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I.

OBJECTIVES

General Objectives:

Be capable enough to acquire knowledge about proper Nursing care to be


rendered to the patient. So as to enhance our skills, widen up concepts to have
deeper understanding on the disease and apply more appropriate treatment and
nursing management through proper establishment of trust and rapport, setting out
right and proper attitude for future application of nursing principles and
responsibilities.

Specific Objectives:

Cognitive:

To acquire the proper knowledge about the disease through chart


reading, physical examination, observation and nurse patient interaction. To
have deeper comprehension regarding the disease entity including the
definition of the disease, manifestation, complications, pathological condition,
its avoidance, curative preferences and proper clinical management.

To become knowledgeable enough of the effective and applicable


treatments, appropriate care and proper management regarding the case of
the patient. As well as to be intelligent enough to know the disease occurring
in the human body and how it affects the normal bodily functions and
processes. To be aware enough of the possible complications that might arise
during home treatment.

And last for us to learn how to improve nursing care plan and know the
important nursing managements.

Affective:

To establish trust and rapport as a basic foundation for a better


communication, effective nurse-patient interaction and proper handling of the
patient for rendering of a quality nursing care.

To develop a more just and humane characteristics for future nursing


management.

Psychomotor:

To enhance and develop skills through practicing on duty with the use
of gained knowledge and proper attitude.

To become better and effective health care provider by seeking


alternative and helpful ways of acquiring the knowledge and to become
better researcher to build up our research ability.
II. PATIENT’S PROFILE

Service: Pedia

Room: Private room

Bed Number: 206

Name: Robert B. Longat

Age: 4 years old

Date of Birth: February 2, 2005

Gender: Male

Civil Status: single

Address: Brgy. Malabanban Norte Candelaria, Quezon

Religion: Roman Catholic

Nationality: Filipino

Occupation: none

Chief Complain: malaise, blood in the stool

Admission Date: January 12, 2010

Admission Time: 8:52 pm

Attending physician: Dra. Melissa Macatangay Abarriao (MMA)

Date of Discharge: January 19, 2010

Length of stay: 8 days

Admitting Diagnosis:

Final Diagnosis:
III. MEDICAL HISTORY
Questions:

– What brought you to the hospital?

– When the symptoms started?

– Whether the onset of symptoms was sudden or gradual?

– How often the problem occur?

– Exact location of the distress.

– Character of the complaint

– Activity in which the client was involved when the problem occurred

– Factors that aggravate or alleviate the problem

Present Medical History


In the present medical history of child named Robert, her mother mentioned
that her son had been show some sign of anxiety so as a mother she asked her
child if her child had problem. Then Robert told that on his stool there is a blood.
Her son also told that he experiencing pain on mild straining during eliminating. The
pain that he experienced had been started on her rectum then goes upper on her
sacrum part. The length of the pain is based on the time of eliminating, and the
severity of it is tolerable according to Robert and had a score of 4 out of 10. There is
no other complaint that Robert had been mentioning or experiencing.

Past Medical History


In his past medical history, Robert’s mother told that her son had not been
admitted in any kind of hospital since the time she gave birth to Robert. Some time
her son experiencing common cold, fever, cough and some mild disease.

Family Medical History

In regards on Robert’s family her mother mentioned that their family had no
serious disease or syndrome that can be inherited through maternal life and her
mother also mentioned that on the side of her husband there is a series of high
blood pressure condition. But all in all according to her mother statement We’ve
been concluded that there is no serious hereditary disease that Robert may acquire
through her mother.

Lifestyle
Robert is only 4 year old he loves to run, play with other child and some
extraneous activity. He love also to eat pork chop, her mother told that she having
difficulty in preparing food for Robert because in terms of vegetable her son doesn’t
like it. In terms of care and sleep time of Robert it had been good for her and
healthy.

Psychosocial Environment

Longat family lives in a concrete house and located at factory side so Robert
complaining that their placed is having a bad smell. Robert’s parent also planning to
transfer on another house that there is limited polluted air in order to achieve more
god condition for their child Robert. They get their drinking water on their faucet
that connected on one of the water supplier in the malabanban norte.

I. Physical Examination
General Appearance
• Conscious and coherent

• weak in appearance

• ambulatory

• w/ poor appetite

Hair
• with normal hair distribution

• w/ fine texture

Head
• no bulging

• skull symmetrical to face

• no lesions

Neck
• no jugular vein distention

• without inflamed lymph nodes

Chest
• symmetrical

• no lesions

• with good rise and fall of chest during inspiration and exhalation

Abdomen
• slightly distended

• no lesions

• bowel sound of 2/30 per minute

Back
• no lesions

• normal spinal curvature

Upper Extremities
• no lesions

• symmetrical
• capillary refill of 1-2secs

• with slightly weak flexion

Lower Extremities
• no lesions

• symmetrical

• with minimal rash

• with slightly weak flexion

Integumentary
• normal skin color

• no lesions

Cardiovascular
• pulse rate 109bpm

Respiratory System
• not in respiratory distress 18bpm

• no distress noted

• with no septal deviation

• with no secretion on nose

Gastrointestinal System
• with abnormal bowel sounds

Urinary System
• with normal urine patterns

Nervous System
• afebrile 37.3 °C

Musculoskeletal System
• w/ weak muscle tone in the extremities
I. COURSE IN THE WARD
The patient was admitted from the ER of peter paul medical center on last
January 12, 2010 around 9:52 in the evening. He weigh 9 kilogram, vital sign
was taken at the ER as follows: Temperature was 37.2°C, Pulse Rate was 109
beats per minute, Respiratory Rate was 29 breaths per minute..

