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College of Nursing
Km. 2, Surigao City

A case presentation

Plasmodium falciparum
Presented to:
Mr. Edsel Paler RN
Mrs. Jecel R. Eupeňa, RN
Mr. Ian Tristan Abedejos, RN
Ms. Vivian Cereyn Cabuga, RN
Ms. Louella Ursua, RN
Mr.Jose P. Ramos RN
Mrs. Lady Mabelle M. Gesta,RN
Mrs. Czarina Mae F. Lumague, RN
Mr. Neil John Plaza,RN

Presented by:
Abarico, Giza Marie
Alsong, Donna Ros
Balicog, Harvey
Borgonia, Glorigin Mary
Donoso, Jean
Lao Singuan, Lara Mae
Lisondra, Raem Grace
Narciso, Stefanny Mae
Ruaya, Arhvee Kristine
Tisang, Maricar
We would like to dedicate this case presentation, first of all to our Almighty God, who
gave the knowledge, strength and wisdom to us at all times.

To our parents who genuinely loved us, by giving their full support that encourage us and
inspire us so much to continue and do our best for this case presentation and for all our finances we
used to make this case presentation possible.

To our clinical instructors, whose support and help is there for the accomplishment of this
case study.

And to all of us, may this case study help us to know deeper about this disease, as part of
our learning in our profession.

We wholeheartedly acknowledge the following persons who helped and untiringly supported
us to make this case presentation possible:

To Mrs. Reflorvic P. Dotillos, one of our clinical instructor who gave us this case we are

To our patient, Mr. ˝Facebook˝ who is diagnosed with malaria, for trusting and believing in us
student nurses; for cooperating and generously provided us information and answered all our

To the Surigao Medical Center staff nurses assigned in station 2, for entertaining us in
gathering pertinent data from the patient’s chart;

To our clinical instructors who gave us ideas and direction in making this output. Who
patiently and thoughtfully taught us important things that we have to know as part of our
profession, and all the knowledge you imparted to us. Rest assured that we will cherish all those
lessons in our hearts, for a life time.

To all our families for their kind understanding when we were away from our houses while
making this case. To their undying support financially and morally, which inspired us to pursue
and do our best for this case presentation.

To Mr. and Mrs. Narciso, as well as Mrs. Balicog for accommodating us in their house to
make our case presentation.

To all my group mates, for the efforts and patience, that they spent sleepless nights in making
this case presentation. It’s such a pleasure to have all of you in this unusual and first time
experience we all had.

Above all, to our Almighty God for His unconditional love, and whose infinite wisdom gave us
the capability to come up with this output.

Malaria is considered as the most important parasitic disease affecting man, as it is
responsible for million deaths annually. It has been identified by the World Health Organization as
one of the three major infectious disease threats, along with HIV and tuberculosis, which together,
cause more than 5 million deaths each year. Despite such high figures in mortality, the disease is
curable if it is promptly and adequately treated.

The nature of malaria as a public health problem requires sustained and systematic efforts
toward two major strategies, namely prevention of transmission through vector control and the
detection and early treatment of cases to reduce morbidity and prevent mortality.

The group of parasites causing malaria belongs to the genus Plasmodium that is normally
transmitted by the bite of an infected female mosquito belonging to the genus Anopheles. Majority
of us do not know how does this parasitic disease affect us human through the carrier mosquito
that can cause malaria.

This was the case of our patient Mr. Facebook, a construction worker in South Africa for
two years, who was diagnosed of Malaria (P. falciparum). He is a 40-year old, male residing at
Purok-2 Brgy. Cayutan, Surigao City. He was admitted in Surigao Medical Center last September
26, 2009.

We choose this case, because it is interesting and because of its popularity worldwide, and
the fact that it has million of deaths each year especially in South Africa. Although malaria is not
common in our country, it is important to know about the nature of this disease. Many countries
are seeing an increasing number of imported malaria cases due to extensive travel and migration,
and we all know that many of our fellowmen are working in different countries worldwide. We
would also like to know and understand what this disease was all about. The pathology and
physiology of malaria, its signs and symptoms, its treatments, prevention and its complications if
not treated immediately. Because of these reasons, this case study was made.


Review of Related Literature__________________________________

Malaria is a vector-borne infectious disease caused by a eukaryotic protist of the genus
Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas,
Asia, and Africa. Each year, there are approximately 350–500 million cases of malaria, killing
between one and three million people, the majority of whom are young children in Sub-Saharan
Africa. Ninety percent of malaria-related deaths occur in Sub-Saharan Africa.

Malaria is one of the most common infectious diseases and an enormous public health
problem. Five species of the plasmodium parasite can infect humans; the most serious forms of the
disease are caused by Plasmodium falciparum. Malaria caused by Plasmodium vivax, Plasmodium
ovale and Plasmodium malariae causes milder disease in humans that is not generally fatal. A fifth
species, Plasmodium knowlesi, causes malaria in macaques but can also infect humans. This group
of human-pathogenic Plasmodium species is usually referred to as malaria parasites.

Usually, people get malaria by being bitten by an infective female Anopheles mosquito.
Only Anopheles mosquitoes can transmit malaria, and they must have been infected through a
previous blood meal taken on an infected person. When a mosquito bites an infected person, a
small amount of blood is taken, which contains microscopic malaria parasites. About one week
later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva
and are injected into the person being bitten. The parasites multiply within red blood cells, causing
symptoms that include symptoms of anemia (light-headedness, shortness of breath, tachycardia,
etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and, in severe
cases, coma, and death.

Although some are under development, no vaccine is currently available for malaria that
provides a high level of protection; preventive drugs must be taken continuously to reduce the risk
of infection. These prophylactic drug treatments are often too expensive for most people living in
endemic areas. Most adults from endemic areas have a degree of long-term infection, which tends
to recur, and also possess partial immunity (resistance); the resistance reduces with time, and such
adults may become susceptible to severe malaria if they have spent a significant amount of time in
non-endemic areas. They are strongly recommended to take full precautions if they return to an
endemic area.


Symptoms of malaria include fever, shivering, headache, nausea, fatigue, tiredness,

vomiting, hemoglobinuria, retinal damage, and convulsions. The classic symptom of malaria is
cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four
to six hours. P. falciparum can have recurrent fever every 36–48 hours or a less pronounced and
almost continuous fever. For reasons that are poorly understood, but that may be related to high
intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign indicating
severe brain damage. Malaria has been found to cause cognitive impairments, especially in
children. It causes widespread anemia during a period of rapid brain development and also direct
brain damage. This neurologic damage results from cerebral malaria to which children are more
vulnerable. Cerebral malaria is associated with retinal whitening, which may be a useful clinical
sign in distinguishing it from other causes of fever.

