Introduction

Leptospirosis (also known as Weil's disease, Weil's syndrome, canicola fever, canefield fever, nanukayami fever, 7-day fever, Rat Catcher's Yellows, Fort Bragg fever, and Pretibial fever) is a disease known to cause heating up and causing redness of the hands. It is caused by infection with bacteria of the genus Leptospira, and affects humans as well as other mammals, birds, amphibians, and reptiles. The disease was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis". Leptospira was first observed in 1907 from a post mortem renal tissue slice. In 1908, Inada and Ito first identified it as the causative organism and in 1916 noted its presence in rats. Though recognised among the world's most common diseases transmitted to people from animals, leptospirosis is nonetheless a relatively rare bacterial infection in humans. The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, the eyes, or with the mucous membranes. Outside of tropical areas, leptospirosis cases have a relatively distinct seasonality with most of them occurring AugustSeptember/FebruaryMarch. Leptospirosis is caused by a spirochaete bacterium called Leptospira spp. There are at least five serovars of importance in the United States and Canada, all of which cause disease in dogs (Icterohaemorrhagiae, Canicola, Pomona, Grippotyphosa, and Bratislava). There are other (less common) infectious strains. Genetically different leptospira organisms may be identical serologically and vice versa. Hence, an argument exists on the basis of strain identification. The traditional serologic system is seemingly more useful from a diagnostic and epidemiologic standpoint at the moment (which may change with further development and spread of technologies like polymerase chain reaction (PCR)). Leptospirosis is transmitted by the urine of an infected animal and is contagious as long as it is still moist. Although rats, mice and moles are important primary hosts, a wide range of other mammals including dogs, deer, rabbits, hedgehogs,

cows, sheep, raccoons, possums, skunks, and certain marine mammals are able to carry and transmit the disease as secondary hosts. Dogs may lick the urine of an infected animal off the grass or soil, or drink from an infected puddle. There have been reports of "house dogs" contracting leptospirosis apparently from licking the urine of infected mice that entered the house. The type of habitats most likely to carry infective bacteria are muddy riverbanks, ditches, gullies, and muddy livestock rearing areas where there is regular passage of either wild or farm mammals. There is a direct correlation between the amount of rainfall and the incidence of leptospirosis, making it seasonal in temperate climates and yearround in tropical climates. Leptospirosis is also transmitted by the semen of infected animals. Slaughterhouse workers may contract the disease through contact with infected blood or body fluids. Humans become infected through contact with water, food, or soil containing urine from these infected animals. This may happen by swallowing contaminated food or water, or through skin contact. The disease is not known to be spread from person to person and cases of bacterial dissemination in convalescence are extremely rare in humans. Leptospirosis is common among water-sport enthusiasts in specific areas as prolonged immersion in water is known to promote the entry of the bacteria. Surfers and whitewater paddlers are at especially high risk in areas that have been shown to contain the bacteria, and can contract the disease by swallowing contaminated water, splashing contaminated water into their eyes or nose, or exposing open wounds to infected water. Occupations at risk include veterinarians, slaughterhouse workers, farmers, sewer workers, and people working on derelict buildings. Rowers are also sometimes known to contract the disease.

General Objectives: This case analysis was designed to develop a holistic and patient centered nursing care and responsibilities. This is to broaden the knowledge of the analyst as well as the student with regards to Leptospirosis, this is also designed to enhance skills and attitudes in the application of nursing process and management of the disease. Specific Objectives: To identify the factors (predisposing, precipitating or etiologic agent if any) that causes the disease.

-To identify the sign and symptoms manifested by the patient with Leptospirosis and perform further assessment to be able to recognize appropriate nursing intervention to be rendered.

-Discuss the anatomy and physiology and how it is being altered the disease process. -To have the pathophysiology and to trace the occurrence of Leptospirosis.

-To utilize properly the nursing process (assessment, diagnosis, planning, intervention, evaluation) as the framework for the care of the patient.

-To select appropriate nursing diagnosis for the patient with Leptospirosis based on assessment findings.

-To learn various medications, it's condition, adverse effects & accompanying nursing responsibilities.

-To put into action what we have learned in the school (such as nursing process) and apply our knowledge in providing quality and individualized nursing care.

-To enhance group's attitude, like discipline, cooperation, leadership abilities and teamwork in making and forming this case analysis.

-To involve the patient's family in the implementation of nursing management throughout hospital experienced.

NURSING HISTORY A. Biographical Data

Patient Name: Address:

Patient X

XXXXXXXXX

Date of Birth: 6-22-93 Birth Place: Quezon City

Occupation: Student Source of health Assistance: nearest health center on Las Pinas City

Source of Referral: Las Pinas healh center Emergency Contact Person and Number: RVB / 0999-xxx-xx-xx

B. CC:

Reason for seeking Health Care vomiting and body weakness.

