A case study of erratic parasitism

BSN3Y2-2

Group2A

General Objective:

To be familiarized and to provide an effective nursing care to a patient diagnosed with Erratic Parasitism through understanding the patient history, disease process and management.

Specific Objective:

I. Classify the parasite that infects the patient.II. Discuss the anatomy and physiology, pathophysiology, usual clinical

manifestations and possible complications of this condition.

III. To have knowledge and be familiarized to the client medications.

IV. To formulate a workable nursing care plan on the subjective and objective datas gathered through nurse-patient interaction to be able to help the patient recover.

Introduction:

The word “erratic” means having no certain or definite course; wandering or moving while “parasitism” is a non-mutual symbiotic relationship between species, where one species, the parasite, benefits at the expense of the other, the host, in this relationship the parasite do not kill its host. In contrast there is also a non-mutal symbiotic relationship called “parasitoids” in where the parasite kill its host.

There are so many types of parasites but such as Pediculus humanus capitis, Schistosoma mansoni. Parasites that live on the outside of the host, either on the skin or the outgrowths of the skin, are called “ectoparasites” while those that live inside the host are called “endoparasites” Endoparasites can exist in one of two forms: “intercellular parasites” (inhabiting spaces in the host’s body) or “intracellular parasites” (inhabiting cells in the host’s body) intracellular parasites, such as protozoa, bacteria or viruses. Our case can be classified as invasion of intercellular parasites.

According to the World Health Organization (WHO), the most common intestinal parasitic worms are roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), and hookworms (Necator americanus and Ancylostoma duodenale). All these are soil-transmitted helminths.

Erratic parasitism is a condition in which the parasite (i.e. Ascaris lumbricoides) moves along the body during larvae stage and will remain on a certain part of the body when finally mature.

As a student nurse this study will enable us to understand better about Erratic Parasitism and will explain the different risk factors for developing the disease, including consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. Since we are client-centered, we really should consider our patient’s comfort and this study will give the students sufficient knowledge that will help us to plan and implement nursing care plans that will provide patient’s needs.

Demographic Profile

Patient’s name: MLM

Gender: Male

Birthday: March 17, 2012

Age: 2 years-old

Hospital #: 723910

Religion: Catholic

Citizenship: Filipino

Place of Birth: Malabon City

Height: 89cm

Weight: 19kg

Date of Admission: January 20, 2015

Time of Admission: 12:20PM

Chief Complaint:

Vomiting

Admitting Diagnosis:

Erratic parasitism with moderate signs of dehydration

History of Present Illness

6 hours PTA patient vomited approximately 1 cup, watery in consistency, with two intestinal parasites described as thin, whitish color. Subsequent vomiting revealed no intestinal parasites, vomitus described as watery, amounting to half cup per episode. Persistence of symptoms prompted consult.

Past Medical History

+) Pneumonia 2012

+) vomited 4 intestinal parasite 2013 – 1 week hospitalize

+) Completely Immunized

Anatomy and Physiology:

Digestive system:

The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste. Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.

The Digestive Process

Mouth:

The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and breakdown starches into smaller molecules).

Esophagus

After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (peristalsis) to keep the food moving along the digestive tract.

Stomach

The stomach is a large, sack-like organ that churns the food and bathes it in a strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.

Small Intestines

After being in the stomach, food enters the duodenum, the first part of the small intestine then it enters jejunum and then the ileum (terminal part of small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.

Large Intestines

After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water and electrolyte are removed from the food. Many microbes in the large intestine help in the digestion process. Food then travels upward in the ascending colon then across the transverse colon, goes down to the descending colon, and then through the sigmoid colon.

Rectum and Anus

End of the digestion process solid waste is then stored in the rectum until it is excreted via anus.

Pathophysiology: PET

Larvae develop Inside the Egg

Child ingested the food/soil together with the egg

Egg hatched in the small intestine

Larvae penetrate intestinal wall and migrates to the pulmonary vascular beds

and to the alveoli via portal veins

Coughing and wheezing

Migrates up to the URT SwallowedLarvae matures,

copulate and lay eggs in the small intestine

Eggs will probably found in stool.

Pathophysiology:

Fertilized eggs in feces/ soil

Risk factors:

Physical Assessment: (ER) Need to Improve… Gordons/ IPPA?

Temp: 36.9C CR: 145 RR: 30 O2 Sat: 96% >anicteric sclerae, Pink palpebral conjunctivae >Skin Pinch <2 secs >w/ good skin turgur

moist lips >not difficult to feed >alert, awake

Eager to drink, Thirsty

Course in the ward:

Date and Time Physicians Order Nurses notes1-20-1512:20pm

>Admit to ward>Secure consent for >Admission>Inform Nurse on duty __ for ward?>NPO except meds>IVF D5IMB 1L X 48cc/HR>Lab diagnostics on the ward

CBC UA Fecalysis NA, K

>Therapeutics Paracetamol

125mg/5ml q4 prn temp >37.8C

OHS as volume per volume replacement for GI loses. (Ano ibig sabihin ng Volume per volume?)