Severe malaria is almost exclusively caused by P. falciparum infection and usually arises
6–14 days after infection. Consequences of severe malaria include coma and death if untreated—
young children and pregnant women are especially vulnerable. Splenomegaly (enlarged spleen),
severe headache, cerebral ischemia, hepatomegaly (enlarged liver), hypoglycemia, and
hemoglobinuria with renal failure may occur. Severe malaria can progress extremely rapidly and
cause death within hours or days. In the most severe cases of the disease fatality rates can exceed
20%, even with intensive care and treatment. In endemic areas, treatment is often less satisfactory
and the overall fatality rate for all cases of malaria can be as high as one in ten. Over the longer
term, developmental impairments have been documented in children who have suffered episodes
of severe malaria.

Chronic malaria is seen in both P. vivax and P. ovale, but not in P. falciparum. Here, the
disease can relapse months or years after exposure, due to the presence of latent parasites in the
liver. Describing a case of malaria as cured by observing the disappearance of parasites from the
bloodstream can, therefore, be deceptive. The longest incubation period reported for a P. vivax
infection is 30 years. Approximately one in five of P. vivax malaria cases in temperate areas
involve overwintering by hypnozoites (i.e., relapses begin the year after the mosquito bite).

Malaria parasites

Malaria parasites are members of the genus Plasmodium (phylum Apicomplexa). In

humans malaria is caused by P. falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. P.
falciparum is the most common cause of infection and is responsible for about 80% of all malaria
cases, and is also responsible for about 90% of the deaths from malaria. Parasitic Plasmodium
species also infect birds, reptiles, monkeys, chimpanzees and rodents.


Microscopic examination of blood films

The most economic, preferred, and reliable diagnosis of malaria is microscopic

examination of blood films because each of the four major parasite species has distinguishing
characteristics. Two sorts of blood film are traditionally used. Thin films are similar to usual blood
films and allow species identification because the parasite's appearance is best preserved in this
preparation. Thick films allow the microscopist to screen a larger volume of blood and are about
eleven times more sensitive than the thin film, so picking up low levels of infection is easier on the
thick film, but the appearance of the parasite is much more distorted and therefore distinguishing
between the different species can be much more difficult. With the pros and cons of both thick and
thin smears taken into consideration, it is imperative to utilize both smears while attempting to
make a definitive diagnosis.


Malaria transmission can be reduced by preventing mosquito bites with mosquito nets and
insect repellents, or by mosquito control measures such as spraying insecticides inside houses and
draining standing water where mosquitoes lay their eggs. Work has been done on malaria vaccines
with limited success and more exotic controls, such as genetic manipulation of mosquitoes to make
them resistant to the parasite have also been considered.

Methods used to prevent the spread of disease, or to protect individuals in areas where
malaria is endemic, include prophylactic drugs, mosquito eradication, and the prevention of
mosquito bites. The continued existence of malaria in an area requires a combination of high
human population density, high mosquito population density, and high rates of transmission from
humans to mosquitoes and from mosquitoes to humans. However, unless the parasite is eliminated
from the whole world, it could become re-established if conditions revert to a combination that
favors the parasite's reproduction.


Active malaria infection with P. falciparum is a medical emergency requiring

hospitalization. Infection with P. vivax, P. ovale or P. malariae can often be treated on an
outpatient basis. Malaria infections are treated through the use of antimalarial drugs, such as
quinine or artemisinin derivatives. Treatment of malaria involves supportive measures as well as
specific antimalarial drugs. When properly treated, someone with malaria can expect a complete
recovery. Malaria infections are treated through the use of antimalarial drugs, such as quinine or
artemisinin derivatives.

Plasmodium falciparum is a protozoan parasite, one of the species of Plasmodium that
cause malaria in humans. It is transmitted by the female Anopheles mosquito. P. falciparum is the
most dangerous of these infections as P. falciparum (or malignant) malaria has the highest rates of
complications and mortality. As of 2006 it accounted for 91% of all 247 million human malarial
infections (98% in Africa) and 90% of the deaths. It is more prevalent in sub-Saharan Africa than
in other regions of the world; in most African countries, more than 75% of cases were due to
P.falciparum, whereas in most other countries with malaria transmission, other Plasmodial species

Mosquito vectors and the Plasmodium life cycle

The parasite's primary (definitive) hosts and transmission vectors are female mosquitoes of
the Anopheles genus. Young mosquitoes first ingest the malaria parasite by feeding on an infected
human carrier and the infected Anopheles mosquitoes carry Plasmodium sporozoites in their
salivary glands. A mosquito becomes infected when it takes a blood meal from an infected human.
Once ingested, the parasite gametocytes taken up in the blood will further differentiate into male or
female gametes and then fuse in the mosquito gut. This produces an ookinete that penetrates the
gut lining and produces an oocyst in the gut wall. When the oocyst ruptures, it releases sporozoites
that migrate through the mosquito's body to the salivary glands, where they are then ready to infect
a new human host. This type of transmission is occasionally referred to as anterior station transfer.
The sporozoites are injected into the skin, alongside saliva, when the mosquito takes a subsequent
blood meal.

Only female mosquitoes feed on blood, thus males do not transmit the disease. The females
of the Anopheles genus of mosquito prefer to feed at night. They usually start searching for a meal
at dusk, and will continue throughout the night until taking a meal. Malaria parasites can also be
transmitted by blood transfusions, although this is rare.