Objective Data: yellowish skin color Subjective Data: (+) dizziness felt

C.

History of Present Illness

1 Week Prior to Admission: The patient is suffering from severe vomiting, abdominal pain and dizziness. His mother brought him to Las Pinas Gen. Hosp, and the physician noted that he has Dyspepsia and Electrolyte Imbalance. His Doctor suggested him to have a laboratory test such as CBC, UA, PC, ECG and Chest x-ray.

10 Hours Prior to admission:

He still felt the following Condition (said above), After the lab results were revealed, Doctor noted the principal diagnosis as acute renal failure resolving t/c Leptospirosis.

Past Medical History This was his first hospitalization. D. Past Health History Cough and Cold, Fever, Chicken pox and Measles during childhood. He never undergone operation.. Paracetamol, Neozep, Anti-histamine No known allergies on food and medications None

Medical History: Surgical History: Medications: Allergies:

Injuries and accidents:

Childhood Illness immunization: Complete childhood immunization in School and Health Centers.

E.

Family Health History

Patient Age: 18 years old AGE Siblings: Has 4. Patients mother: 34y/o eldest 54y/o HEALTH STATUS no pertinent data no pertinent data

Patients father

Deceased

History of hypertension.

F. a. b. c. d. e.

Social History Alcohol use: Drug use: Tobacco use: Sexual practice: Travel history: The patient said that she never drink alcohol. The patient said she never used any prohibited drugs No history of smoking as stated by the patient Not Active From Quezon City, they move their house at Las Pinas City for

f. Home environment: The patient said their house is quiet spacious and conducive healthy living. g. Hobbies and Leisure act: The patient is the youngest in the family. He said his past time activities are playing computer and using cell phone. h. Education: He is currently a college student.

i. Economic status: sideline job. j. Religion:

Their familys main source of income is from his eldest brothers job as well as his mothers

Roman Catholic

k. Ethnic background: Rules and policies of their religion are slightly followed by the Family. Examples is going to church once a week.

ftVital Signs ( upon admission)

BP: 130/100 mmHg Pulse rate: 96bpm RR: 59 cpm Temp: 37 C

*Pertinent P.E done

GORDONS FUNCTIONAL HEALTH PATTERN BEFORE HOSPITALIZATION 1. Health perception/ Whenever the pt gets sick, management he immediately seeks medical attention to the nearest health center. COMPONENTS DURING HOSPITALIZATION The pt realized the importance of regular checkups. He still believes that immunity is the most important aspect in attaining maximum health ANALYSIS Pts health awareness is high; she accepts the responsibilities & does preventive measurements to decrease the possible outcome of a disease or health deterrent. Because he w ill be undergone on an ultrasound. Because he is in NPO, thats why he often have any output. The pt needs a CBR to return back his body strength.

2. Nutritional/ metabolic

3. Elimination

4. Activity/ Exercise

The pt said, he is not choosy The pt is in NPO. in the food, but he didnt like eating junk foods. The pt voids/ bowel The pt doesnt eliminate his movement3x a day bowel movement &no urine output. The pts hobbies are playing The pt cannot do his computer and using cell hobbies because of body phone. weakness.

5. Sleep/ Rest

The pt used to sleep at 1am because of playing computer. The pt is alert, active and can response immediately. The pt is in good condition and in good condition. A happy-go-lucky person.

The pt always felt sleepy because hes bored and has no choice but to sleep.

6. Cognitive/ perceptual 7. Self-perception/ selfconcept

8. Role/ relationship

The pt is the youngest among his 4 siblings. Pt doesnt used any family planning.

9. Sexuality/ reproductive

Adequate sleep will help him to pay for the times that he is sleeping late at night before he was hospitalized. The pt can still answer to the Nothing has change to pts questions asked to him. perception. The pt is quite depressed When illness started, the pt because he doesnt feel doesnt feel good anymore good about his self. about his self, but he doesnt lose hope, he believes that he will recover on his illness. The pt is taken care of by his Since he is the youngest, all mother & sister. of the attention was given unto him. He doesnt think about The pts reproductive system sexuality/reproductive. But is normal. he stated that he was circumcised at the age of 12y/o. He let his family resolved their problem. Even the pt is happy-goglucky, deep inside he pity his family because of the problem they are experiencing. The pt realized that God is still the center of all the existance on earth.

10. Coping/ Stress Tolerance

If he has a problem, he choose to live alone.

11. Values/ Beliefs

The pt is a roman catholic but doesnt want to go to church except for midnight mass during Christmas.

