preferred to went home and just take the prescribed medications.
From July 2008, the client’s condition stabilized and symptoms were alleviated. There was
a gradual improvement on client’s bowel movement. Normal bowel movement decreases from 1-2
times per day, semi formed, brownish in color and 1 cup per bout. The abdominal pain was also
relief. No follow up consultation took place after symptoms was alleviated.
By early August 2008, the client felt a sudden body weakness and loss of appetite with decrease
energy levels. This was accompanied again with loose bowel movements of at least 2-3 times per
day, mucoid consistency, brownish yellow, foul odor and amounting to 1 to 1 ½ cup per bout.
These symptoms persist for almost a five days before the client started to consult for the third time.
By August 13, 2008, the client consulted for medical advice at Metropolitan Medical
Center under the service of Mr. William Hoping Gan, a specialist on internal medicine. The
physician was referred to client’s mother by her superior on the house she works. Another set of
laboratory test was prescribed to the client including fecalysis with culture and sensitivity. They
were advised to continue taking the medications previously prescribed and was advised to go back
at his clinic after 3 days and reports if symptoms still persist.
By August 16, 2008, two hours prior to client’s admission, they went back to Dr. Gan’s
clinic for follow up consultation. The result of the following test including fecalysis with culture
and sensitivity revealed that the client still suffered from a chronic Amoebiasis and considering the
client of having a complication of amoebic colitis. This prompted the physician to advise the client
to be confined at the hospital institution for further medical management and treatment modalities.
She was admitted at Metropolitan Medical Center at station Annex room 105A.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
DEVELOPMENTAL DATA
Erik Erickson adapts and expands Freud’s theory of development to include the entire life
span, believing that people continue to develop throughout life. He believed in the massive
influence of culture on behavior and placed more emphasis on the external world such as
depression and was according to his theory, each stage signals a task that must be achieved. The
resolution of task can be complete, partial and successful. He believes that the greater the task
achievements the healthier the personality of the person. Failure to achieve a task influences the
person’s ability to achieve the next tasks. Erickson emphasizes that people must change and adapt
their behavior to maintain control over their lives.
The seventh stage is that of middle adulthood. It is hard to pin a time to it, but it would
include the period during which we are actively involved in raising children. For most people in
our society, this would put it somewhere between the middle twenties and the late fifties. The task
here is to cultivate the proper balance of generativity and stagnation.
Generativity is an extension of love into the future. It is a concern for the next generation
and all future generations. As such, it is considerably less "selfish" than the intimacy of the
previous stage. Generativity on Erikson considers teaching, writing, invention, the arts and
sciences, social activism, and generally contributing to the welfare of future generations to be
generativity as well -- anything, in fact, that satisfies that old "need to be needed."
Stagnation, on the other hand, is self-absorption, caring for no-one. The stagnant person
ceases to be a productive member of society. It is perhaps hard to imagine that we should have any
"stagnation" in our lives, but the maladaptive tendency Erikson calls overextension illustrates the
problem: Some people try to be so generative that they no longer allow time for themselves, for
rest and relaxation. The person who is overextended no longer contributes well. I'm sure we all
know someone who belongs to so many clubs, or is devoted to so many causes, or tries to take so
many classes or hold so many jobs that they no longer have time for any of them
More obvious, of course, is the malignant tendency of rejectivity. Too little generativity
and too much stagnation and you are no longer participating in or contributing to society. And
much of what we call "the meaning of life" is a matter of how we participate and what we
contribute.
This is the stage of the "midlife crisis." Sometimes men and women take a look at their
lives and ask that big, bad question "what am I doing all this for?" Notice the question carefully:
Because their focus is on themselves, they ask what, rather than whom, they are doing it for. In
their panic at getting older and not having experienced or accomplished what they imagined they
would when they were younger, they try to recapture their youth. Men are often the most
flambouyant examples: They leave their long-suffering wives, quit their humdrum jobs, buy some
"hip" new clothes, and start hanging around singles bars. Of course, they seldom find what they are
looking for, because they are looking for the wrong thing.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
But if
you are
successful at this stage, you will have a capacity for caring that will serve you through the rest of
your life.
Ms. L.G, a 33 year old single woman lives most of her life alone and is independent as with
regards to making decision. She finished a two-year vocational course and became a sewer in
South Africa from 2004-2006 but had resigned last mid 2006 and went home. Now she owned a
sari-sari store from which she managed alone. The income she gets from her sari-sari store
provides her needs and allows her to somehow support her nephew and niece with their basic
needs as well. Her usual activities are primarily focused on household chores, watching her store
and house keeping. She likes sewing most especially when she had nothing so important to do. Ms.
L.G. is not affiliated or involved to any organizations or institutions within their community or the
society as a whole. However, she is able to interact with her neighbors and mingled with them
during free her free time.
Physical Development
Mrs. L.G.weighs 42.7 kg or 94 lbs and stands 5 foot or 1.524m and is conscious but
appears irritable and less pleasant. She appears younger than her chronological age. She has no
deformities noted. According to her mother,“Hindi siya malakas kumain pero hindi naman siya
mapili sa pagkain”. Neuromuscular skills are refined and eye-hand coordination is facilitated. Mrs.
L.G can dress herself, is able to wash her own face and hands, brush teeth and attend to her own
toilet needs. She is able to write and read. In essence, she is able to do the usual activities of daily
living with no limitations. Her menstruation period start at age 13 and she is regular since then.
Psychosocial Development
For many women in midlife, sexuality has achieved a degree of stability. A sense of
femininity and comfortable patterns of behavior has been established. This increased security in
identity can promote greater intimacy in sexual and social relationships. This may also be the time
when adults allow themselves more freedom in exploring and satisfying sexual needs.
Midlife is often a time. When women reexamine life goals, careers, accomplishments,
values systems and familial and social relationships, as a result some people adapt, whereas, other
experience stress or a crisis. This reexamination can positively or negatively affect individual
gender identity and sexuality.
As with regards to Ms. L.G’s developmental assessment, she remains single up to her
present age and does not have any affair with anyone. In this stage, it can be considered that
through this time where she is at her midlife, Ms. L.G. had already achieved a sense of stability as
with regards to her sexuality. However, exploring and satisfying sexual needs might be a problem
to Ms. L.G. This is of the reason that she was not able to experience intimate relationship from her
past as with regards to the opposite sex as to build her own family. Another reason is that she had
lived most of her life alone and independent that such support system coming from friends, family
and other significant others is less achieved.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
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Ms.
L.G. is also
experiencing current issues and problems that involve her family and immediate relatives. These
issues involve supporting her relatives, financial constraints and conflicts that arises among family
members. This had become her stressor through this stage of her development which has greater
impact to the way she thinks and make decisions. Such stressors and crisis might affect the way
Ms. L.G. reexamines her goal and value system as part of her task on her age now.
She is also at risk of failing her developmental task for the reason that generating goals and
values that focus on unselfish desires are hindered resulting to stagnation and becoming self
absorbed. This is evident to Ms. L.G. since she happened to live alone and independent, limited
support system and social functioning is quite unmet and might result to rejectivity.
Robert Havighurts
Developmental Task
The idea of "developmental task" is generally credited to the work of Robert Havighurst who
indicates that the concept was developed through the work in the 1930s and 40s of Frank, Zachary,
Prescott, and Tyron. Others elaborated and were influenced by the work of Erik Erikson in the
theory of psychosocial development. Havighurst states:.