III. TABLE OF CONTENTS____________________________________

I. Dedication i
II. Acknowledgement ii
III. Introduction iii
IV. Review of Related Literature
• Malarial Infection (Plasmodium falciparum) 1-4
V. Anatomy and Physiology 5-7
VI. Patient’s Health History (initial data)
A. Biographic Data 8
B. History of Present Illness 9
C. Past Health History 10
a. Family Health History 10
b. Genogram 11
c. Personal Health History 12
1. Lifestyle 12
1.1 Personal Habits 12
1.2 Diet 12
1.3 Sleep and Rest Patterns 12
1.4 Elimination Patterns 12
1.5 Activities of Daily Living 13
1.6 Instrumental Activities of Daily Living
d. Social Data 13
2. Family Relationships/ Friendships 13
3. Ethnic Affiliation 13
4. Educational Level 13
5. Economic Status 13
6. Psychological Data 13
e. Patterns of Health Care 13
V11. Physical Examination and Review of Systems
A. General Survey 14
B. Integument
a. Skin 14
b. Hair 14
c. Nails 14
C. Head, Eyes, Ears, Nose and Throat (HEENT)
a. Skull and Face 14
b. Eyes and Vision 15
c. Ears and Hearing 15
d. Nose and Sinuses 15
D. Oropharynx 15
E. Neck 15
F. Thorax and Lungs 16
G. Cardiovascular 16
H. Breast and Axillae 16
I. Abdomen 16
J. Musculoskeletal System 16
K. Lower Extremities 16
L. Neurological Systems
 Level of Consciousness 16
M. Cranial Nerves 17
a. Language
b. Orientation
c. Memory
d. Attention Span Demonstrated Several Errors
N. Reproductive System
1X. Laboratory Data
A. Hematology
X. Medication Sheet
XI. Drug Study
XII. Pathology and Physiology of Disease
XIII. Nursing Care Plan (NCP)
XIV. Discharge Plan
A. Medications
B. Environmental Concerns
C. Treatment
D. Health Teachings
E. Out Patient Check-up
F. Diet
XV. Appendices
• IVF Chart
• Input and Output
XVI. Definition of Terms
XVII. References
VI. PATIENT’S HEALTH HISTORY_____________________________

A.Patient’s Profile/Biographic Data

Hospital : Surigao Medical Center

Case Number : 40086
Fiscal Year : 2009
Name : Mr.Facebook
Gender : Male
Birth date : January 22, 1969
Birth place : Purok-2 Brgy. Cayutan, Surigao City
Home Address : Purok-2 Brgy.Cayutan, Surigao City
Civil Status : Married
Religion : Roman Catholic
Nationality : Filipino
Occupation : Construction worker
Educational Attainment : High School Graduate
Height : 5’5’’
Weight : 67 kg

Mode of Admission : Ambulatory
Date of Admission : September 26, 2009
Time of Admission : 3:00 pm
Vital Signs upon Admission
Temperature: 39˚C
Pulse Rate: 110bpm
Respiration Rate: 26cpm
Blood pressure: 110/90 mmHg
Admitting Physician : Dr. Zulueta
Attending Physician : Dr. Fuentes, Alpiniano
Chief Complaint : Fever
Room : PR6
Date of Discharge : October 1, 2009

PRESENT ILLNESS: Present condition started 2 days PTA as low-med grade fever (-) dysuria,
(-) odynophagia, (-) cough and colds

IMPRESSION: Dengue Fever vs. Malaria

FINAL DIAGNOSIS: Malarial Infection (P. falciparum)

Sources of data gathered:

 the patient himself and his wife
 the patient’s chart

BMI= weight (kg)/ height (m)2

= 67kg/ (1.65m)2
= 67kg/ 2.7
= 24.8 Normal

C. History of Present Illness_____________________________________

For the last two years, patient worked as a construction worker in South Africa- where
Malaria is epidemic. Last September 18, 2009, patient arrived here in Surigao City due to finished
contract. Five days after the arrival, 2 days prior to admission, patient had fever. According to him,
it was only treated with paracetamol. He also felt nauseated and had experienced headache. He lost
his appetite, and so he doesn’t like to eat. His fever lasted for three days, and noticed his skin
became yellowish. Thus, prompted him and his wife to seek medical care in Surigao Medical

D. Past Health History__________________________________________

a. Childhood Illnesses

According to patient, he had experienced chicken pox at the age of 9 years old, mumps at
the age of 12 years old.

b. Immunizations

According to patient, he was immunized with BCG,DPT,OPV,Hepatitis A, Hepatitis B, and

MMR but he could not recall the exact dates the immunization were given. He was immunized of
Hepatitis B vaccine before going to Africa.

c. History of Hospitalization

He had his circumcision when he was 9 year old and never had any accidents and injuries
experienced. The patient was never been hospitalized before; hence, this was his first

d. Allergies

The patient had no allergic reactions in any foods and drugs, as what he had stated.

e. Medications

Since patient had not been hospitalized before, he had not received any prescribed
medications. However, his usual non-prescription drugs were Paracetamol (Biogesic) 500mg 2
tablets twice a day for fever and headache, Neozep for common colds.

f. Family Health History:

Our patient Mr. Facebook is the third child among the five children of Mr. and Mrs. E. He
had one elder brother and sister, one younger brother and two younger sisters. His father died
because of alcoholism, while his mother is still alive. As of his brothers and sisters, he claimed that
no one has illness or disease. All his brothers and sisters are in healthy condition. He was married
and has one child.



: Father : Patient
: Brother
: Mother : Sister

Father Mother
(Deceased) alcoholism (69 yrs old)

48 yrs old 47 yrs old 40 yrs old 38 yrs old 36 yrs old 31 yrs old

g. Personal Health History:
o Lifestyle
 Personal Habits- Patient claimed that never in his life he had smoked, took
prohibited drugs. But he drinks alcoholic beverages/ liquors.

 Diet- Before hospitalization, patient’s typical diet for the day would consist
of rice, ˝tinola˝, fried fish, ˝ paksiw˝, and vegetables. The patient usually
eats 3 times a day and sometimes when there is extra money he will have his

o Sleep and rest pattern

Before hospitalization, patient sleeps around 8:00 pm, and

wakes up at around 5:00 am.
During hospitalization, he felt uncomfortable with the
environment thus, he can’t sleep well. He only sleeps about 1-2 hours and wake up

o Elimination Pattern

Before hospitalization, patient urinates 5-6 times a

day. He only defecates twice a day usually with soft,
formed brown stool. He claimed that he has no history of difficulties of
During hospitalization the patient defecated twice
a day, and urinates regularly.

o Activities of Daily Living (ADL)

Patient had no difficulty in eating, grooming, dressing, and fecal elimination. He can
perform well in terms of his personal hygiene, such as tooth brushing every after meal, taking a
bath, and washing his hands.


o Instrumental Activities of Daily Living

Patient had no difficulties experienced in food preparation infact; he used to cook for
their meal. He is also able to used cell phone and even handles finances.

h. Social Data

1.1 Family relationship/friendship

Patient has good relationships to his family and friends. They help each other in time
of stress or any problems the encounter especially during his hospitalization.

1.2 Ethnic Affiliation

The patient is a native Surigaonon. He claimed that he believed in quack doctors.