The pt said that she will go to church after she gets discharge from the hospital as a thanks giving

EYES Bulbar Conjunctiva

Inspection

Transparent, capillaries sometimes evident, sclera appears white (darker or yellowish and small brown macules in dark-skinned clients) Shiny, smooth, pink or r ed. No edema or tenderness over lacrimal gland

Transparent, capillaries are evident, sclera is yellow.

The patient has abnormal conjunctiva.

Note for jaundice sclera (liver disease); excessively pale sclera; lesions or nodules (bacterial agents)

Palpebral conjunctiva (lining the eyelids)

Palpation, inspection

The conjunctiva is dry, smooth and yellow.

The patient has abnormal and poor conjunctiva.

Skin Color

Inspection

Skin uniform color (same as skin of abdomen or back) skin smooth and intact

Skin uniform color (same as skin of abdomen or back) skin dry and yellowish

Abnormal skin color of chest

Extremely pale: possible anemia; extremely red; inflammation; nodules or other lesions are not normal. Generalized discoloration

MOUTH Lips symmetry of contour, color and texture

Inspection

Uniform pink color soft, moist, smooth texture, symmetry of contour, able to purse lips.

Pale in color, soft, moist, smooth texture symmetry of contour, is able to purse lips.

The patents tongue is normal with no lesions.

Inner lips and Inspection and Uniform pink color, buccal mucosa palpation moist smooth, soft, glistening and elastic texture.

Slightly pale in color, moist, smooth, glistening and elastic.

Pales/ pallor may indicate blood circulation problem (anemia) on patient.

Deviated from center (hypoglossal or 12th cranial nerve); smooth red tongue (Vit. B12 or B3 deficiency); dry furry tongue (fluid deficit); white coating (oral yeast infection) Pallor, leukoplakia, red, bleeding, excess dryness, mucosal cysts, ulcerations, nodules.

Urinalysis Examination MACROSCOPIC EXAM Normal Values Findings Analysis

Color

Dark Yellow

Yellow

The color of urine indicates the concentration of urine.

Transparency

turbidslight

Hazy

abnormally colored urine may Result from a pathologic con-

Protein

trace

Negative

dition or in the ingestion of Certain foods or medicines

Sugar

negative

Negative

Dark yellow urine may indicaTes the presence or urobiligen or bilirubin Protein is a sensitive

indicator of kidney function. Normal protein excretion must be differentiated from that due to dis. States. Persons who do not have renal dis. May have proteinuria after strenuous exercise or when dehydrated.

HEMATOLOGY

Examination Complete Blood Count Hemoglobin the Hematocrit system White Blood Cells tissue RBC Count inc. Neutrophil leukocy-

Normal Values

Findings

Analysis

12- 18 g/L

8.9

White blood cells constitute

0.37- 0.47

0.27

bodys primary defense

4- 11x 10/ L

4-2

against foreign organisms,

4-2 6.0

3.23

and other substances. An

55- 70

96

WBC count is termed as

Lymphocytes indicate Monocyte a path

0.20- 0.05

tosis. A total WBC count

0.02- 0.05

the degree of response to

Ologic process.Acute leukocys-Tosis is initially accompanied by Changes in WBC count population , followed by changes within The individual WBCs

Medical Management Oxygen The patient was ordered to have 3 to 4 liters per minute of oxygen. Because he has having tachypnea Blood transfusion From the previous lab result which is his hematology his Hgb,Hct and RBC are decreased. Ranitidine The patient is taking this medicine because hes having heart burn,acid indigestion and sour stomach

MEDICATION INDICATION

CLASSIFICATION CONTRAINDICATION AND ADVERSE EFFECT CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL:

NURSING RESPONSIBILITY Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

GENERIC NAME: Ranitidine BRAND NAME: Z a n ta c

Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists

Nurse should know that it may cause falsepositive results for urine protein; test with sulfosalicylic acid.

Inform patient that it may cause drowsiness or dizziness.

Inform patient that increased fluid and fiber intake may minimize

constipation.

Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly.