From examining the changes in your own life span you can see that critical tasks arise at certain
times in our lives. Mastery of these tasks is satisfying and encourages us to go on to new
challenges. Difficulty with them slows progress toward future accomplishments and goals. As a
mechanism for understanding the changes that occur during the life span.
Robert Havighurst(1952, 1972, 1982) has identified critical developmental tasks that occur
throughout the life span. Although our interpretations of these tasks naturally change over the
years and with new research findings. Havighurst's developmental tasks offer lasting testimony to
the belief that we continue to develop throughout our lives.
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.
Ms. L.G. is able to achieve this stage of her life as evidence by the following aspects. First Ms.
L.G. has finished a 2 year vocational course and is currently owning a small sari-sari store that she
is currently managing, also the client is able to have her time for relaxation and she has a good
relationship with her parents. The client has not complained any emotional aspects regarding the
state of her parents but there is no sign on her that she is not coping with the physiological changes
of her life.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
LEVEL OF
COMPETENCIES
PHYSICAL COMPETENCY
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
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MENTAL
COMPETENCY
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#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
EMOTIONAL COMPETENCY
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
SOCIAL
COMPETENCY
SEXUAL COMPETENCY
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#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
SPIRITUAL COMPETENCY
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
BEFORE
ILLNESS DURING ILLNESS
( BEFORE DURING PRIOR ANALYSIS
APRIL 2008) HOSPITALIZATION DISCHARGE
PRIOR ONSET ( APRIL 2008- DATE OF
OF SIGNS AND AUGUST 2008) DISCHARGE:
SYMPTOMS DATE OF AUGUST 28, 2008
CONFINEMENT:
AUGUST 16-28, 2008
The client is a During her After hospitalization, The client was
Roman Catholic confinement, the client the client resumed her unable to attend
and attends was unable to attend regular attendance with her
Sunday mass on a Sunday mass but was during Sunday mass religious activity
regular basis and able to pray anytime and prays regularly such as attending
practices religious she wants. The client anytime she wants. The church mass
beliefs. The client verbalized, “ Syempre client verbalized, “ every Sunday
verbalized, “ nung nasa hospital ako, Nung makalabas na when she was
Palage ako hindi ako ako ng ospital at hospitalized.
nagsisimba nakakapagsimba. Pero medyo ok na yung However, was
tuwing lingo. kahit papaano pakiramdam ko, able to resume
Pinapraktis nagdadasal ap din ako nagsisimba na uli ako.” again after
naming yung mga lalo pa at may sakit hospitalization.
prusisyon, ako.” The clients have
penitensya kapag an aptitude on
mahal na araw.’ attending regular
church mass and
have faith and
believe to the
Lord Almighty.
She presented
personal, health
and family
problems to God
through prayers
and religious
activities.
PATTERNS OF FUNCTIONING
EATING PATTERN (Consists only of samples of what the patient usually consumes.)
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
DURING ILLNESS
Prior to Hospitalization During Hospitalization
Before Illness (Early April 2008-Early (August 16 2008-August 28, Analysis
(Daily Basis) August 2008 ) 2008)
Onset of recurrent signs and
symptoms
BREAKFAST (7 am- BREAKFAST (7 am-varies) DIET UPON ADMISSION: There is a decreased in
varies) Usually consumes 1-2 pcs. Of Low fat diet food intake of the
Usually consume 3-4 medium size pandesal, at least patient prior to
pcs. of medium size 2 thin slices of dairy cream, ½ hospitalization. During
pandesal, 3-4 thin cup coffee with creamer Succeeding Diet: the onset of signs and
slices of dairy cream BRAT diet and Bland Diet symptoms, the client
and 1 cup of coffee LUNCH without dairy products has a gradual decrease
with creamer (12:00 NN – time varies ) • Usual meal of the on servings of her
Usually consumes a cup of client during previous meals eaten.
LUNCH rice, approximately ¼ portion hospitalization varies This could be related to
(12:00 NN – time of meat or fish, and 1-2 to the hospital food client’s altered comfort
varies ) glasses of water being given. This primarily by her
Usually consumes a includes 1 cup of recurrent loose bowel
1- 1 1/2 cup of rice, SNACK rice, a portion of fish movements and
a portion of meat or (4:00 pm) or meat without abdominal pain. Once
fish,1 cup of soup Usually 3-4 pcs. Of crackers spices, side the client was
and 2 glasses of or biscuits and a glass of vegetables, banana hospitalized, there is a
water or sometimes water. and apple. However sudden change on
12oz. of soft drinks. the client only client’s food
DINNER consumes 3-6 tbsp. of preferences as ordered
SNACK (8:00 – 8:30 pm) rice, ¼ portion of the by her physician.
(4:00 pm) Usually consumes a ¾ to 1 viand, 2 tbsp. of the Previously eaten food
Usually just a glass cup of rice, a portion of meat side vegetables, ¼ to such as dairy products,
of water or juice and or fish, and a glass of water. half servings of either coffee and soft drinks
bread or banana cue. banana or apple, 1-2 are prohibited for her.
glasses of water per There is a remarkable
DINNER meal loss of appetite by the
(7:30 – 8:00 pm) client during
Usually consumes a Patient verbalized, “Wala hospitalization that
cup of rice, a portion akong ganang kumain nung leads her to some
of meat or fish, and a nasa ospital ako. Sobrang degree of weakness and
glass of water. nanghihina din talaga ako.” decrease energy levels.
DRINKING PATTERN
DURING ILLNESS
Prior to Hospitalization During Hospitalization
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
ELIMINATION PATTERN
URINATION
DURING ILLNESS
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
BOWEL MOVEMENT
DURING ILLNESS
Prior to Hospitalization During Hospitalization
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
BATHING PATTERN
DURING ILLNESS
Prior to Hospitalization During Hospitalization
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
SLEEPING PATTERN
DURING ILLNESS
Prior to Hospitalization During Hospitalization
Before Illness (Early April 2008-Early (August 16 2008-August 28, Analysis
(Daily Basis) August 2008 ) 2008)
Onset of recurrent signs and
symptoms
Duration : 7-8 Duration : 5-6 hrs/day Duration : Irregular The client has
hrs/day = Time of sleep is usually but reaches 5-6 hours a day. enough sleeping
= Time of sleep is 11:00 in the evening and hours before her
usually 11:00 in the awakens by 7:00 in the illness. But prior to
evening and morning. Interruption of sleep her hospitalization,
awakens by 7:00 in is experienced whenever the she experienced a
the morning. client experienced defecating decrease on the
= Does not take naps due to episodes loose bowel duration of her sleep
during mid- movement. and was interrupted
afternoon since the = Does not take naps during whenever she felt the
client watches her mid-afternoon since the client urge to defecate due
‘sari-sari’ store. watches her ‘sari-sari’ store. to her loose bowel
movement. Once the
client was
hospitalized, she had
still insufficient time
of sleep. This
interruption on
client’s sleeping
pattern is related to
alteration in comfort
due to illness state.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
DAY TO
DAY APPRAISAL
08/17/08
0700H-1500H • The client was scheduled for colonoscopy and
proctosigmoidoscopy c/o gastro point of view by 08/19/08
early in the morning
• With orders to give lemonada purgante 720 ml on
08/18/08 to start at 7pm to 10pm
• To give dulcolax 2 tabs at 6pm on 08/18/08
• Client was instructed to have clear liquid diet on 08/18/08
after dinner until 5am of 08/19/08 the nothing per orem
prior the procedure
• With an on going IVF of D5LR 1L + 20meqs KCl as
follow up to above consumed IVF.
