126553270 amoebiasis-case

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TARLAC STATE UNIVERSITY
COLLEGE OF NURSING
Lucinda Campus,Brgy. Ungot, Tarlac City Philippines 2300
Tel No.: (045) 982-6062 Fax: (045) 982-0110 website: www.tsu.edu.ph
A Case Study on Amoebiasis
In Partial Fulfillment of the Requirements of the Subject
Nursing Care Management 103 RLE
Presented to the Faculty
Of the Tarlac State University
College of Nursing
Presented by:
BSN III - C Group C4
Querido, Richen T.
Raiz, Jayscent F.
Rodriguez II, Rolando D.
Sabat, Aprillyn A.

Santos, Marivic C.
Santos, Willa Milafrosa M.
Sotelo, Jeffrey R.
Suarez, Christine Karen A.
Sumang, Jerico B.
Sumaoang, Maria Luisa S.
Date Submitted:
June 13, 2010
INTRODUCTION
Amoebiasis is a protozoal infection of bowel in the human beings. It initially involves the
colon, characterized by diarrhea, but may spread to soft tissues, most commonly to the liver or
lungs, by contiguity or hematogenous or lymphatic dissemination. It is caused by the amoeba
Entamoeba histolytica that is prevalent in unsanitary areas, common in warm climate, and
acquired by swallowing. It is an intestinal infection that may or may not be symptomatic and can
be present in an infected person for several years. When symptoms are present it is generally
known as invasive amoebiasis and occurs in two major forms. Invasion of the intestinal lining
causes "amoebic dysentery" or "amoebic colitis". If the parasite reaches the bloodstream it can
spread through the body, most frequently ending up in the liver where it causes "amoebic liver
abscesses". When no symptoms are present, the infected individual is still a carrier, able to
spread the parasite to others through poor hygienic practices. While symptoms at onset can be
similar to bacillary dysentery, amoebiasis is not bacteriological in origin and treatments differ,
although both infections can be prevented by good sanitary practices.
Amoebiasis is characterized by abdominal pain with an urge to go to the bathroom
frequently and fever and diarrhea which frequently accompanied with blood and/or mucous
discharge. But sometimes diarrhea alternates with bouts of constipation, with one occurring for
several days, followed by the other.
It is estimated n that amoebiasis, accounts annually for 40,000 to 110,000 deaths in the
world per year. Prevalence rates vary from as low as 2 per cent to 60 per cent or more in areas

devoid of sanitation .Symptoms, when present, can range from mild diarrhea to dysentery with
blood and mucus in the stool. The disease can be passed from one person to another through
fecal-oral transmission but it can also be transmitted through direct contact, through sexual
contact by orogenital, oroanal, and proctogenital sexual activity. And 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.
Objectives
General:
The objective of our case study is to develop and acquire understanding, skills, and
knowledge about the disease, and health promotion to prevent further complication on the
condition of the patient.
Specific:
Nurse Centered
 To assess the patient’s overall health status .
 To impart necessary health teachings to the patient’s significant others.
 To perform appropriate nursing care in conjunction with the condition of the patient
 To be more familiarized with the nurses’ roles in caring the patient and to educate
patient’s significant others regarding the pt’s condition.
 To widen and enhance the student nurses’ knowledge and skills through additional
research about the nature of the disease, its signs and symptoms, its pathophysiology, its
diagnosis and treatment.
Patient Centered

 To know when to seek help from the health care providers whenever the signs and
symptoms may appear.
 To understand the occurrence of Amoebiasis.
 To know what other complications may arise, if left untreated.
 To gather information about the therapeutic regimen
Reasons in choosing the Case Study
Our group chose this case study to gain more additional knowledge about the disease.
The group wants to know more about the disease, its treatment, and the proper nursing
management for patients with this kind of disease. The case will help the group in dealing with
patient with this condition.
Promotion of health, prevention of diseases and illnesses, rehabilitation and restoration
of good health are important in doing the case. In the accomplishment of case study, the group
will be able to know and develop more fully our skills in assessment, planning, nursing care
plans, implementation/interventions and evaluation for this particular chosen condition.
Importance of the Study
The case study is primarily important because it enhances the students’ skills, knowledge and
attitude on the practice of the nursing process. It provides broader comprehension about the condition
chosen through research and actual observation as it serves as a training ground and practice in
developing learned skills in the assessment and management of Amoebiasis.
Through this case study, a holistic approach in assessing patient’s health will be delivered, where
it can be immediately attended to and given proper interventions. It serves as a way to familiarize the
students with the different medical approaches toward the ongoing curative phase. This study serves as a