Inform patient that medication may temporarily cause stools and tongue to appear gray black. Penicillin G potassium Drug Class Antibiotic Peniciliin Antibiotic Rat-bite fever Dosage Treatment of severe infections caused by sensitive organisms leptotrichiabuccalis, staphylococci, pneumococci, Neisseria gonorrhea Contraindicated with allergy to penicillins, cephalosporin, Bactericida;: Inhibits synthesis imipenem, beta-lactamase inhibitors, other allergens. of cell wall of Use cautiously with renal sensitive orgnisms, causing disease, pregnancy, lactations cell death. 1. Assess the patients history to allergy to penicillins, cephalosporins, imipenem, betalactamase inhibitors, other allergens, renal disease, lactation and pregnancy. 2. Monitor intake and output. Dehydration

decreases drug excretion and may raise blood level of penicillin G to dangerously high levels causing kidney damage. GI disturbances may lead to dehydration. 3. Culture infection before beginning treatment; reculture if response is not as expected.. 4. Continue the treatment for 48-72 hours after the patient is asymptomatic. 5. Monitor serum electrolytes and cardiac status if penicillin G is given by IV infusion. Sodium or potassium preparations have been associated with severe electrolyte imbalances. 6. Keep epinephrine, IV fluids, vasopressors, bronchodiators, oxygen, and emergency

equipment readily available in case of serious hypersensitivity reaction. 7. Inform the patient that this drug is given by injection for severe infections. 8. Use the smallest dose possible for IM injection to avoid pain and discomfort. 9. Apply ice to relieve pain experienced at injection site for IM preparation. 10. Instruct the patient to report any unusual bruising, bleeding, nausea and vomiting, sore mouth, diarrhea, rash, fever, difficulty breathing, adverse side effects, or lack of imp.

:Paracetamol Tylenol Tempra Pedric

Fever Reduction. Temporary Relief mild to moderate pain Adult PO 500mg q4 hour

Non- Narcotic Analgesic Produces analgesia by unknown mechanism, perhaps by action on peripheral nervous system. Reduces fever by direct action on hypothalamus heat regulating center with consequent peripheral vasodilation, sweating and dissipiatation of heat Bactericida;: Inhibits synthesis of cell wall of sensitive orgnisms, causing cell death.

Hypersensitivity to aceminophen or phenacetin Side effects: Hepatic failure hepatotoxicity GU: renal failure (high doses/chronic use) Derm: rash, urticaria

1. Do not use this medicationwithout medical direction for:fever persisting longer than 3days, fever over 39.5C (103F)or recurrence fever 2.Do not self medicateadultsfor pain more than 10 dayswithout consulting a physician 3.Do not take othermedication (e.g., coldpreparations) containingacetaminophen without medicaladvice, overdosing and chronicuse can cause liver damage andother toxic effects

Doxycyline

Doxycycline is used to treat periodontitis; respiratory, skin or soft tissue, and urinary tract infections; syphilis; uncomplicated gonorrhea; pelvic inflammatory disease; a rheumatic fever prophylaxis; brucellosis; trachoma; Rocky Mountain spotted fever; typhus; Q fever; rickettsia; smallpox; psittacosis; ornithosis; granuloma inguinale; lymphogranulomavenerum and; adjunct treatment of intestinal amoebiasis. Doxycycline can also be used as treatment for malaria, atypical mycobacterial infections, prophylaxis or treatment of traveler s diarrhea, rheumatoid arthritis, and prevention of Lyme disease.

Bacteriostatic, Inhibits of bacteria, causing cell death

y Anorexia y Nausea y Vomiting y Diarrhea y Dysphagia y Photosensitivity y Rash y Urticaria Adverse Reactions of y Superinfection y Benign intracranial hypertension y Liver toxicity y Fatty degeneration of the liver y Pacreatitis

y y y

Do not administer intramuscularl y or subcutaneous ly. Space doses evenly a r o u n d th e clock. Store capsules, tablets at r oom temperature. Oral suspension is stable for 2 weeks at r oom temperature. Give with full glass of fluid May take with food or milk. Protect IV Infusion from sunlight. if precipitate forms, discard.

y y

Infuse for >14 hours given by intermittent IV infusions. Question history of allergies especially to tetracycline and sulfites. Determine p a tte r n o f bowel activity and stool consistency. Assess skin for rash. Monitor levels of consciousnes s d u e to potential increase in intracranial pressure. Be alert for signs of superinfection : diarrhea, ulceration or

DICLOFENAC Drug Class Analgesis, AntiInflammatory, Anti-pyeretic, NSAID,

Acute or long term treatment of mild to moderate pain, including dysmenorrhea RheaumatoidAnthritis Acute treatement of migraine head ache or without aura OsteoAthritis

Inhibits prostaglandin synthetase to cause anti-pyretic and anti inflammatory, the exact mechanism is unknown

Contraindicated with allergy to NSAIDs, significant renal impairment, pregnancy, lactation. Use cautiously with impaired hearing, allergies, hepatic, CV, GI, conditions, and in elderly patients

changes of oral mucosa, and genital pruritus. y Administer drug with fo o d o r a fte r meal if GI upset occurs Arange for opthamologic exam during long-term th e r a p y Institute emergency procedure if overdose occurs