• Flagyl discontinued- Dr. Gan aware
• Metronidazole 750mg/ tab every 8 hours if not ok.
• To start Diloxamide Furoarte 500mg/tab 1 tab OD
1500H-2300H
• For stool culture and sensitivity with specimen bottle
• For acid either concentration tech. of the stool with SB.
• Client defered modified Kinyoun acid fast stain of the
stool with blue form and med. abstract with chart
• (+) blood streaked stool, water with some particles,
moderate in amount, mucoid in consistency, 1x
• Client has 3 episodes of vomiting of previously ingested
food.
41
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
08/19/08
0700H-1500H
• Client was on pulse oximeter
• Dormicum 2.5mg given as stat dose given prior
procedure
• Demerol 12.5 mg given prior procedure
• Proctosigmoidoscopy done
• Biopsy taken from sigmoid colon to rectum and was
sent to the laboratory
• With results of histopathology and biopsy report to be
follow up
42
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
08/19/08
1500H-2300H • Seen
patient by Dr. Cuaresma with suggestion- Dr. P. Te
aware
• Vomited once; previously ingested food
• Dr. P. Te with orders to give:
• Metronidazole tab shifted to 500mg IVT q8
• Metronidazole 1g/supp. OD/rectum
• Imodium 2mg/tab given now then q4 PRN for loose
stool
2300H-0700H
• BM-1x mucoid, brown in color, with blood streaked
moderate in amount.
• Dr. P. Te ordered same IVF as follow up to above
consumed IVF
• Afebrile
ASSESSMENT FINDINGS
GENERAL SURVEY
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
The patient
was conscious and coherent. However, she appears to be irritable and uncomfortable and avoids
conversing to others. She also appears to be ill with thin and frail body. Her stated chronological
appearance is not proportion with her present appearance. The client appears to be younger than
her age.
PHYSICAL ASSESSMENT
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
tempomandibular
joint; articulates
smoothly
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
47
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
48
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
49
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Respiration
muscles are used accessory
in normal muscles being
breathing used; no
exaggerated
respiratory effort
upon breathing
noted
c. Tactile Palpation Normal Fremitus Buzzing is felt Normal
Fremitus is felt as buzzing on the ulnar
on the ulnar aspect of the
aspect of the hand upon
hand palpation; no
increase or
decrease
Fremitus was
observed
c. Breath Auscultation Blowing or Fine crackles Abnormal
Sounds hollow sound, (rales) heard Heard when
high in pitch upon there is fluid
( Bronchial); auscultation accumulation
gentle rustling or on the alveoli
breezy, low in of the lungs
pitch
( Vesicular); no
adventitious
breath sounds
should be heard
Heart
a. Precordium Inspection & Symmetrical; no Adynamic Normal
Palpation vibrations, thrills precordium; PMI
and expansions at 5th Intercostal
noted space, left
midclavicular
line
b. Heart Sounds Auscultation Rhythm is Regular heart Normal
regular; sounds; S1 and
distinguishable S2 are
S1 and S2; no distinguishable
murmurs heard upon
auscultation
Peripheral Inspection No pallor, No discoloration Normal
Vasculature cyanosis or and complains of
ulceration noted; pain or
no complaints of discomfort noted
pain or
discomfort
Abdomen
a. Contour, Inspection Flat or rounded; Flat abdomen; Normal
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Symmetry
and symmetrical non tender;
Pigmentation bilaterally; no symmetrical;
discoloration uniform in color
and
pigmentation; no
scars, striae or
lesions noted
b. Umbilicus Inspection Should be Umbilicus at Normal
depressed and lower midline of
beneath the abdomen;
abdominal depressed and
surface beneath
abdominal
surface
c. Bowel Sounds Auscultation Intermittent Normoactive to Abnormal
gurgling sounds hyperactive
throughout bowel sounds
abdominal prominent at
quadrants; high right lower
pitched and quadrant
occurs 5 to 30
times per minute
Musculoskeletal
System
a. Muscle size Inspection Muscle shape Reduced muscle Abnormal
and shape may be size; thin and Decrease in
accentuated in flabby muscles; muscle size and
certain body contour is less shape is due to
areas but should distinct; no nutritional
be symmetrical; involuntary imbalances and
no involuntary movement noted lack of
movement movements
leading to
atrophy
b. Muscle Inspection Complete Decrease muscle Normal
Strength voluntary range strength was
of joint motion observed on
against gravity upper
and moderate to extremities;
full resistance; complete range
strength is of joint motion
equally bilateral; against both
no involuntary gravity and
muscle moderate manual
movements resistance; good
muscle strength
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
REVIEW OF SYSTEM
The review of system is the client’s subjective response to a series of body system related
questions. It follows a head-to-toe approach and includes the signs and symptoms related to
disease. Mentioned among are the positive findings assessed from the client.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
General
Subjective:
“Hindi maganda ang pakiramdam ko,
medyo sumasakit ang tiyan ko at hindi at
mapalagay. Nararamdaman ko din na
nanghihina ako at para bang palage akong
walang lakas.”
Integumentary Subjective:
“Wala naman ako mga peklat o sugat.
Medyo ‘dry’ nga lang ang balat ko, di kasi
akon nakakapag lotion madalas”
Respiratory Subjective:
“ Medyo inuubo ako ngayon pero hindi
naman ako nahihirapan huminga.”
Gastrointestinal Subjective:
“Madalas ako nadudume na may kasamang
dugo at medyo basa. Nakaramdam din ako
ng pagsusuka. Pabalik balik ang pananakit
ng tiyan, humihilab at para bang umiikot
yung sikmura ko,”
Urinary Subjective:
“ Wla naman akong problem sa pag-ihi o
sakit na nararamdaman. Dalawa hanggang
tatlong beses ako umiihi. Medyo mahina
din kasi ako uminom ng tubig eh.”
Musculoskeletal Subjective:
” Nahihirapan ako maglakad at magkikilos
ngayon, nanghihna kasi ako at madaling
mahapo.’
Neurological Subjective:
“Medyo nahihirapan ako magsalita ngayon,
nauutal ako. Masakit din ang tiyan ko.
“Nagmamanhid nga din yung mga daliri ko
sa paa, para bang hindi ako
nakakaramdam.”
Female Reproductive ( no positive findings)
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Nutrition
Subjective:
“Wala talaga akong ganang kumain. Mga
3-4 na subo lang ayoko na agad. Sumasakit
kasi ang tiyan ko at masama talaga ang
pakiramdam ko”
Endocrine ( no positive findings)
Hematological Subjective:
“ Medyo nanghihina ako at walang gana.
Madali ako mapagod at mahapo.’