tool for future upcoming nursing students of the school. To share to other student nursing colleagues to
understand the dynamics of Amoebiasis as to the book based management and actual clinical
interventions. Furthermore, this study may be used as a spring board for a more advanced and in-depth
study that is in accordance to changing and developing society.
ASSESSMENT
I.PERSONAL DATA
A.Demographic Data
Name of the patient: Pt. AO
Age: 2 y/o
Sex: Female
Civil status : Single
Occupation: None
Religious Affiliation: Roman Carholic
Role position in the Family: Daughter
Address: 965 Luzon St. Tondo Manila
Date of Birth: October 01,2008
Place of birth: Tondo Manila
Nationality: Filipino
Health Care Financing: Philhealth
Chief Complaint: Vomiting
Admitting diagnosis: AcuteGastroenteritis with some Dehydration
Revised diagnosis: Amoebiasis with some signs of Dehydraiton
B. Lifestyle
According to the mother the client sleeps at around 11 o’clock in the evening and wakes
up up to 12 o’clock in the morning. She spends most of his time watching television and playing
with her peer neighbor with her toys with Bahay bahayan. Her favorite foods are meat and
fish.During snack time she eats biscuits.

C. Environment
Their house is made up of wood and located near the road. It has 2 rooms with a small
sala and kitchen. It is a congested place.Their sources of water for washing , taking a bath,
laundry and drinking water from NAWASA. The toilet is located near the barangay hall wherein
everybody can use it.Their source of transportation from city to their house are jeeps , tricycle
and pedicabs. The family source of income is that the father is a pedicab driver. Their house is
near a canal called “estero” .It is a squatters area.

HISTORY OF PAST HEALTH ILLNESS
According to the mother the patient never been hospitalized. Her immunization
were completed. During fever and colds they buy over the counter medicines at their
barangay botika because it is cheaper.
HISTORY OF PRESENT ILLNESS
Three days prior to admission the patien only drunk her milk and she suffer
stonmache after that. The next day she has already diarrhea (+)vomiting (+)fever of 39°C
and 20 times bowel movement.Weak looking and pale. She has already (+) sunken eyes
and dry lips.
Prior to admission as described as 20 times bowel movement as mucoid,
watery,non-foul smelling and vomiting was also noted approximately 15 times and there
was also loss of appetite she brought to San Lazaru Hospital for proper and appropriate
management and she confine.

ANATOMY AND PHYSIOLOGY
An overview of the Digestive System
Digestion is the breaking down of food in the body, into a form that can be
absorbed. It is also the process by which the body breaks down food into smaller
components that can be absorbed by the blood stream. In mammals, preparation for
digestion begins with the cephalic phase in which saliva is produced in the mouth and
digestive enzymes are produced in the stomach. Mechanical and chemical digestion
begins in the mouth where food is chewed, and mixed with saliva to break down starches.
The stomach continues to break food down mechanically and chemically through the
churning of the stomach and mixing with enzymes. Absorption occurs in the stomach and
gastrointestinal tract, and the process finishes with excretion.
Digestion is usually divided into mechanical processing to reduce the size of food
particles and chemical action to further reduce the size of particles and prepare them for
absorption. In most vertebrates, digestion is a multi-stage process in the digestive system,
following ingestion of the raw materials, most often other organisms. The process of
ingestion usually involves some type of mechanical and chemical processing. Digestion
is separated into four separate processes:
1. Ingestion: The first activity of the digestive system is to take in food through the
mouth. This process has to take place before anything else can happen.
2. Mechanical Digestion: The large pieces of food that are ingested have to be
broken into smaller particles that can be acted upon by various enzymes. This is