>Monitor VS q4>I&O q shift>Refer

Date and Time Physicians Order Nurses notes1-20-155:15pm

>Shift IVF to PLR 1L X 70cc/HR>Diet: Brat diet, NPO if w/ reoccurrence of vomiting.>Zinc sulfate syrup 4ml OD>Diphenhydramine 12.5mg/ 5ml. 4ml stat then q8>Pls. carry out other orders>Refer

Date and Time Physicians Order Nurses notes1-21-158:00am

>Patient is awake and coherent sitting on bed>Zinc sulphate 4ml given>Diphenhydramine 4ml q8>Physical assessment pa…> Vital signs taken

Temp : 36.8 PR : 102 RR : 34

LAB:

CBC Results Ref. value

o WBC 22.23 H 4.8- 10.8o RBC 5.24 H 4.1-5.1o Hgb 129 L 140 - 175o Hct 0.380 0.359-0.445o MCV 74.8 L 82-98o MCH 24.6 L 29-33o MCHC 32.8 L 33-36o Platelet count 550 H 150-400o RWD 15.8 H 11.4-14.0

Neutrophils 73.50 H 40-70o Lymphocyte 19.50 19-48o Eosinophils 2.90 2-8o Monocytes 3.60 0-15o Basophils 0.40 0-5

Serum Electrolytes

o Na 139.10 139-149o K 4.74 3.5-5.5

An increased production of white blood cells indicates infection caused by bacteria, viruses, fungi or parasites, Inflammation, allergies or Immune disorders. Elevated neutrophils indicate bacterial infection, in some cases elevated neutrophils are seen in some parasitic infections.

Drug Study:

DRUG NAME CLASSIFICATIO INDICATION ADVERSE CONTRAINDICATIO NURSING

N EFFECTS N CONSIDERATION

Generic Name:

Diphenhydramine

Brand Name:

Benadryl

Dose:

12.5mg/5ml4ml q8

Route:

Oral

Antihistamine Diphenhydramine is used to sedate the parasitic worms

Also has anti

Sleepiness ,fatigue, dizziness, headache, dry mouth, Drowsiness

Hypersensitivity to anti-histamines.

Breathing problems (such as asthma, emphysema), high pressure in the eye (glaucoma), heart problems, high blood pressure, liver disease, seizures, stomach/intestine problems (such as ulcers, blockage), overactive thyroid (hyperthyroidism), difficulty urinating (for example, due to enlarged prostate).

Give as prescribed; avoid excessive dosage.

Take with food if GI upset occurs.

Ask the mother if the patient has allergies to anti-histamines

DRUG NAME CLASSIFICATION INDICATION ADVERSE EFFECTS

CONTRAINDICATION NURSING CONSIDERATION

Generic Name:

Paracetamol

Brand Name:

Tempra

Dose:

125mg/5ml q4 prn temp >37.8CRoute:

Oral

Analgesic anti-pyretic

Symptoms of fever

increased sweating

loss of appetite

Hematologic: hemolytic anemia, neutropenia, leukopenia, pancytopenia. Hepatic: Jaundice Metabolic: Hypoglycemia

Skin: rash, urticaria.

Hypersensitivity to drug

In children, don’t exceed five doses in 24 hours.

Warn the mother that high doses or unsupervised long term use can cause liver damage.

DRUG NAME

CLASSIFICATION INDICATION ADVERSE EFFECTS

CONTRAINDICATION NURSING CONSIDERATION

Generic Name:

Zinc Sulfate

Brand Name:

E-Zinc

Dose:

4ml OD

Route:

Oral

Dietary supplement

As an adjunct in the management of acute diarrhea

To help boost immune function

Nausea and vomiting

Fever

Metallic taste

Lethargy

Hypersensitivity to drug

Give as prescribed; avoid excessive dosage.

Ask the mother if the patient has allergies to drug

NCP: 2

Risk for injury”

Risk for Fluid volume Deficit”

Imbalanced nutrition

Assessment Diagnosis Planning Intervention Rationale EvaluationSubjective:

“madaming beses na siya sumuka halos hindi ko na mabilang kung ilan” as verbalized by the mother

Objectives:

>Thirsty

>Dry Skin

>Dec. urine output 25ml/hr

>Episodes of vomiting

Risk for fluid volume deficit r/t to active fluid volume loss as manifeted by episodes of vomiting.

Within 8 hours of nursing intervention the patient willExperience adequate fluid volume as evidenced by urine output >30 ml per hr, moist skin, and minimal episodes of vomiting

Continuous VS and I & O monitoring.

Monitor active fluid loss from episodes of vomiting

Administer parenteral fluids as ordered

Maintain IV flow rate

Explain importance of maintaining proper nutrition and hydration.

Encourage patient to drink prescribed fluid amounts

Give medications as ordered by the physician

To facilitate accurate measurement and avoid complications.

To avoid circulatory overload

To promote proper nutrition and hydration

To keep the patient well hydrated.

Diphenhydramine has Anti-emetic property

After 8 hours of nursing intervention the patient experienced adequate fluid volume as evidenced by increased urine output, moist skin, and minimal episodes of vomiting. The goals are met.

Assessment Diagnosis Planning Intervention Rationale EvaluationSubjective:

“Hinahatak nya yung linya ng dextrose” As verbalized by the mother.

Objectives:

>IV contraptions

>Agitated

>Pulling of IV tubing

>Toddler

Risk for injury related to psychomotor agitation as manifested by pulling of IV tubing.

Within 8 hours of nursing intervention the patient will not experience physical injury.

.

Maintain a closed central IV system by taping of all connections

Inspect peripheral IV site routinely

Instruct to keep the bed side rails raised, and lock the wheels.

Ask family to stay with client to prevent client from accidentally falling or pulling out tubes.

Remove all possible hazards in environment such as razors, medications, and matches.

Inadvertent disconnection of central IV system can result in lethal air emboli.

Irritation may develop

After 8 hours of nursing care the patient remains free of injuries

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective:“May dalawang bulate akong nakita sa suka niya” as verbalized by the mother.

Objectives:

>Episodes of vomiting

>lack of interest in food

Imbalanced nutrition less than body requirement related tovomiting and

Within 8 hours of nursing intervention the patient will consume adequate nourishment.

Determine daily calorie needs are realistic and adequate.

Explain the importance of adequate nutrition.

Instruct mother to feed her child on time.

Discharge Plan / Recommendations: (Recommendations lang ba tayo kasi di pa ididischarge?)