DIAGNOSTIC PROCEDURES
LABORATORY EXAMINATION
COMPLETE BLOOD COUNT (CBC). Done to assess if the patient has increase or decrease
WBC due to detect infection.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Differential Count
Results Normal Values
Segmenters 0.58 0.55- 0.70
Lymphocytes 0.29 0.25- 0.40
Monocytes 0.08 0.02- 0.08
Eosinophils 0.04 0.01- 0.06
Basophils 0.01 0.00- 0.05
ANALYSIS:
The result of e exam of hemoglobin 100 g/L show a decrease in number of circulating
hemoglobin iron-protein compound in red blood cells which transport oxygen for to the body
tissue thus implicate a poor tissue perfusion. This also show a decrease number of RBC TO
3.72.Thus decreasing the percentage of a blood sample that consists of red blood cells, measured
after the blood has been centrifuged and the cells compacted called Hematocrit to 0.31.
Differential counts are within normal values.
Hematology
It is a series of screening test, which consists of hemoglobin and hematocrit measurement for the
detection of certain diseases. It provides complete evaluation of all the formed elements of the
blood. It can supply a great deal of information to diagnose hematopoietic system and helps to
evaluate these stages and prognosis of certain diseases.
Differential Count
The differential count measures the percentage of each type of leukocytes. An increased of
percentage of one type of leukocyte, maybe a decreased in percentage of the other type. The
leukocyte type can be identified easily by their morphology in venous blood smear.
Platelet
Platelets are part of cytoplasm that are involved in the coagulation process. Platelet attach or
55
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
adhere to the
walls of
injures blood vessels, where they clump together or aggregate to form platelet plugs necessary for
coagulation. It is produced by bone marrow and processed and removed by the spleen when they
are damaged or old.
Lymphocytes
Is a class of leukocytes produced in a variety of lymphoid organs throughout the body and is
responsible for cellular and normal immune responses. Leukocytes are often seen in sites of
chronic inflammation. They produce many secretory products that modulate the functional of a
wide variety of cell types.
Eosinophils
It is a variety of white blood cells distinguished by the presence of cytoplasm. It is capable of
ingesting foreign particles.
Monocytes
It is the largest cell of a normal blood that transforms into macrophages and become responsible
for phagocytosis of unwanted particular matter.
Analysis:
The result of the exam for hemoglobin 105 g/L shows decrease in number of circulating
hemoglobin contained entirely in the red blood cells, amounting to perhaps 35 percent of their
weight. To combine properly with oxygen, red blood cells must contain adequate hemoglobin.
Hemoglobin, in turn, is dependent on iron for its formation. A deficiency of hemoglobin caused by
a lack of iron in the body leads to anemia. Thus decreasing red blood cells in a blood sample in
order to determine the percentage of the blood that consists of cells Decrease in hemoglobin,
Hematocrit, and RBC shows the relation to amoebiasis in a way that trophozoites a parasite that
invade tissue found in liquid colonic contents burrow deeper with tendency to spread laterally by
continous lysis of cell until they reach the muscalaris mucosae frequently erode the lymphatic or
walls of the mesenteric venules in the floor of ulcers, which may enter , and in carried into
intraheptic portal veins. If thrombi occur in small branches of the portal vein, the trohozoites held
in the thrombi cause lytic necrosis of the wall of vessel and digest s pathway into the lobules
Date received: 08/22/08 02:25 PM
Date released: 08/22/08 03:55PM
Requested by: William Hoping Gan, MD
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Analysis:
The result of e exam of hemoglobin 114 g/L show a slightly decrease in number of
circulating hemoglobin. In addition alterations in the structure of hemoglobin can lead to life-
threatening illnesses. The most important of these conditions is sickle-cell anemia, which involves
a hereditary change in one of the amino acids that make up hemoglobin. The thalassemias are a
group of hereditary diseases of similar origin. A decrease in the fraction of blood occupied by
erythrocyte or hematocrit.
Hemoglobin
Hemoglobin is the main components of red blood cells. The main function is to carry
oxygen from the lungs to the tissue and transport carbon dioxide, the product of metabolism, back
to the lungs. It is often ordered as part of complete blood count. Red blood cells are complete with
hemoglobin.
Hematocrit
The hematocrit is the percent of whole blood that is comprised of red blood cells. It is
compound measures how much space in the blood is occupied by red blood cells. It is useful when
evaluating a person with anemia.
PROTHROMBIN PT
Protime 14.6
% activity 84.4 sec
INR 1.15 %
ISI 1.21
Control 13.0 sec
Analysis
An increase in APTT indicates a decrease clotting time which initiates bleeding tendency
and a blood-clotting factor in blood platelets that converts prothrombin to thrombin to promote
scar formation and wound healing. Normal prohrombin activity in the blood depends on adequate
absorption of Vitamin K from the GI tract and adequate liver function. Therefore deficiency may
arise from factor that affects vitamin K absorption such as diarrhea. Increase in APTT is related in
a amoebiasis in a way that it may affect the liver decreasing production of several clotting factors
may be due to deficient vitamin K from the gastrointestinal tract. This probably is caused by the
57
METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
inability of
liver cells to
use vitamin K to make prothrombin. Absorption of the other fat-soluble vitamin (vitamin A, D,
and E) as well the dietary fats may also be impaired because of the decreased secretion of bile salt
in the intestine. The production of blood clotting factor of the liver is also reduced, leading in an
increased incidence of bruising, nosebleed, bleeding from wounds and gastrointestinal bleeding.
BLOOD CHEMISTRY
Analysis
A decrease in BUN indicates a decrease in index of renal excretory capacity. Serum urea
nitrogen is dependent on the body’s urea production and on urine flow. Urea’s are nitrogenous end
product of protein metabolism and are also affected by protein intake. A decrease in potassium
which can cause such problems as thirst, fatigue, low blood pressure, muscle cramps, nausea, and
irregular heartbeat. Some diuretics (medications that increase urination) and heart drugs, as well as
certain diseases, can cause potassium deficiency. SGPT, Creatinine, Sodium are at normal range.
Decrease in BUN and potassium due to slight attack of diarrhea eructations after eating and slight
nausea partly because potassium is actually lost when gastric fluid is lost; but more so because
potassium is lost through the kidneys in association with metabolic alkalosis. Relatively large
amounts of potassium are contained in intestinal fluid for example diarrheal fluid may contain as
much as 30 mEq.L. Therefore potassium deficit occurs frequently with diarrhea that may cause
cardiac dysrythmias as a complication. A decrease in BUN indicates a low index in renal excretory
capacity and is associated in low protein intake therefore decrease protein metabolism causing by
product urea to decrease.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Analysis
The test show a slightly decrease in potassium which plays an important role in normal
muscle activity symptoms of deficiency include muscle weakness. Potassium chloride works by
controlling the body’s water balance and regulating such processes as nerve transmission, muscle
contraction, and normal heart rhythm. Laboratory chemistry branch of science dealing with the
structure, composition, properties, and reactive characteristics of substances, especially at the
atomic and molecular levels.
BLOOD EXTRACTION
Nursing responsibilities:
Before:
1. Greet client by name and validate client’s identification. Check full name and ID band –
for verification purposes.
1. Explain the procedure and its importance.
2. Tell the patient that no special diet or fasting is required.
3. Give details about the collection of the blood sample which is brief but if causes some
discomfort.