mechanical digestion, which begins in the mouth with chewing or mastication and
continues with churning and mixing actions in the stomach.
3. Chemical Digestion: The complex molecules of carbohydrates, proteins, and fats
are transformed by chemical digestion into smaller molecules that can be
absorbed and utilized by the cells. Chemical digestion, through a process called
hydrolysis, uses water and digestive enzymes to break down the complex
molecules. Digestive enzymes speed up the hydrolysis process, which is
otherwise very slow.
4. Movements: After ingestion and mastication, the food particles move from the
mouth into the pharynx, then into the esophagus. This movement is deglutition, or
swallowing. Mixing movements occur in the stomach as a result of smooth
muscle contraction. These repetitive contractions usually occur in small segments
of the digestive tract and mix the food particles with enzymes and other fluids.
The movements that propel the food particles through the digestive tract are called
peristalsis. These are rhythmic waves of contractions that move the food particles
through the various regions in which mechanical and chemical digestion takes
place.
5. Absorption: movement of nutrients from the digestive system to the circulatory
and lymphatic capillaries through osmosis, active transport, and diffusion
6. Elimination: The food molecules that cannot be digested or absorbed need to be
eliminated from the body. The removal of indigestible wastes through the anus, in
the form of feces, is defecation or elimination
Underlying the process is muscle movement throughout the system, swallowing and
peristalsis.
Human digestion process
Phases of Gastric Secretion
• Cephalic phase - This phase occurs before food enters the stomach and involves
preparation of the body for eating and digestion. Sight and thought stimulate the
cerebral cortex. Taste and smell stimulus is sent to the hypothalamus and medulla
oblongata. After this it is routed through the vagus nerve and release of
acetylcholine. Gastric secretion at this phase rises to 40% of maximum rate.
Acidity in the stomach is not buffered by food at this point and thus acts to inhibit
parietal (secretes acid) and G cell (secretes gastrin) activity via D cell secretion of
somatostatin.
• Gastric phase - This phase takes 3 to 4 hours. It is stimulated by distention of the
stomach, presence of food in stomach and increase in pH. Distention activates
long and myentric reflexes. This activates the release of acetylcholine which
stimulates the release of more gastric juices. As protein enters the stomach, it
binds to hydrogen ions, which raises the pH of the stomach to around pH 6.
Inhibition of gastrin and HCl secretion is lifted. This triggers G cells to release
gastrin, which in turn stimulates parietal cells to secrete HCl. HCl release is also
triggered by acetylcholine and histamine.