➢ On the last day of his admission until he discharge at January 19,2010 just
a series of fecalysis and medication administration had been ordered to
him
I. DISEASE ENTITY with
PATHOPHYSIOLOGY

Dysentery
DEFINITION

Dysentery is an inflammation of the intestine characterized by the frequent


passage of feces, usually with blood and mucus. The two most common causes of
dysentery are infection with a bacillus of the Shigella group, and infestation by an
ameba, Entamoeba histolytica. Both bacillary and amebic dysentery are spread by
fecal contamination of food and water and are most common where sanitation is
poor. They are primarily diseases of the tropics, but may occur in any climate.
Dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of
the intestine, especially of the colon, that results in severe diarrhea containing
mucus and/or blood in the feces. If left untreated, dysentery can be fatal.

CAUSES
Dysentery is usually caused by a bacterial or protozoan infection or
infestation of parasitic worms, but can also be caused by a chemical irritant or viral
infection. The most common cause of the disease in developed countries is infection
with a bacillus of the Shigella group (causing bacillary dysentery). Infection with the
amoeba Entamoeba histolytica, can cause amoebic dysentery.
Shigella is a genus of Gram-negative, non-spore forming rod-shaped bacteria
closely related to Escherichia coli and Salmonella. The causative agent of human
shigellosis, Shigella cause disease in primates, but not in other mammals. It is only
naturally found in humans and apes. During infection, it typically causes dysentery.
Shigella causes dysentery that result in the destruction of the epithelial cells
of the intestinal mucosa in the cecum and rectum.
Entamoeba histolytica is an anaerobic parasitic protozoan, part of the genus
Entamoeba. Predominantly infecting humans and other primates, E. histolytica is
estimated to infect about 50 million people worldwide. 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.

E. histolytica was also found to be transmitted through anal-oral sex. The


research has shown that HIV-infected gay men were at greater risk of getting
infected than healthy population and than seropositive heterosexuals.

Modes of Transmission:
1. The disease can be passed from one person to another through fecal-oral
transmission.
2. The disease can be transmitted through direct contact, through sexual
contact by orogenital, oroanal, and proctogenital sexual activity.
3. Through indirect contact, the disease can infect humans by ingestion of food
especially uncooked leafy vegetables or foods contaminated with fecal
materials containing E. histolytica cysts.

PATHOPHYSIOLOGY AND MANIFESTATIONS

DIAGNOSTIC TESTS
It can be diagnosed by stool samples but it is important to note that certain
other species are impossible to distinguish by microscopy alone. Trophozoites may
be seen in a fresh fecal smear and cysts in an ordinary stool sample.

MEDICATIONS
Ciprofloxacin
Metronidazole
Dysentery is initially managed by maintaining fluid intake using oral
rehydration therapy. If this treatment cannot be adequately maintained due to
vomiting or the profuseness of diarrhea, hospital admission may be required for
intravenous fluid replacement.
DIETARY MANAGEMENT
Diet restriction, to known well-tolerated foods, and the BRAT diet and its
extensions, may be used for 1-to-3 days. However, limiting milk to children has no
effect on the duration of diarrhea
Banana
Rice
Apple
Tea
Nursing Management:
1. Observe isolation and enteric precaution
2. Provide health education and instruct patient to
○ Boil water for drinking or use purified water
○ Avoid washing food from open drum or pail
○ Cover leftover food
○ Wash hands after defecations and before eating
○ Avoid ground vegetables (lettuce, carrots, and the like)
Methods of Prevention:
1. Health education
2. Sanitary disposal of feces
3. Protect, chlorinate, and purify drinking water
4. Observe scrupulous cleanliness in food preparation and food handling
5. Detection and treatment of carriers
6. Fly control (they can serve as vector)

MANUEL S. ENVERGA UNIVERSITY FOUNDATION CANDELARIA INC


Candelaria Quezon

COLLEGE OF NURSING AND SCHOOL OF ALLIED HEALTH SCIENCES


In Partial Fulfillment of the Requirements
in Related Learning Experience

CASE STUDY

HYPOKALEMIA with PERIODIC PARALYSIS

Presented By:

GROUP II

Llada. Kim B.

Vidal, Abbie Faye

Jumawan Marah

De Roxas, Jennifer M.

Alip, Shena Marie C.

Bukid, Ma. Catherine

Umali, Joan Kae D.

Macasaet, Rachel H.

Garcia, Carina

Maralit, Maria Theresa V.

Velasco, Franz L.

To:

Mr. Reynelio S. Galang

Clinical Instructor

Date: January 26, 2010