4. Notify the patient that pressure will be applied to the puncture site for few minutes.
5. Hand washing – to prevent contamination of microorganisms.
During:
1. Inform the patient to avoid closing and opening the hand after the tourniquet is applied.
2. Position client’s arm to form a straight line from the shoulder to wrist. Place pillow under
upper arm to enhance extension. Client should be in supine or semi-fowler’s position – to
facilitate easy blood drawing.
3. Indicate on the laboratory slip any drugs that can affect the result.
After:
1. Apply pressure or a pressure dressing area to the venipuncture site.
2. Assess the venipuncture site for bleeding.
3. Dispose the needles, syringe and soiled equipments to proper container – to prevent
contamination.
4. Hand washing – to prevent contamination.
5. Validate client’s reaction – to assess feelings and reactions of patient after the procedure.
6. Send specimen into the laboratory with the client’s complete identification – inaccurate
identification on the specimen container can lead to errors of diagnosis or therapy.
7. Follow up the result and report to AMD.
COMPLETE URINALYSIS
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
MACROSCOPIC
Physical/Macroscopic Result
Color Amber
Transparency Slightly hazy
Specific Gravity 1.010
Ph 7.5 Alkaline
Protein Negative
Glucose Negative
MICROSCOPIC
Analysis
Urinalysis shown normal urine color amber and slightly hazy a decrease urine specific gravity
it is less precise than urine osmolality and reflects both the quantity and the nature of particles.
Therefore, protein, Glucose, and intravenous contrast agent specific gravity than osmolality. Urine
is a good medium for growth of bacteria that’s why urine ideally performed on fresh specimen
preferably the first voiding. If left standing at room temperature urine become alkaline because of
contamination of urea-splitting bacteria.
Mucous thread moderates in amount, Bacteria many in amount A. Phosphate moderate epithelial
cell occasional. The normal urinary tract is sterile above the urethra bacteria may be due to
incomplete emptying of the bladder and urinary stasis. Decreased natural host defense and
instrumentation of the urinary tract including catheterization and cystoscopic procedure
MACROSCOPIC
Physical/Macroscopic Result
Color Yellow
Transparency Slightly hazy
Specific Gravity 1.030
Reaction 6.0
Protein Negative
Glucose Negative
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
MACROSCOPIC
Analysis
Show normal urine color and transparency increase specific gravity indicate presence of
substances found in urine. Negative for protenuria and glycosuria. In addition urinalysis may
provide important clinical information. Although urinalysis is usually performed routinely it
evaluates urine color, clarity and odor. Measurement urine acidity and specific gravity. Test for
presence of protein, glucose and ketone, hematuria, cast (cylinduria), crystals (crystalluria), pus
(pyuria) and bacteria (bacteriuria).
NOTE:
Hematology-Specimen rechecked
Results verified
Chem: Specimen rechecked. Abnormal results verified.
Clinical microscopy verified. Specimen rechecked. Results verified
FECALYSIS
MACROSCOPIC MICROSCOPIC
Color Red RBC 70- 80/ HPF
Consistency WATERY/MUCOID Pus cells 12-20/ HPF
Others
SPECIAL TEST
Occult blood: NOT REQUESTED
Entamoeba histolytica
Cyst 1-3L/LPF
Trophozoite 1-2/LPF
Parasites
Ascariasis ova: NONE SEEN
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Analysis:
Stool exam show a red in color which is an indicator of blood entering the lower portion of
the GI tract or passing rapidly through it. Carrots and beets may cause a red stool. A normal
mucoid consistency no presence of ascariasis ova, hookworm ova, trichiuris ova a parasite usually
found in stool. Color red watery mucoid in consistency in relation to amoebiasis that a watery
mucoid stool are characteristics of small bowel disease whereas loose, semisolid stool are
associated more often in the disorder of the colon it denotes inflammatory enteritis or colitis. Color
red stool may indicate a blood entering the lower portion of the gastrointestinal tract or passing
rapidly through it will appear bright or dark red that is associate4d in amoebiasis an a way that
there is ulceration in lymphatic vessel of the gastrointestinal tract.
Analysis
Stool acid indicates no found for ova, parasites and amoeba no changes noted. In addition
there are factors that interfere with the sensitivity and specificity of the test. Careful assessment of
diet and mediation regimen is necessary to eliminate the chance of false-positive results.
BACTERIOLOGY
STOOL CULTURE AND SENSITIVITY
Date received: 08/18/ 08
Date released: 08/21/0808
Requested by: William Hoping Gan
Analysis
Stool culture shown no presence of enteric pathogen it include inspection of the specimen
for its amount, consistency, and color, and a screening test for occult blood. The test done to
patient is a special test which includes for pathogen and collected in a random basis. In addition
bacteriology is the scientific study of bacteria, especially in relation to medicine
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Clinical
history:
slurring speech
Canial CT scan: with delayed conttrast
Findings:
Tiny parenchymal is note in the left pareital lobe
The gray white matter interface is well defined
Te ventricles, sulci, and cisterns are normal
No evidence of hydrocephalus, acute parenchymal hemorrhage of midline shift
Posterior fossa structure are intact
Visualized paranasal sinises petromastoid are clear
No abnormal enhancementis seen contrast study
Impression:
Tiny parenchymal calcification with adjacent edema, left lateral lobe.
This may relate to vascular abnormal, previous injection or less likely peoplastic process
Indication:
The test is done to the patient to see if there is mass, cyst,
inflammatory lesions, abscess of the chest, abdomen, pelvis and extremities.
ULTRASOUND REPORT
Date: 08/19/2008
Findings:
The liver is normal in size and echo pattern
There is no dilation of the intra-hepatic ducts
No mass seen
The gallbladder5 measuring 6.1 x 2.0cm with anaerobis lumen. The wall is not thickened
The pancreas is normal in size and echo pattern
No mass seen in at or near the region of the pancreas
The spleen is not enlarged. Negative for intrasplenic mass.
Indication:
This test is done to see if there is any problem like mass or cyst regarding the liver, gallbladder
pancreas and spleen.
Impression:
Essentially there is normal
COLONOSCOPY
Date: 09/19/08
Findings:
Seen Finding Biopsy
Anus / / /
Rectum / / /
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Sigmoid
/
Descending colon /
Sple flexure /
Trans colon /
Hop. Flexure /
Ascending colon /
Scope was inserted until terminal ileum. Normal terminal ileal mucosa. From level 40cm, there are
multiple white base mucosa erosion with erythematotous border seen. Circumferential mucosa
erosion with whitish mucous seen from level 35cmdown to the rectum. Multiple biopsies taken
from erosion and normal mucosa to send for hiatopath. The rest of the examination are
unremarkable.
Indication:
This test is done to see if client is at high risk of having colon cancer. Patient with a history
of diarrhea and constipation, persistent rectal bleeding or lower abdominal pain.
Impression:
There is normal ileal mucosa
There is multiple whtie base matter erosion with erythematotous
Pathology Report
Diagnosis:
A. Fragments of unremarkable mucosa
B. Consistent with chronic active colitis with ulceration
Description of notes:
MEDICAL MANAGEMENT
INTRAVENOUS THERAPY
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Succeeding
Intravenous
Fluid:
Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It
can be intermittent or continuous; continuous administration is called an intravenous drip. The
word intravenous simply means “within a vein”, but is most commonly used to refer IV therapy.