• Intestinal phase - This phase has 2 parts, the excitatory and the inhibitory.
Partially-digested food fills the duodenum. This triggers intestinal gastrin to be
released. Enterogastric reflex inhibits vagal nuclei, activating sympathetic fibers
causing the pyloric sphincter to tighten to prevent more food from entering, and
inhibits local reflexes.
The digestive system includes the digestive tract and its accessory organs, which
process food into molecules that can be absorbed and utilized by the cells of the body.
Food is broken down, bit by bit, until the molecules are small enough to be absorbed and
the waste products are eliminated. The digestive tract, also called the alimentary canal or
gastrointestinal (GI) tract, consists of a long continuous tube that extends from the mouth
to the anus. It includes the mouth, pharynx, esophagus, stomach, small intestine, and
large intestine. The tongue and teeth are accessory structures located in the mouth. The
salivary glands, liver, gallbladder, and pancreas are major accessory organs that have a
role in digestion. These organs secrete fluids into the digestive tract
Digestion begins in the oral cavity where food is chewed. Saliva is secreted in
large amounts (1-1.5 litre/day) by three pairs of exocrine salivary glands (parotid,
submandibular, and sublingual) in the oral cavity, and is mixed with the chewed food by
the tongue. There are two types of saliva. One is a thin, watery secretion, and its purpose
is to wet the food. The other is a thick, mucous secretion, and it acts as a lubricant and
causes food particles to stick together and form a bolus. The saliva serves to clean the
oral cavity and moisten the food, and contains digestive enzymes such as salivary
amylase, which aids in the chemical breakdown of polysaccharides such as starch into
disaccharides such as maltose. It also contains mucin, a glycoprotein which helps soften
the food into a bolus. the tongue which tastes and manipulates the food
Swallowing transports the chewed food into the esophagus, passing through the
oropharynx and hypopharynx. The mechanism for swallowing is coordinated by the
swallowing center in the medulla oblongata and pons. The reflex is initiated by touch
receptors in the pharynx as the bolus of food is pushed to the back of the mouth.
Pharynx, leads to both the trachea and the esophagus. The Esophagus, a narrow,
muscular tube about 25 centimeters (11 inches) long, starts at the pharynx, passes through
the larynx and diaphragm, and ends at the cardiac orifice of the stomach. The wall of the
Esophagus is made up of two layers of smooth muscles, which form a continuous layer
from the Esophagus to the oten and contract slowly, over long periods of time. The inner
layer of muscles is arranged circularly in a series of descending rings, while the outer
layer is arranged longitudinally. At the top of the Esophagus, is a flap of tissue called the
epiglottis that closes during swallowing to prevent food from entering the trachea
(windpipe) while. The uvula blocks off the nose. The chewed food is pushed down the
Esophagus to the stomach through peristaltic contraction of these muscles. It takes only
seconds for food to pass through the Esophagus, and little digestion actually takes place.
The stomach is a pear shaped pouch and it is also described as a thick walled elastic
bag. The food enters the stomach after passing through the cardiac orifice. In the

stomach, food is further broken apart, and thoroughly mixed with gastric acid and
digestive enzymes that break down proteins. The acid itself does not break down food
molecules; rather, the acid provides an optimum pH for the reaction of the enzyme
pepsin. The parietal cells of the stomach also secrete a glycoprotein called intrinsic factor
which enables the absorption of vitamin B-12. Other small molecules such as alcohol are
absorbed in the stomach as well by passing through the membrane of the stomach and
entering the circulatory system directly. The form of the food in the stomach is in semi-
liquid form.
The transverse section of the alimentary canal reveals four distinct and well
developed layers called serosa, muscular coat, submucosa and mucosa. Serosa: It is the
outermost thin layer of single cells called mesothelial cells. Muscular coat: It is very well
developed for churning of food. It has outer longitudinal, middle smooth and inner
oblique muscles. Submucosa: It has connective tissue containing lymph vessels, blood
vessels and nerves. Mucosa: It contains large folds filled with connective tissue. The
gastric glands have a packing of lamina propria. Gastric glands may be simple or
branched tubular secreting mucus, hydrochloric acid, pepsinogen and renin. The cardiac
sphincter which closes off the top end of the stomach and the pyloric sphincter, which
closes off the bottom. Small intestine which has a length of about 6 m. The surface of the
small intestine is wrinkled and convoluted to produce a greater surface area for
absorption. the sections of the small intestine include the duodenum, jejunum, ileum.
After being processed in the stomach, food is passed to the small intestine via the
Pyloric sphincter. The majority of digestion and absorption occurs here as chyme
enters the duodenum. Here it is further mixed with three different liquids:
1. bile, which emulsifies fats to allow absorption, neutralizes the chyme, and is used
to excrete waste products such as bilin and bile acids (which has other uses as
well). It is not an enzyme, however. The bile juice is stored in a small organ
called the gall bladder.
2. pancreatic juice made by the pancreas.
3. intestinal enzymes of the alkaline mucosal membranes. The enzymes include:
maltase, lactase and sucrase, to process sugars; trypsin and chymotrypsin are also
added in the small intestine.
Most nutrient absorption takes place in the small intestine. As the acid level changes
in the small intestines, more enzymes are activated to split apart the molecular structure
of the various nutrients so they may be absorbed into the circulatory or lymphatic
systems. Nutrients pass through the small intestine's wall, which contains small, finger-
like structures called villi, each of which is covered with even smaller hair-like structures
called microvilli. The blood, which has absorbed nutrients, is carried away from the small
intestine via the hepatic portal vein and goes to the liver for filtering, removal of toxins,
and nutrient processing.
The small intestine and remainder of the digestive tract undergoes peristalsis to
transport food from the stomach to the rectum and allow food to be mixed with the
digestive juices and absorbed. The circular muscles and longitudinal muscles are