1.3 Educational Level

The patient is a high school graduate and did not continued college education
because of financial problem.

1.4 Economic Status

The patient is not a Phil Health member. He claimed that he is the one paying the medical
bill and also with the help of his relatives.

1.5 Psychological Data

The patients experienced major stressor when his father died. He felt depressed and
managed it by talking to his wife and relatives, until he recovered.

Patterns of health care:

If there is any of the family members of their family suffered from illness, they used herbal
medicine for treatment and if does not cured, they immediately seek medical help from the health

VII. PHYSICAL EXAMINATION_______________________________
(September 28-29, 2009)


The patient was lying on bed on a semi-fowlers position with IVF of PLR at the level of
500cc running @ 40gtts. / min. infusing well at the left metacarpal vein. He looks pale, weak and
his skin is slightly yellowish. He is conscious and cooperative in answering our questions.

Vital Signs:
• Temperature: 38.4°C
• Respiratory Rate: 28 cpm
• Pulse Rate: 93 bpm
• Blood Pressure: 110/90 mmHg


• Patients skin is dry
• Skin color is brown and slightly yellowish
• Warm to touch
• No lesions
• Intact dermis
• Hair is evenly distributed
• No presence of lice
• Black hair; no dandruff noted
• Normal curvature
• Smooth texture
• Intact skin surrounding nails
• Prompt return of usual color ‘pink’ ( 3 seconds after performing ‘blanch test’)

Head, Eyes, Ears, Nose and throat (HEENT)

• Rounded in shape and symmetrical
• Smooth skull contour
• Absence of masses
• Symmetric facial features
• Symmetric facial movement

Eyes and vision
• Skin intact
• No discharge; no discoloration
• Symmetrical eye brows
• Equally distributed eye lashes
• Black color of pupils; equal in size
• Pupils constrict when looking at near object; dilate when looking at far object
• When looking straight ahead, client can see objects in the periphery.
• Both eyes coordinated

Ears and Hearing

• Symmetrical
• Color same as facial skin
• Mobile firm and not tender
• Able to hear taking of the clock in both ears while performing ‘watch tick test’

Nose and Sinuses

• Symmetric and straight
• No discharge
• Uniform color
• Not tender
• Air moves freely as the client breathe through the nares

Oropharynx (Mouth and Throat)

• Lips is slightly darker
• No dentures
• Teeth color is slightly yellowish
• Slightly dark gums
• Tongue moves freely
• Pink and smooth tonsils
• Dry mouth

• Muscle equal in size
• Coordinated movements with no discomfort
• Equal strength

Thorax and Lungs

• Chest symmetric
• Spine vertically aligned
• Absence of adventitious breath sounds
• No tenderness, absence of masses

• Pulsations noted
• Presence of audible sounds ( S1, S2 )
• Blood Pressure = 110/90 mmHg

Breast and Axillae

• Skin uniform in color
• No tenderness and masses noted
• Round nipples, similar in color

• Absence of rashes or lesions
• Uniform in color
• Presence of pain on the right side when palpated

Musculoskeletal System
• Firm muscles, weakness noted at lower extremities
• Muscles in the arm and foot were equal in size
• No contractures noted
• No deformities noted
• No tenderness; no swelling

Neurological System

Level of Consciousness:

The patient was conscious on the day of admission until he was discharged.

Cranial Nerves

I. Olfactory Patient was able to smell.

II.Optic Patient can able to read newsprint at a distance.
Patient’s pupils constricted when looking at near objects and
dilated when looking at far objects. Patient’s pupils also
III.Oculomotor converged at the center of both eyes when penlight was moved.

Patient’s both eyes were coordinated and moved

simultaneously with parallel alignment when penlight was
moved at six cardinal fields of gaze using the six ocular
IV. Trochlear muscles, namely: Superior Rectus, Inferior Rectus, Lateral
Rectus, Superior Oblique, Inferior Oblique, and Medial Rectus.

Patient elicited blink reflex when sclera of the eye was slightly
V. Trigeminal touch using a wisp of cotton while looking upward.

VI.Abducens Patient was able to move eyeballs laterally and parallel

alignment using the six ocular muscles.
VII. Facial Patient could identify sharp and dull using. He could also smile
and frown.
Patient was able to hear normal voice tones
VIII. Auditory
Patient was able to move his tongue from side to side and up
IX. and down when asked to do so.

X. Vagus Patient had presence of swallowing reflex.

XI. Accessory Patient was able to shrug shoulders.
XII. Hypoglossal Patient could protrude her tongue at midline.

VIII. Review of Systems
(September 30, 2009)

General Survey
 Feels weak
 Restless
 Conscious
 With IVF of PLR 1000cc at level of 500cc running @ 40gtts/min hooked well in
the left arm.

Integumentary System:

According to the patient he had no history of itching, lesions, abrasion and bruises. He said
that he has no allergies from fury animals, plants and foods.
The patient stated that he uses efficascent oil in relieving mosquito bites, muscle pain, and

HEENT (Head, Eyes, Ears, Nose, Throat):

Patient claimed that he experienced headache during worked especially when he’s having
an overtime, and take an analgesic (Paracetamol, biogesic).The patient claimed that he has no
visual hearing problem. The patient claimed that he always experience cold especially during rainy

The patient said that he doesn’t have any neck lumps, goiter, stiffness, and diagnosis of any
thyroid problem.

Thorax and Lungs:

The patient didn’t experienced emphysema, pneumonia, tuberculosis and asthma. The
patient claimed that he has no problem in his breathing.

Cardiovascular System:
According to patient, he has no history problem in his cardiovascular system such as
hypertension, rheumatic fever, heart failure, varicosities and fatigue. He claimed that he used to
drink alcohol beverages occasionally, but he doesn’t smoke.

Gastrointestinal tract:
The patient claimed that he has no history of difficulty in swallowing and gastric ulcer. He
also claimed that he has no history of hematemesis. During hospitalization, patient claimed that he
feels nauseated before and after he took his meal.

Patient claimed that he doesn’t experience any muscle/joint pain. He also claimed that he
has no arthritis.

Urinary System:
The patient claimed that he urinates 5-6 times a day and 2-3 times at night.

Neurological System

A. Language
The patient speaks slowly but clear in answering our questions.

The patient was able to identify himself, the name of significant others who are always
with him, and is oriented to time and place.

C. Memory
The patient was able to recall the things happened to his life months or years ago. He was
able to answer our questions immediately.