Therapies administered intravenously are often called specialty pharmaceuticals.
Compared with other routes of administration, the intravenous route is the fastest way to
deliver fluids and medications throughout the body. Some medications, as well as blood
transfusions and lethal injections, can only be given intravenously.
D5LR/ PLR
Lactated Ringer's solution is a solution that is isotonic with blood and intended for
intravenous administration. Veterinary administration may also be subcutaneous.
Lactated Ringer
Lactated Ringer's Solution is often used for fluid resuscitation after a blood loss due to
trauma, surgery, or a burn injury. Previously, it was used to induce urine output in patients with
renal failure.Lactated Ringer's Solution is used because the byproducts of lactate metabolism in the
liver counteract acidosis, which is a chemical imbalance that occurs with acute fluid loss or renal
failure.
The intravenous dose of Lactated Ringer's Solution is usually calculated by estimated fluid
loss and presumed fluid deficit. For fluid resuscitation the usual rate of administration is 20 to 30
ml/kg body weight/hour. Lactated Ringer's Solution is not suitable for maintenance therapy
because the sodium content (130 mEq/L) is considered too high, particularly for children, whereas
the potassium content (4 mEq/L) is too low, in view of electrolyte daily requirement.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Other
commonly
used intravenous solutions include normal saline and hespan (used in hypovolemic shock).
Lactated Ringer's is also used as a conduit for the delivery of drugs. Lactated Ringer's is usually
given intravenously, but if a suitable vein is not found, it can be taken orally (although it has an
unpleasant taste).
D5NS
The amount of normal saline infused depends largely on the needs of the patient (e.g.
ongoing diarrhea or heart failure) but is typically between 1.5 and 3 litres a day for an adult.
Other concentrations of saline are frequently used for other medical purposes, such as
supplying extra water to a dehydrated patient or supplying the daily water and salt needs
("maintenance" needs) of a patient who is unable to take them by mouth. Because infusing a
solution of low osmolality can cause problems, intravenous solutions with reduced saline
concentrations typically have dextrose (glucose) added to maintain a safe osmolality while
providing less sodium chloride. As the molecular weight (MW) of dextrose is greater, this has the
same osmolality as normal saline despite having less sodium. Because the dextrose used in these
preparations is dextrose monohydrate (a commercial form having MW 198 in contrast to MW 180
for glucose), 5% dextrose is equivalent to 4.5% glucose.
NURSING RESPONSIBILITIES:
DIET
• Initial diet upon admission: low fat diet
Succeeding diet:
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
In
nutrition, the diet is the sum of food consumed by a person or other organism Dietary habits are
the habitual decisions an individual or culture makes when choosing what foods to eat. Although
humans are omnivores, each culture holds some food preferences and some food taboos.
Individual dietary choices may be more or less healthy. Proper nutrition requires the proper
ingestion and equally important, the absorption of vitamins, minerals, and fuel in the form of
carbohydrates, proteins, and fats. Dietary habits and choices play a significant role in health and
mortality, and can also define cultures and play a role in religion.
BRAT DIET
The BRAT diet is a historically prescribed treatment for patients with various forms of
gastrointestinal distress such as diarrhea, dyspepsia, and/or gastroenteritis. The BRAT diet consists
of foods that are relatively bland, easy to digest, and low in fiber. Low-fiber foods are
recommended because foods high in fiber may cause gas, possibly worsening the gastrointestinal
upset. The foods from the BRAT diet may be added, but should not replace normal, tolerated
foods. Sugary drinks and carbonated beverages should be avoided.A well-balanced diet is best
even during diarrhea, but studies have found that incorporating foods from the BRAT diet can
reduce the severity of diarrhea (see Contrary medical advice). Applesauce provides pectin, as does
toast with grape jelly.
The BRAT diet should include additional protein supplements such as tofu or protein pills.
BLAND DIET
Purpose: The bland or soft diet is designed to decrease peristalsis and avoid irritation of the
gastrointestinal tract.
Use: It is appropriate for people with peptic ulcer disease, chronic gastritis, Reflux esophagitis or
dyspepsia. It may also be used in the treatment of hiatal hernia.
Description: The soft/ bland diet consists of foods that are easily digestible, mildly seasoned and
tender. Fried foods, highly seasoned foods and most raw or gas-forming fruits and vegetables are
eliminated. Drinks containing Xanthine and alcohol should also be avoided.
DIAGNOSTIC PROCEDURES:
COLONOSCOPY
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Why is
colonoscopy done?
This test may be done for a variety of reasons. Most often it is done to investigate the finding
of blood in the stool, abdominal pain, diarrhea, a change in the bowel habits, or an abnormality
found on colon x- ray or a CT scan. Certain individuals with previous history of polyps or colon
cancer and certain individuals with family history of particular malignancies or colon problems
may be advised to have periodic colonoscopies because they are at a greater risk of polyps or colon
cancer.
NURSING RESPONSIBILITIES:
Client preparation
Before procedure
After procedure
• You may have increased flatus as air is instilled into the bowel during the
procedure.
• Report any abdominal pain, chills, fever, rectal bleeding or mucopurulent discharge.
• If polyps have been removed, avoid heavy lifting for 7 days and avoid high fiber
food foe 1-2 days.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
The
frequency
with which even relatively inexpensive and non-invasive diagnostic tests are performed clearly
places a burden on health care.
NURSING RESPONSIBILITIES:
Client preparation
1. Ask patient to wear comfortable, loose-fitting clothing for ultrasound exam. The patient
will need to remove all clothing and jewelry in the area to be examined. You may be asked to wear
a gown during the procedure.
2. Ask patient to inform the doctor if he/she have had a barium enema or a series of upper
GI (gastrointestinal) tests within the past two days. Barium that remains in the intestines can
interfere with the ultrasound test.
1. Inform the patient that after he or she positioned on the examination table, the radiologist, or
sonographer will spread some warm gel on his/her skin and then press the transducer firmly
against the body, moving it back and forth over the area of interest until the desired images are
captured. There may be varying degrees of discomfort from pressure as the transducer is pressed
against the area being examined.
2. If scanning is performed over an area of tenderness, the patient may feel pressure or minor pain
from the procedure.
3. If a Doppler ultrasound study is performed, the patient may actually hear pulse-like sounds that
change in pitch as the blood flow is monitored and measured.
• Once the imaging is complete, the gel will be wiped off on skin.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
PROCTOSIGMOIDOSCOPY/ SIGMOIDOSCOPY
Sigmoidoscopy is the minimally invasive medical examination of the large intestine from
the rectum through the last part of the colon. There are two types of sigmoidoscopy, flexible
sigmoidoscopy, which uses a flexible endoscope, and rigid sigmoidoscopy, which uses a rigid
device. Flexible sigmoidoscopy is today generally the preferred procedure. Sigmoidoscopy is a
very effective screening tool. Sigmoidoscopy is similar but not the same as colonoscopy.
Sigmoidoscopy only examines up to the sigmoid, the most distal part of the colon, while
colonoscopy examines the whole large bowel.
Client Preparation:
The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough
and safe, so the physician will probably tell the patient to drink only clear liquids for 12 to 24
hours beforehand. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water,
plain coffee, plain tea, or diet soft drinks. The night before or right before the procedure, the
patient receives a laxative and an enema, which is a liquid solution that washes out the intestines.