antagonistic muscles, with one contracting as the other relaxes. When the circular
muscles contract, the lumen becomes narrower and longer and the food is squeezed and
pushed forward. When the longitudinal muscles contract, the circular muscles relax and
the gut dilates to become wider and shorter to allow food to enter. In the stomach there is
another phase that is called Mucus which promotes easy movement of food by wetting
the food. It also nullifies the effect of HCl on the stomach by wetting the walls of the
stomach as HCl has the capacity to digest the stomach. If the form of food in the stomach
is semi-liquid form, the form of food in the small intestine is liquid form. It is in the small
intestine where the digestion of food is completed.
After the food has been passed through the small intestine, the food enters the large
intestine. The large intestine is roughly 1.5 meters long, with three parts: the cecum at the
junction with the small intestine, the colon, and the rectum. The colon it has four parts:
the ascending colon, the transverse colon, the descending colon, and the sigmoid colon.
The large intestine absorbs water from the bolus and stores feces until it can be egested.
Food products that cannot go through the villi, such as cellulose (dietary fiber), are mixed
with other waste products from the body and become hard and concentrated feces. The
feces is stored in the rectum for a certain period and then the stored feces is egested due
to the contraction and relaxation through the anus. The exit of this waste material is
regulated by the anal sphincter. The large intestine functions to re-absorb (resorb) water
and in the further absorption of nutrients. The bacterial flora of the large intestine
includes such things as Escherichia coli, acidophilus spp., and other bacteria, as well as
Candida yeast (a fungus). These bacteria produce methane (CH4), hydrogen sulfide
(H2S), and other gases as they ferment their food. Occasionally, some of this gas is
released as flatus. As these bacteria digest/ferment left-over food, they secrete beneficial
chemicals such as vitamin K, biotin (a B vitamin), and some amino acids, and are our
main source of some of these nutrients.
The rectum is the terminal portion of the large intestine and functions for storage of
the feces, the wastes of the digestive tract, until these are eliminated. The external
opening at the end of the rectum is called the anus. The anus has two sphincters, one
voluntary and one involuntary. The pressure of the feces on the involuntary sphincter
causes the urge to defecate and the voluntary sphincter controls whether a person
defecates or not.
Carbohydrate digestion
Carbohydrates are formed in growing plants and are found in grains, leafy
vegetables, and other edible plant foods. The molecular structure of these plants is
complex, or a polysaccharide; poly is a prefix meaning many. Plants form carbohydrate
chains during growth by trapping carbon from the atmosphere, initially carbon dioxide
(CO2). Carbon is stored within the plant along with water (H2O) to form a complex starch
containing a combination of carbon-hydrogen-oxygen in a fixed ratio of 1:2:1
respectively. Plants with a high sugar content and table sugar represent a less complex
structure and are called disaccharides, or two sugar molecules bonded. Once digestion of
either of these forms of carbohydrates is complete, the result is a single sugar structure, a