D. Attention Span
The patient counting from 1 to 50, indicating that the patient had an ability to focus on such
mental task.

Reproductive System

There are no inflammations, swelling or discharges on his reproductive organ as claimed by

the patient.


DATE: 9/26/09 TIME: 1:24 PM

HGB 16.69 g/L 12.O-17.0 Normal
RBC 3.01 X 10 ^12/L 4.0-6.0 Anemia
HCT 49.12 % 37-54 Normal
MCV 85.06 U^3 87+-5 Normal
MCH 28.9 pg 29+-2 Normal
MCHC 33.97 g/dl 34+-2 Normal
RDW 12.15 11.6-14.6 Normal

PLATELET 52 L 150-450 Thrombocytopenia

WBC 7.34 L 4.5-10.0 Normal
LYMPHOCYTES 35.4 % 20-40 Normal
MONOCYTES 15.7 % 0-7 Infection

EOSINOPHILS 1.7 % 0-5 Normal



09-26-09 11:34 PM
Requesting Physician :Dr. Fuentes
Exam name Result Unit Normal value Significance

HGB 13.64 g/L 12.0-17.0 Normal

HCT 39.08 % 37-54 Normal

Platelet Count 58 ×10^9/L 150-450 Thrombocytopenia


09-27-09 06:03pm
Requesting Physician :Dr. Fuentes
Exam name Result Unit Normal value Significance

HGB 13.57 g/L 12.0-17.0 Normal

HCT 39.89 % 37-54 Normal

Platelet Count 59 ×10^9/L 150-450 Thrombocytopenia


09-28-09 12:02am
Requesting Physician :Dr. Fuentes
Exam name Result Unit Normal value Significance

HGB 13.77 g/L 12.0-17.0 Normal

HCT 40.09 % 37-54 Normal

Platelet Count 43 ×10^9/L 150-450 Thrombocytopenia



9-26-09 6pm

Hemoglobin 120-170gm/L 165gm/L Normal

Hematocrit 37-52gm/L 47.8gm/L Normal
Platelet count 150- 48,000mm3 Thrombocytopenia
Blood type B+


9-27-09 6pm

Hemoglobin 120-170gm/L 164.6gm/L Normal

Hematocrit 37-52gm/L 49.14gm/L Normal
Platelet count 150- 350,000/ 41,000mm3 Thrombocytopenia


9-27-09 6pm

Hemoglobin 120-170gm/L 143gm/L Normal

Hematocrit 37-52gm/L 42.2gm/L Normal
Platelet count 150- 350,000/ 54,000mm3 Thrombocytopenia

Glycosylated 5.5 % 4.5-6.3 Normal


09-27-09 6pm
Total Bilirubin 8.92 mg/dl 0 - 1.3 Liver produced
more than the
required amount.


Patient’s Temperature 39.2 c

BSMP Result (2nd) (+) for malarial parasite


Drugs Frequency and Dosage

Godex DS 1 tab. OD PO

Coartem 2 tab now then 2 tabs after 8hrs. then 2

tabs BID 2x a week

Paracetamol 500mg 1 tab now then q 4° PRN for fever

above 38°C
Mobic 15 mg 1 tab. OD PO PRN for headache

Ursofalk 250 mg/tab 1 tab BID PO


X. DRUG STUDY_____________________________________________


Liver therapy

Route/ Dosage:
1 tab once a day per orem

Acute & chronic hepatitis, drug-induced hepatitis, fatty liver


Cholelitholytics & Hepatic Protectors

250mg / tab, 1 tab bid per orem

Cholestatic liver disease

Acute inflammation of the gallbladder, bile duct or of cystic duct. Pregnancy & lactation.

Adverse Drug Reactions:

Porridge-like stools.


Medical Surgical Nursing 8th Edition by: Joyce M. Black

Public Health Nursing in the Philippines
Burton’s Microbiology for the Health Sciences 8th Edition by: Lippincot Williams
and Wilkins
Essential’s of Human Anatomy & Physiology 8TH Edition by: Elaine N. Marieb

• Anti malarial

2 tab now then 2 tabs after 8 hrs. then 2 tabs BID 2x a week

Treatment, including stand-by emergency, of adults & children due to P. falciparum or
mixed infections including P. falciparum. Also recommended for malaria infections acquired in
areas where the parasites may be resistant to other antimalarials.

Severe malaria. Family history of congenital prolongation of the QTc interval or sudden
death, history of symptomatic cardiac arrhythmias, w/ clinically relevant relevant bradycardia or
w/ severe cardiac diseases. 1st trimester of pregnancy. Patients w/ known disturbances of
electrolyte balance eg hypokalemia or hypomagnesemia. Not indicated for treatment of malaria
due to P. vivax, P. malariae or P. ovale.

Special Precautions
Dehydration, electrolyte imbalance. Pregnancy & lactation.

Adverse Drug Reactions

Headache, dizziness, asthenia, palpitation, sleep & GI disturbance, pruritus, rash, cough,
arthralgia, myalgia.

XI. PATHOLOGY AND PHYSIOLOGY____________________

Predisposing factors: Precipitating factors:

 Age  Environment
 Sex
 Race

Travel into
P. falciparum Anopheles mosquito Sporozoites the blood
(carrier of sporozoites) (injected into the steam
subcutaneous tissue)

Travel into the

liver and invade
liver cells

Develop Schizonts (liver

cells containg numerous

Schizonts rupture
Sporozoites (mature releases merozoites
sporoblast-enter the
mosquito salivary
glands) Merozoites enter red
blood cells & invade

The RBC ruptures and Within an erythrocyte,
(develop within
signs & symptoms are the merozoite
evidenced, such as: transforms into a
headache, fever, chills & trophozoite (in RBC)
Oocyst (escaped from the
mosquito’s stomach by Trophozoite mature &
Sweating produce male & female
squeezing between cells in
occurred gametocyte (in RBC)
the stomach wall &
encysts on the outer wall)

Ookinete Male Female

(mature gametocyte gametocytes

Zygote is Ingested by a
produce female anopheles
(within mosquito while
mosquito taking a blood meal
Male & Female
Male & female gametocytes Male & female
gametes fuse mature into gametocytes
within mosquito male & female
stomach (within gametes
(September 28, 2009)

Subjective cues:
Taghilantan ako sir", as verbalized by the patient.

Objective cues:
 Skin is warm to touch
 Vital signs:
Temperature: 38.4 ˚c
Pulse rate: 100 bpm
Respiratory rate: 28 cpm
Blood pressure: 110/90mmHg

Diagnosis: Hyperthermia related to underlying infection.