No sedation is required during this procedure as long as the examination does not exceed
the level of the splenic flexure
CT imaging is particularly useful because it can show several types of tissue with great
clarity, including organs such as the liver, spleen, pancreas and kidneys. Using specialized
equipment and expertise to create and interpret CT scans of the lower gastrointestinal (GI) tract,
the colon and rectum, an experienced radiologist can accurately diagnose many causes of
abdominal pain, such as an abscess in the abdomen, inflamed colon or colon cancer, diverticulitis
and appendicitis. Often, no additional diagnostic work-up is necessary and treatment planning can
begin immediately.
In cases of acute abdominal distress, CT can quickly identify the source of pain. Especially
when pain is caused by infection and inflammation, the speed, ease and accuracy of a CT
examination can reduce the risk of serious complications caused by a burst appendix or ruptured
diverticulum and the subsequent spread of infection.
CLIENT PREPARATION
1. The client should wear comfortable, loose-fitting clothing for the CT exam.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
2. Metal
objects
can affect the image, so avoid clothing with zippers and snaps. The client may be asked to
remove hairpins, jewelry, eyeglasses, hearing aids and any removable dental work that
could obscure the images.
3. The client may also be asked to refrain from eating or drinking anything for an hour or
longer before the exam.
4. Women should always inform their doctor or x-ray technologist if there is any possibility
that they are pregnant.
The technologist begins by positioning the patient on the CT table. The patient's body may
be supported by pillows to help hold it still and in the proper position during the scan. As the study
proceeds, the table will move slowly into the CT scanner. Depending on the area of the body being
examined, the increments of movement may be so small that they are almost undetectable, or large
enough that the patient feels the sensation of motion.
NURSING RESPONSIBILITIES:
1. The client will lie on a table that will pass slowly through a large opening in the scanner as
x-rays are taken.
2. The client will be asked to lie perfectly still throughout the procedure, so that blurring does
not occur. Even though the client will be alone in the room, the client will be closely
observed at all times. If contrast is used, it will be injected into the client’s arm through an
IV line.
3. At the time of injection, client may have a momentary feeling of warmth and flushing, a
salty taste in the mouth, and possibly some mild nausea.
1. After the scan, inform the client that he/she should be able to resume his/her normal diet
and activities.
2. Encourage to drink at least 5 to 6 glasses of water a day for 2 days after the scan. The water
helps flush the contrast media from the system. If the client must limit fluid intake because
of a heart problem or for any other reason, he/she should inform doctor about how much
water he/she can safely drink.
3. If the client is diabetic who takes any medication that contains metformin, the client must
have a blood test to check kidney function before he/she can start taking metformin again.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Call
thedoctor for the results of the blood test and for instructions about resuming metformin.
This is to prevent kidney damage and a serious reaction called lactic acidosis
PHARMACOLOGICAL INTERVENTIONS
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Date
Discontinued:
August 21, 2008
Generic Name: Metronidazole
Brand Name: Flagyl
Drug Classification: Amebicides and antiprotozoals
Dosage: 750mg 1 tab per orem
Frequency: every 8 hours
Mechanism of Action:
To exert bactericidal effects, metronidazole must first be taken up by cells and then converted into
its active form; only anaerobes can perform the conversion.the active form interacts with DNA to
cause strand breakage and loss of helical structures, effects that result in inhibition of nucleic acid
synthesis and,ultimately cell death.
Indication: Intestinal amoebiasis
Adverse Reaction:
CNS: headache, seizures
GI: nausea,
GU: vaginitis,
Hematologic: transient leucopenia, neutropenia
Respiratory: Upper respiratory tract infection
Skin: rash
Contraindications:
Contraindicated in patients with:
• hypersensitive to drug or other nitroimidazole derivatoives
• first trimester of pregnancy
• history of blood dyscrasia
• CNS disorder
• Retinal or visual field changes
Drug Interactions:
Cimetidine: May increase risk of metronidazole toxicity because of inhibited hepatic
metabolism.
Disulfiram: May cause psychosis and confusion.
Lithium: May increase lithium level, which may cause toxicity.
Oral anticoagulants: May increase anticoagulant effects.
Phenobarnital, phenytoin: may decrease metronidazole effectiveness; may reduce total
phenytoin resistance
Nursing Considerations:
• Monitor liver function test results carefully in elderly patients
• Give oral forms with meals
• Observe patient for edema, especially if taking corticosteroids; Flagyl IV may cause
sodium retention
• Record number and character of stool.
Patient Teaching:
• Instruct patient to take extended-release tablets from at least 1 hour before or 2 hours
after meals but to take all other oral forms with food to minimize GI upset.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
• Tel
l
patient to avoid alcohol and alcohol containing drugs during and for atleast 3 days after
treatment course.
• Tell patient he may experience a metallic taste and have dark or red-brown urine
• Tell patient to report to prescriber any neurologic symptoms.
Contraindications:
Contraindicated in patients with:
• Angleclosure glaucoma, obstructive uropathy, obstructive disease of the GI
tract, asthma, Chronic pulmonary disease, myasthenia gravis, paralytic ileus,
intestinal atony, unstable CV status.
Drug Interactions:
Antacid: May decrease oral absorption of anticholinergics. Separate doses by 2 or 3 hours
CNS Depressants: May increase risk of CNS depression
Digoxin: May increase digoxin level
Ketoconazole: May interfere with ketoconazole absorption
Nursing Considerations:
• Raise side rails as a precaution because some patients become temporarily
excited or disoriented and some develop amnesia or become drowsy. Reorient
patient as needed.
• Tolerance may develop when therapy is prolonged
• Atropine-like toxicity may cause dose-related adverse reactions
• Overdose may cause curarelike effects, such as respiratory paralysis.
Patient Teaching:
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
• Warn
patient
to avoid activities that require alertness until CNS effects of drug are known.
• Urge the patient to report urinary hesitancy or urine retention.
Nursing Considerations:
• If clinical symptoms don’t improve within 48 hours, stop therapy and consider other
alternatives
• Drug produces antidiarrheal action similar to that of diphenoxylate but without as many
adverse CNS effects.
Patient Teaching:
• Advise patient not to exceed recommended dosage
• Tell patient with acute diarrhes to stop drug abd seek medical attention if no
improvement occurs within 48 hours.
• Advise patient with acute colitis to stop drug immediately and report abdominal
distention.
• Tell patient to report nausea, abdominal pain or abdominal discomfort.
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Date
Ordered:
Auguts 17, 208
Date Discontinued: August 23, 2008
Generic Name: Prednisone
Brand Name: Deltasone
Drug Classification: Corticosteroids
Dosage: 10 mg 1 tab per orem
Frequency: three times a day
Mechanism of Action:
Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses
immune response; stimulates bone marrow; and influences protein, fat and carbohydrate
metabolism.