monosaccharide. These monosaccharide can be absorbed into the blood and used by
individual cells to produce the energy compound adenosine triphosphate (ATP).
The digestive system starts the process of breaking down polysaccharides in the
mouth through the introduction of amylase, a digestive enzyme in saliva. The high acid
content of the stomach inhibits the enzyme activity, so carbohydrate digestion is
suspended in the stomach. Upon emptying into the small intestines, potential hydrogen
(pH) changes dramatically from a strong acid to an alkaline content. The pancreas
secretes bicarbonate to neutralize the acid from the stomach, and the mucus secreted in
the tissue lining the intestines is alkaline which promotes digestive enzyme activity.
Amylase is secreted by the pancreas into the small intestines and works with other
enzymes to complete the breakdown of carbohydrate into a monosaccharide which is
absorbed into the surrounding capillaries of the villi.
Nutrients in the blood are transported to the liver via the hepatic portal circuit, or
loop, where final carbohydrate digestion is accomplished in the liver. The liver
accomplishes carbohydrate digestion in response to the hormones insulin and glucagon.
As blood glucose levels increase following digestion of a meal, the pancreas secretes
insulin causing the liver to transform glucose to glycogen, which is stored in the liver,
adipose tissue, and in muscle cells, preventing hyperglycemia. A few hours following a
meal, blood glucose will drop due to muscle activity, and the pancreas will now secrete
glucagon which causes glycogen to be converted into glucose to prevent hypoglycemia.
Note: In the discussion of digestion of carbohydrates; nouns ending in the suffix
-ose usually indicate a sugar, such as lactose. Nouns ending in the suffix -ase indicates
the enzyme that will break down the sugar, such as lactase. Enzymes usually begin with
the substrate (substance) they are breaking down. For example: maltose, a disaccharide,
is broken down by the enzyme maltase (by the process of hydrolysis), resulting in a two
glucose molecules, a monosaccharide.
Fat digestion
The presence of fat in the small intestine produces hormones which stimulate the release
of lipase from the pancreas and bile from the gallbladder. The lipase (activated by acid)
breaks down the fat into monoglycerides and fatty acids. The bile emulsifies the fatty
acids so they may be easily absorbed. Short- and medium chain fatty acids are absorbed
directly into the blood via intestine capillaries and travel through the portal vein just as
other absorbed nutrients do. However, long chain fatty acids are too large to be directly
released into the tiny intestinal capillaries. Instead they are absorbed into the fatty walls
of the intestine villi and reassembled again into triglycerides. The triglycerides are coated
with cholesterol and protein (protein coat) into a compound called a chylomicron.
Within the villi, the chylomicron enters a lymphatic capillary called a lacteal,
which merges into larger lymphatic vessels. It is transported via the lymphatic system and
the thoracic duct up to a location near the heart (where the arteries and veins are larger).
The thoracic duct empties the chylomicrons into the bloodstream via the left subclavian

vein. At this point the chylomicrons can transport the triglycerides to where they are
needed.
Digestive hormones
There are at least four hormones that aid and regulate the digestive system:
• Gastrin - is in the stomach and stimulates the gastric glands to secrete
pepsinogen(an inactive form of the enzyme pepsin) and hydrochloric acid.
Secretion of gastrin is stimulated by food arriving in stomach. The secretion is
inhibited by low pH .
• Secretin - is in the duodenum and signals the secretion of sodium bicarbonate in
the pancreas and it stimulates the bile secretion in the liver. This hormone
responds to the acidity of the chyme.
• Cholecystokinin (CCK) - is in the duodenum and stimulates the release of
digestive enzymes in the pancreas and stimulates the emptying of bile in the gall
bladder. This hormone is secreted in response to fat in chyme.
• Gastric inhibitory peptide (GIP) - is in the duodenum and decreases the stomach
churning in turn slowing the emptying in the stomach. Another function is to
induce insulin secretion.
Significance of pH in digestion
Digestion is a complex process which is controlled by several factors. pH plays a
crucial role in a normally functioning digestive tract. In the mouth, pharynx, and
esophagus, pH is typically about 6.8, very weakly acidic. Saliva controls pH in this
region of the digestive tract. Salivary amylase is contained in saliva and starts the
breakdown of carbohydrates into monosaccharides. Most digestive enzymes are sensitive
to pH and will not function in a low-pH environment like the stomach. Low pH (below 5)
indicates a strong acid, while a high pH (above 8) indicates a strong base; the
concentration of the acid or base, however, does also play a role.
pH in the stomach is very acidic and inhibits the breakdown of carbohydrates while there.
The strong acid content of the stomach provides two benefits, both serving to denature
proteins for further digestion in the small intestines, as well as providing non-specific
immunity, retarding or eliminating various pathogens.
In the small intestines, the duodenum provides critical pH balancing to activate
digestive enzymes. The liver secretes bile into the duodenum to neutralise the acidic
conditions from the stomach. Also the pancreatic duct empties into the duodenum, adding
bicarbonate to neutralize the acidic chyme, thus creating a neutral environment. The
mucosal tissue of the small intestines is alkaline, creating a pH of about 8.5, thus enabling
absorption in a mild alkaline in the environment.
COLON (LARGE INTESTINE)

