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 HISTORYQuestions:

- 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.

IV. 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

V. COURSE IN THE WARDThe 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

VI. 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 precaution2. Provide health education and instruct patient to

o Boil water for drinking or use purified watero Avoid washing food from open drum or pailo Cover leftover foodo Wash hands after defecations and before eatingo Avoid ground vegetables (lettuce, carrots, and the like)

Methods of Prevention:

1. Health education2. Sanitary disposal of feces3. Protect, chlorinate, and purify drinking water4. Observe scrupulous cleanliness in food preparation and food handling5. Detection and treatment of carriers6. Fly control (they can serve as vector)

MANUEL S. ENVERGA UNIVERSITY FOUNDATION CANDELARIA INCCandelaria Quezon

COLLEGE OF NURSING AND SCHOOL OF ALLIED HEALTH SCIENCES

In Partial Fulfillment of the Requirementsin 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