Planning: Within four hours of giving appropriate nursing intervention, patients

Temperature will return within normal range (36.5- 37.5°c).

Interventions Rationale

 Monitored body temperature  Fever pattern may aid in diagnosis e.g.

periodically 38.9-41˚ c suggest in infectious disease
 Maintained bed rest  To reduced metabolic demands/ oxygen
 Tepid sponge bath provided  May help reduced fever through heat
loss or by conduction
 Encouraged patient to  To replace the loss of fluid
increase fluid intake

 Provided client safety  To prevent in patient from injury

 Remove excess bed linens  To reduced heat and prevent increase in

 Health Teaching imparted:

• Encouraged increase  To prevent patient from dehydration

fluid intake
 To help patient achieve fast recovery and
• Encouraged to eat gain energy from foods
nutritious foods such
as green leafy
vegetables & fruits

 May relieve fever by direct action on the
Collaborative: hypothalamus, the center of heat
 Administered antipyretic such regulator.
as paracetamol 500 mg P.O.
as prescribed.

Goal was met as evidence by the patient’s temperature that was normalized, from 38.4۫ C to


(September 28, 2009)

Subjective cues:
“Sakit ako uyo”, as verbalized by the patient.

Objective cues:
 Guarding behavior
 Facial grimacing
 Pain scale of 6/10

Acute pain related to infectious process.

Within 8 hours of giving appropriate nursing intervention, patient pain will reduce or lessen
from pain scale of 6/10 to 3/10.

Interventions Rationale
 Observed nonverbal cues/pain.  Observation may/may not
congruent with verbal reports or
may be only indicator present when
client is unable to verbalize.
 Monitored skin color/ temperature  Which are usually altered in acute
and patient’s vital sign. pain.
 Provided comfort measures, quiet  To promote non-pharmacological
environment, and calm activities. pain management.
 Instructed/ encouraged use of  To distract attention and reduce
relaxation techniques such as tension.
focused breathing, imaging,
 Encouraged adequate rest periods.  To prevent fatigue.

 Provided for individualized  Promotes active not passive, role
physical therapy/exercise program and enhances sense of control.
that can be continued by the client
after discharge.

Goal met:
The patient’s pains were reduced from the scale of 6/10 to 3, as evidenced by
patient’s feeling of comfort and absence of facial grimacing.


(September 28, 2009)

Subjective cues:
“Dili ko katuyog”, as verbalized by the patient.

Objective cues:
• He easily get mad if there is unnecessary noise
• Sleeps only for 1-2 hours
• Inability to concentrate

Sleep pattern disturbance related to uncomfortable sleeping environment.

After 8hrs. of providing appropriate nursing interventions, patient will be able to report
improvement in sleep/ rest pattern.

Interventions Rationale
 Determined client’s usual sleep pattern  Provides comparative baseline.
and expectations.
 Promoted adequate physical exercise  Enhances expenditure of energy or
activity during day. release of tension so that client feels
ready for sleep/rest.
 Recommended quite activities, such as  To reduce stimulation so client can
reading or listening to soothing music relax.
in the evening.
 Instructed in relaxation techniques.  To decrease tension, prepare for rest
 Discussed/ implemented effective age-  To enhance client’s ability to fall
appropriate bedtime rituals (ex. asleep.
Drinking warm milk).
 Provide calm, quiet environment and  To enhance client to fall asleep.
manage controllable sleep disturbing

Goal was met, progress towards desired outcome. Patient can sleep well within normal pattern.



(September 28, 2009)

Subjective cues:
“Kasukaon ko”, as verbalized by the patient.

Objective cues:
 Aversion toward food

Nausea related to disease process.

Within 8 hours of giving appropriate nursing interventions, patient will be able to lessen or be
free of nausea.

Interventions: Rationale

 Checked vital signs and note signs of  Nausea may occur in the presence of
dehydrations. postural hypotension/ fluid volume
 Advised client to drink water after 30
minutes before or after meals, instead
of with meal.
 Encouraged client to eat small meals  So stomach does not feel excessive
spaced throughout the day instead of fully.
large meals.
 Instructed client to eat slowly,  To enhance digestion.
chewing food well
 Avoid offending odors, such as  As they may stimulate or worsen nausea.
cooking, smoke, perfumes, mechanical
emissions when possible  To promote relaxation and refocus
 Encouraged deep, slow breathing attention away from nausea.
Goal met, Patient feels comfortable and free from nausea.



(September 29, 2009)

Subjective cues:
“Wala koy gana mo kaon”, as verbalized by the patient.

Objective cues:
 Fatigue
 Loss of appetite
 Didn’t like to eat

Nursing Diagnosis:
Imbalanced nutrition less than body requirements related to lack of interest in food.

Within 8 hours of rendering appropriate nursing intervention, patient will regain his
appetite and/or interest in food.

 Weighed daily or as indicated.  Assess adequacy of nutritional intake.

 Ascertained patient’s dietary  Identifies deficit and deviations from

program and usual pattern compared therapeutic needs.
with recent intake.
 Provided liquids continuing  Oral rate is preferred when patient is
nutrients and electrolytes as soon as alert and a bowel function is restored.
patient can tolerate oral fluids
progress to more solid foods as
 Included SO in meal planning as  Provide re use of involvement; provide
indicated. information for SO to understand
nutritional needs.
 Discuss eating habits, including  To appeal to client’s likes or dislikes.
food preferences/ intolerances.

 Encourage client to choose foods or  To stimulate appetite.

have family members bring foods
that seam appealing
 Promote pleasant, relaxing  To enhance intake.
environment, including socialization
when possible.


 Prevent/ minimize unpleasant odors.  May have a negative effect on appetite/


Goal was met. Patient regains his appetite and interest in food.
(September 29, 2009)

Subjective cues:
“Tagkuyba ako sa ako sakit”, as verbalized by the patient.

Objective cues:
 Restless
 Poor eye contact
 Dry mouth
 Weak
 Loss of appetite

Nursing Diagnosis:
Anxiety related to disease process

After 8hrs. of giving appropriate nursing interventions, the patient will be able to verbalize
awareness of feelings of anxiety.

 Monitored Vital Signs  To identify physical responses
associated with both medical &
emotional conditions.