The colon is approximately 4.5 feet long, 2.5 inches wide, and is a muscular tube
composed of lymphatic tissue, blood vessels, connective tissue, and specialized muscles
for carrying out the tasks of water absorption and waste removal. The tough outer
covering of the colon protects the inner layer of the colon with circular muscles for
propelling waste out of the body in an action called peristalsis. Under the outer muscular
layer is a sub-mucous coat containing the lymphatic tissue, blood vessels, and connective
tissue. The innermost lining is highly moist and sensitive, and contains the villi- or tiny
structures providing blood to the colon. The location of the parts of the colon is either in
the abdominal cavity or behind it in the retroperitoneum. The colon in those areas is fixed
in location.
The colon is actually just another name for the large intestine. The shorter of the
two intestinal groups, the large intestine, consists of parts with various responsibilities.
The names of these parts are: the transverse colon, ascending colon, appendix,
descending colon, sigmoid colon, and the rectum and anus.
PARTS OF THE COLON
Several parts make up the continuous tube of the colon. Each part contributes to
the movement of materials and the formation of stools. The parts include:
Illeocecal Valve:
The illeocecal valve is a fold of mucus membrane at the entry way to the colon. It
is located where the small intestine meets the colon. Materials from the small intestine
pass into the colon through this valve.

Vermiform Appendix:
The appendix is attached to the bottom of the cecum. This is a twisted coiled tube
that is about 3 inches long. The function of the appendix is not known.
Cecum:
It is located below the illeocecal valve at the base of the colon. The upper part of
the cecum is open to the colon. The muscles of the cecum and the colon advance feces
upward out of the cecum.
Ascending Colon:
The ascending colon is located on the right side of the abdomen above the cecum.
Here, most of the water is absorbed from the feces as it moves upward through the
ascending colon. The ascending colon “ends” at the hepatic flexure where the colon
bends to the left and connects to the transverse colon.
Transverse Colon:
The transverse colon runs laterally across the abdomen below the belly button. As
feces move across the transverse colon, stools begin to take form. The transverse colon
“ends” at the splenic flexure where the colon bends again and connects to the descending
colon which heads down the left side.
Descending Colon:
The descending colon runs down the left side of the abdomen. Stools move down
the descending colon. Stools are now more solid in form. Here, stools may be stored for a
time. The descending colon “ends” where it continues into the sigmoid colon.
Sigmoid Colon:
The sigmoid colon angles to the right, curving down and inward to about the
midline, then it curves slightly upward where it connects to the top of rectum. Stools
continue their descent as they move through sigmoid colon. Stools may also be stored
here for a time before they are moved into the rectum.
Rectum and Rectal Sac:
The rectum is a passageway about 8 inches long that leads to the anus. The rectum
is usually empty until mass peristalsis drives the stools into the rectum. When stools fill
the rectum, the elastic qualities of the walls permit the rectum to expand, creating a sac to
accommodate stools just prior to elimination.
Anal Canal and Anus:
The last inch of the rectum is called the anal canal. The mucus membrane of the
canal has folds called anal columns that contain arteries and veins. The opening of the
anal canal to the exterior is called the anus. The anus is guarded by internal and external
sphincters (muscles) that keep the anus closed except during elimination of a stool.
The colon has no villi (multiple, minute projections of the intestinal mucous layer which
serve to absorb fluids and nutrients) as compared to the small intestine and produces no