Indication: Sever inflammation, immunosuppression
Adverse Reactions:
CNS: euphoria, insomnia, pseudotumor cerebri, headache, seizures
CV: heart failure, arrhythmias, thromboembolism
GI: peptic ulceration, pancreatitis, nausea,
GU: menstrual irregularities, increased urine calcium level
Skin: hirsutism, delayed wound healing
Contraindications:
Contraindicated in patients with:
• hypersensitive to drug
• systemic fungal infection
• client receiving immunosuppressive doses with live virus vaccines
Drug Interactions:
Aspirin: May increase risk of GI distress and bleeding
Barbiturates, rifampin, phenytoin: may decrease corticosteroid effect
Cyclosporine: May increase toxicity
Oral anti coagulants: May alter dosage requirements
Skin-test antigens: may decrease response
Nursing Considerations:
a.) Determine whether patient is sensitive to other corticosteroids
b.) Drug may be used for alternate-day therapy
c.) Always adjust to lowest effective dose
d.) For better results and less toxicity, give a once-daily dose in the morning
e.) Give oral dose with meal to reduce GI irritation
f.) Monitor patient’s blood pressure, sleep pattern and sodium level.
g.) Report sudden weight gain
h.) Monitor patient for Cushingoid effects
i.) Drug may mask or worsen infections. Including latent amoebiasis.
Patient Teaching:
• Tell patient not to stop drug abruptly or without prescriber’s consent
• Instruct patient to take the drug with food or milk
• Teach patient signs and symptoms of early adrenal insufficiency
• Tell patient to report slow healing
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Nursing Considerations:
j.) Determine whether patient is sensitive to other corticosteroids
k.) Drug may be used for alternate-day therapy
l.) Always adjust to lowest effective dose
m.) For better results and less toxicity, give a once-daily dose in the morning
n.) Give oral dose with meal to reduce GI irritation
o.) Monitor patient’s blood pressure, sleep pattern and sodium level.
p.) Report sudden weight gain
q.) Monitor patient for Cushingoid effects
r.) Drug may mask or worsen infections. Including latent amoebiasis.
Patient Teaching:
• Tell patient not to stop drug abruptly or without prescriber’s consent
• Instruct patient to take the drug with food or milk
• Teach patient signs and symptoms of early adrenal insufficiency
• Tell patient to report slow healing
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Nursing Considerations:
• Consider additional courses of therapy if duodenal ulcer isn’t healed after
first course therapy
• Amoxicillin may trigger anaphylaxis in patients with a history of penicillin
hypersensitivity
• Symptomatic response to therapy doesn’t preclude presence of gastric
malignancy
Patient Teaching:
Explain importance of taking drugs exactly as prescribed
Advice patient to swallow delayed release tablets whole and to crush, shew or split it
Inform patient that drug may be taken without regard to meals
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
Contraindications:
Contraindicated in patients with:
• hypersensitive to fluoroquinolones
•
Drug Interactions:
Aluminum hydroxide, aluminum-magnesium hydroxide, calcium carbonate
Magnesium hydroxide: may decrease ciprofloxacin absorption and effects
Cyclosporine: May increase risk for cyclosporine toxicity
Nursing Considerations:
• Obtain specimen for culture and sensitivity before giving first dose.
• Some drugs require waiting up to 6 hours after giving this drug to avoid decreasing its
effects
• Monitor patient’s intake and output and observe patient for sign and symptoms of
crystalluria.
Patient Teaching:
5. Tell patient to take drug as prescribed, even after he feels better.
6. Advise patient to drink plenty of fluids to reduce risk of urine crystals
7. Advise patient not to chew, crush or split the extended-release tablets
8. Instruct patient not to take caffeine while taking drug because of potential increase
caffeine effects
9. Breastfeeding should be stop while taking the drug
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
TEN
IDENTIFIED
PROBLEMS
1. Diarrhea
2. Fluid Volume Deficit
3. Acute Pain
4. Altered Sensory Perception
5. Imbalance Nutrition less than Body Requirements
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
LONG TERM
Result: Medical intervention the -To replenish GOAL
Cyst = 1-3L/LPF Surgical client will be -Administer IV and establish
Trophozoite= Nursing by able to fluids as indicated hydration and After
1-2/LPF Black and reestablish with electrolyte maintain implementation
Hokanson hydration supplements (KCl) electrolyte of appropriate
Pg 1078-1079 status as to balance nursing
prevent intervention, the
dehydration client was able
through -Inhibits partially
physical -Administer nucleic acid of reestablished
assessment and antiprotozoal the bacteria hydration status
careful medication there by as to prevent
monitoring of (Flagyl) eliminating dehydration
intake and spread of through absence
output. infection of signs of
dehydration
minimum intake
and output
- Goal is partially
met
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#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
and understand
the reason of
sensory deficit
> Discuss with the and allow
client the cause of the client to make
alteration in tactile appropriate
perception and ways to deal
measures to deal with with it
it
> To promote
stimulation of
COLLABORATIVE tactile
perception and
> Advice client to regain it
undergo physical
rehabilitation or
therapy
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
> To enhance
> Prepare foods that mechanical
are easy to chew and digestion of
palatable food and
promote
client’s
appetite
DEPENDENT
>Administer vitamins > To build
and supplements as strong immune
per doctors order system and
body
resistance to
COLLABORATIVE diseases
> Refer to dietician
for diet regimen > To
determine
appropriate
dietary
regimen
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
DISCHARGE PLANNING
DIETARY MANAGEMENT
• clear liquids such as water, juice, tea
• oral rehydrating or electrolyte solutions
• Drinking small amounts at frequent intervals is better accepted in cases of nausea.
• Avoid solids because they can cause cramps
• Light soups, toast, rice and eggs are good foods
ACTIVITIES
• bed rest upon arrival from the hospital
• light exercise every morning
• eventually the patient can return to its normal activities of daily living
HYGENIC PRACTICES
• wash hands with soap after going to the toilet and before eating or preparing food
• Avoiding sexual practices that may lead to fecal-oral contact
• Proper hand washing is necessary
• Cut and keep your nails clean
• Avoid sharing towels with infected persons
• Avoid alcohol for preventing intestinal complications
• Take care of drinking water - either opt for mineral water or water boiled for 20 minutes
SPECIAL CARE
• Never use any soap or chemical that are not specifically stated by your doctor
• Eating slippery elm will usually ease ulcer pain in less than twenty minutes with no
negative side effects
• Specifically no water containing chlorine
• No milk or milk products should be taken as this could cause irritation
SCHEDULE CLINIC
• Continuous follow-up care - a schedule of follow-up care
• Return again after a month for follow up check- up
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
HOME
PREVENTION
• Avoidance of drinking unboiled or unbottled water in endemic areas.
• Uncooked food such as fruit and vegetables that may have been washed in local water
should also not be consumed.
• Amoebic cysts are resistant to chlorine at the levels used in water supplies, but
disinfection with iodine may be effective.
• Wash hands with soap and warm water after going to the toilet and before eating or
preparing food.
• Proper food storage and preventing its contamination with faeces, flies, and contaminated
water
• Avoiding sexual practices that may lead to fecal-oral contact
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METROPOLITAN HOSPITAL COLLEGE OF NURSING
#1357 G. Masangkay Corner Mayhaligue Streets, Sta. Cruz, Manila
BIBLIOGRAPHIES
Joyce M. Black, et al. Study Guide for Medical-Surgical Nursing -- Clinical Management for
Positive Outcomes. Saunders: 2004
Marilynn E. Doenges, et al. Nursing Care Plans: Guidelines for Individualizing Client Care
Across the Life Span. F. A. Davis Company: 2006
Marilynn E. Doenges, et al. Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and
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