 Observed behaviors  Which can point to the client’s level

of anxiety

 Bedside Care rendered  Patient to be comfortable

 Provided comfort through resting  To promote relaxation

 Establish a therapeutic relationship,  To avoid the contagious

conveying empathy and effect/transmission of anxiety
unconditional positive regard

 Provide accurate information about  Helps client to identify what is

the situation. reality based

Goal was met. Patient was able to verbalized awareness of feelings of anxiety.

XIII. DISCHARGE PLAN______________________________________
Date of discharged: October 1, 2009
Condition upon discharged: Improved


 Advice patient and SO to facilitate in taking medications on time and in proper
administration, as prescribed.
 Point out the importance of completing the duration of take home medications even if the
patient shows wellness.
 Instructed patient to take the maintained medications as prescribed, such as: Godex and

Environmental Concern
 Encouraged patient and SO to maintain proper sanitation.
 Encouraged patient and SO to clean their house and surroundings, especially with those
areas that mosquitoes can live.

 Instructed patient as well as the SO to continue his medicines for the entire length of
prescribed period.
 Advised patient or SO to always read the label of the medication and be aware of the date
of expiration of the drug.
 Always follow doctor’s order or instruction.

Health Teachings
 Encouraged patient to eat nutritious foods such as vegetables and fruits.
 Advised the importance of cleanliness at all times.
 Encouraged patient to take enough rest and sleep.
 Advised patient to have daily exercise, only those activities which he can tolerate.
 Encourage patient to maintain proper hygiene.

Out Patient Check-up

 Instructed patient to report for follow up check-up, as ordered by the physician.
 Instructed patient to consult the physician immediately, if any complications occur.

 Advised patient to eat nutritious foods such as fruits and vegetables such as pineapple,
carrots, legumes, grains.
 Encouraged patient to have adequate fluid intake.

 Encouraged patient and SO to attend mass once a week or every Sunday and encouraged to
pray and thank God always.
XIV. APPENDICES___________________________________________


Date Bottle Type of fluid/ Flow Rate Time Started
No. Volume
9-26-09 #1 D5LR 1L 60gtts/min. SR @ 3:00am
↓ 40 gtts/min

#2 D5LR 1L @40gtts/min 8:50 pm

#3 D5LR 1L @60gtts/min. 6am

9-27-09 #4 D5LR 1L @60gtts/min. 11:35am

#5 PLR 1L @60gtts/min 5:45pm

#6 PLR 1L @60gtts/min. 10:00pm

#7 PLR 1L @60gtts/min 2:35am

#8 PLR 1L @60gtts/min 6:00 am

#9 PLR 1L @60gtts/min. .10:30am

#10 PLR 1L ↓ 40gtts/min. 3:00pm



DATE SHIFT IVF Oral Total Urine Vom BM Total

Credit Consumed FluidsTaken intake Output itus Output
09-26-09 7-3
3-11 700 1,300 1,600 2,900 2,000 - 2x 2,000+
2x BM
11-7 NH 1,000 2,000 3,000 2L - - 2L
24 HRS. 2x BM

DATE SHIFT IVF Oral Total Urine Vom BM Total

Credit Consumed FluidsTaken intake Output itus Output
09-27-09 7-3 500 1,500 2,000 3,500 2,000 - 2x 2,000+
3-11 900 1,600 1,000 2,600 1,450 - - 1,450
11-7 NH 1,900 1,000 2,900 2,500 - - 2,500 +
24 HRS. 2x BM

DATE SHIFT IVF Oral Total Urine Vom BM Total

Credit Consumed FluidsTaken intake Output itus Output
09-28-09 7-3 470 1,530 2,000 3,530 2,700 - 2x 2,700+
3-11 650 820 1,000 1,820 1,500 - 1x 1,500+
1x BM
11-7 NH 650 1,500 2,150 1,500 - - 1,550
24 HRS. 3x BM

Definition of Terms

1. Sporozoites - one of the many cells formed as a result of * sporongony during the life cycle of a
sporozoan. In “plasmodium sporozoites are formed by repeated division of the contents of the
oocyst inside the body of the mosquito.
2. Hepatocytes- the principal cell type in the liver, a large cell with many metabolic functions,
including synthesis, storage, and detoxification and bile production.

3. Schizonts - one of the stages that occurs during the asexual phase of the life cycle of a

4. Merozoite- stage in the life cycle of the malaria parasite. Many merozoites are formed during
the asexual division of the schizonts.

5. Erythrocyte (red blood cell) - blood cell containing the red pigment, hemoglobin, the principal
function of w/c is the transport of oxygen.

6. Trophozoite – stage4 in life cycle of the malarial parasite (plasmodium) that develops from
merozoite in the red blood cells.

7. Gametocytes – any of the cells that are in the process of developing into gametes by undergoing

8. Zygote – fertilized ovum before cleavage begins. It contains both male and female pronuclei.

9. Ookinete – the motile elongated “zygote” of the malarial parasite (plasmodium), formed after
fertilization of the macrogamete.

10. Encyts – enclosed in a cyst.

11. Sporoblasts – An early stage in the development of a sporocyst, prior to differentiation of the

12. Parasitemia – is the quantitative content of parasites in the blood. It is used as a measurement
of parasite load in the organism and an indication of the degree of an active parasitic infection.

13. Paroxysms – sudden violent attack, especially a spasm or convulsion the abrupt worsening of
symptoms or recurrence of disease.

14. Epidemic- occurs when new cases of a certain disease, in a given human population, and
during a given period, substantially exceed what is "expected," based on recent.

15. Plasmodium falciparum is a protozoan parasite, one of the species of Plasmodium that cause
malaria in humans. It is transmitted by the female Anopheles mosquito.

V. Anatomy and Physiology

The liver, weighing roughly 1.2-1.6 kg, performs many of the functions necessary for
staying healthy. It is located in the right side of the body under the lower ribs and is divided into
four lobes of unequal size. Two large vessels carry blood to the liver. The hepatic artery comes
from the heart and carries blood rich in oxygen. The portal vein brings the liver blood rich in
nutrients absorbed from the small intestine. These vessels divide into smaller and smaller vessels,
ending in capillaries. These capillaries end in the thousands of lobules of the liver. Each lobule is
composed of hepatocytes, and as blood passes through, they are able to monitor, add, and remove
substances from it. The blood then leaves the liver via the hepatic vein, returns to the heart, and is
ready to be pumped to the rest of the body.

Among the most important liver functions are:

· Removing and excreting body wastes and hormones as well as drugs and other foreign
substances. These substances have entered the blood supply either through production by
metabolism within the body or from the outside in the form of drugs or other foreign compounds
· Synthesizing plasma proteins, including those necessary for blood clotting. Most of the 12
clotting factors are plasma proteins produced by the liver. If the liver is damaged or diseased, it can
take longer for the body to form clots.

· Producing immune factors and removing bacteria, helping the body fight infection The
phagocytes in the liver produce acute-phase proteins in response to microbes. These proteins are
associated with the inflammation process, tissue repair, and immune cell activities.

Other important but less immediate functions include:

· Producing bile to aid in digestion. Bile salts aid in fat digestion and absorption. Bile is
continuously secreted by the liver and stored in the gallbladder until a meal, when bile enters the
beginning of the small intestine. Bile production ranges from 250 mL to 1 L per day depending of
amount of food eaten.

· Excretion of bilirubin. Bilirubin is one of the few waste products excreted in bile.. Bilirubin
then results from the breakdown of the hemoglobin in the red blood cells and is excreted into bile
by hepatocytes. Jaundice results when bilirubin cannot be removed from the blood quickly enough
due to gallstones, liver disease, or the excessive breakdown of red blood cells.

· Storing certain vitamins, minerals, and sugars .The liver stores enough glucose in the form of
glycogen to provide about a day's worth of energy. The liver also stores fats, iron, copper, and
many vitamins including vitamins A, D, K, and B12.

· Processing nutrients absorbed from digestive tract. The liver converts glucose into glycogen,
its storage form. This glycogen can then be transformed back into glucose if the body needs
energy. The fatty acids produced by the digestion of lipids are used to synthesize cholesterol and
other substances. The liver also has the ability to convert certain amino acids into others.

One of the liver's most interesting abilities is self-repair and the regeneration of damaged tissues.
In clearing the body of toxins, the liver is damaged by exposure to harmful substances,
demonstrating why this capability is important. It also gives hope that if a failing liver can be
supported for a certain period of time, it might regenerate and allows the patient to survive and
regain a normal life.

Brand Name:
 Mobic
• Therapeutic Effects: non steroidal anti-inflammatory agents
• Pharmacologic: non opioid analgesics
Prescribed, Recommended Dosage, Frequency, and Route of Administration
15mg 1 tab OD PO PRN for headache

Inhibit prostaglandin synthesis, probably by inhibiting the enzyme
cyclooxegenase.Therapeutic effects: Decreased pain and inflammation associated with
osteoarthritis.Also decreases fever.

Relief signs and symptoms of osteoarthritis and rheumatoid arthritis (including juvenile
rheumatoid arthritis).

Contraindicated in: Hypersensitivity. Cross sensitivity may occur with other NSAID’s
including aspirin. Severe renal impairment. Concurrent use of aspirin ( increased risk of adverse
reactions). Peri-operative pain from coronary artery bypass graft (CABG) surgery.
 CV: edema

 GI: GI bleeding, abnormal liver function tests, diarrhea, dyspepsia, nausea

 DERM: Exfoliative dermatitis, Stevens-johnson syndrome, toxic epidermal necrolysis,


 HEMAT: anemia, leucopenia, thrombocytopenia.

• Advise patient to take this medication with a full glass of water and to reman in an upright
position for 15-30 min after administration.

• Instruct patient to take medication as directed. Take missed doses as soon as remembered
but not if almost time for the next dose. Don not double doses.

• Caution patient to avoid concurrent use of alcohol, aspirin, acetaminophen, or other OTC
medications without consulting healthcare professional.

• Advise patient to inform healthcare professional of medication regimen prir to treatment or


• Advise patient to consult healthcare professional if rash, itching, visual disturbances,

weight gain, edema, black stools, or signs of hepatotoxicity (nausea, fatigue, lethargy,
jaundice, upper right quadrant tenderness, flu-like symptoms) occur.

Brand Name:
 Paracetamol
• Therapeutic: antipyretics, non opioid analgesics
Prescribed, Recommended Dosage, Frequency, and Route of Administration
500 mg 1 tab now then q 4 prn ≥ 38˚ c

Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever,
primarily in the CNS.Has no significant anti-inflammatory properties or GI toxicity. Therapeutic
Effects: Analgesia. Antipyresis.

Mild pain. Fever.

Contraindicated in: Previous hypersensitivity. Products containing alcohol, aspartame,
saccharin, sugar, or tartrazine should be avoided in patients who have hypersensitivity or
intolerance to these compounds.

 GI: Hepatic failure, hepatotoxicity(overdose)

 GU: renal failure( high doses/ chronic use).

 Hemat: neutropenia, pancytopenia, leucopenia

 Derm: rash, urticaria

• Advise patient to take medication exactly as directed and not to take more than the
recommended amount. Chronic excessive use of >4g/day (2 g in chronic alcoholics) may
lead to hepatotoxicity , renal or cardiac damage. Adults should not take acetaminophen
longer than 10 days and children not longer than 5 days unless directed by healthcare
professional.Short-term doses of acetaminophen with salicylates or NSAIDs should not
exceed the recommended daily dose of either drug alone.

• Advise patient to avoid alcohol (3 or more glasses per day increases the risk of liver
damage) if taking more than an occasional 1-2 doses and to avoid taking concurrently with
salicylates or NSAIDs for more than a few days, unless directed by healthcare professional.


• Pedi: Advise parents or caregivers to check concentrations of liquid preparations. Errors

have resulted in serious liver damage. Have parents or caregivers determine the correct
formulation and dose for their child(based on the child’s age/weight), and demonstrate how
to measure it using an appropriate measuring device.

• Inform patients with diabetes that acetaminophen may alter results of blood glucose
monitoring. Advise patient to notify health care professional if changes are noted.
• Caution patient to check labels on all OTC products. Advise patients to avoid taking more
than one product containing acetaminophen at a time to prevent toxicity.

• Advise patient to consult healthcare professional if discomfort or fever is not relieved by

routine doses of this drug or if fever is greater than 39.5 degree celcius or lasts longer than
3 days.


Red blood cells (also referred to as erythrocytes) are the most common type of blood cell
and the vertebrate body's principal means of delivering oxygen to the body tissues via the blood.
They take up oxygen in the lungs or gills and release it while squeezing through the body's
capillaries. The cells are filled with hemoglobin, a biomolecule that can bind to oxygen. The
blood's red color is due to the color of oxygen-rich hemoglobin. In humans, red blood cells
develop in the bone marrow and live for about 120 days; they take the form of flexible biconcave
disks that lack a cell nucleus and organelles and they cannot synthesize protein.