digestive enzymes. It is like a tube of circular muscle lined with a layer of moist mucous
cells that lubricate the contents. The smooth folds of the colon are speckled with glands
that resemble skin pores. These glands extract the fluids and electrolytes from the passing
food residue. Between 1/3 -1 liter of water (which is recycled and eventually filtered and
excreted by the kidneys as urine), electrolytes, and some vitamins, are absorbed daily
through the colon. If colon bacteria are normal, vitamins B-1, B-2, B-12 and K are
produced by them, and all with the possible exception of B-12 are absorbed and used by
the body traveling first to the liver via the portal circulation. Absorption and storing fecal
material are the colon's two main functions.
The colon does secrete mucus to help the digested food along and hold the fecal material
together. It also plays a role in protecting the walls of the colon from bacterial activity
and neutralizes some of the fecal acids. After processed matter from the small intestine
enters the colon much absorption occurs in the cecum and ascending colon. Mixing
movements called haustrations occur every few minutes and last about one minute
apiece. They roll and mix the matter to expose most of it to the colon’s surface for
absorption. Over 80% of the material reaching the colon is reabsorbed. There are no
peristaltic waves in the colon but a few times daily (usually after meals) a segment of the
colon usually eight inches long will constrict (usually in the transverse or descending
colon) to force the fecal material along. Our Feces are usually 75% water, 7-8% dead
bacteria, 2-7% fat, .5-10% protein, 5-10% roughage, byproducts, digestive juices, etc.
Once the stool moves out of the sigmoid colon into the rectum, a parasympathetic reflex
is set up and the brain gets the signal that nature is calling, and so we go. The external
sphincter is under voluntary control and we can mentally overcome this reflex and
prevent defecation if we desire to. Of all the vital organs in the body, the one that suffers
the most abuse from modern dietary habits is the colon.
Large Intestine Microscopic Cross Section

Mucosal layer on the surface is made up simple columnar cells and a mucosal muscularis on the
deep side .
Submucosa contains fibrous connective tissue and blood vessels.
The muscularis externa is made up of a circular and a longitudinal muscle layer with a
myenteric plexus in between the layers.
A very thin layer of Serosa is also present .
PROCESSING AND ACTIVITY OF THE COLON
Aided by enzymes and muscular action, the mouth, stomach and small intestine
perform their individuated jobs of breaking down and absorbing nutrients. The liquid that
these organs generate is called chyme. However, when it passes to the colon, the liquid
that is leftover is mostly waste matter. This liquid waste matter is called feces. It is passed
to the colon for further processing and elimination. In the colon, instead of the enzymatic
action that occurs in other organs of the G.I. tract, further breakdown of fecal matter and
the production of substances occur by way of bacterial fermentation. Cellular exchanges,
bacteria, and muscular actions all play a part in processing the feces as it passes through
the colon:
Fluid Absorption:
The colon lining contains epithelial cells that absorb fluids and other substances
such as vitamins and electrolytes. It is the absorption of fluids and bacterial processing
that transforms the soupy fecal matter into a stool.
Secretion of Mucus:
The colon lining contains epithelial cells that secrete mucus. This mucus
moisturizes and lubricates the colon lining. This lining protects the colon wall and nerve
tissues.
Bacterial Growth:
Bacteria live and grow along the colon lining. Using the fluids and foods you
intake, bacteria actually manufacture the nutrients that sustain their environment and their
food supply.
Manufacture of Some Vitamins & Electrolytes:

Bacteria change proteins into amino acids and break these amino acids down
further into indole and skatole (which gives stools their odor), hydrogen sulfide, and fatty
acids. Bacterial action also synthesizes some vitamins (K and some B), electrolytes, and
breaks down bilirubin into a pigment that gives stools their brown color.
Production of Lubrication:
Bacteria ferment soluble fiber into a lubricating gel that is incorporated into the
stool mass as it is formed. This gel helps to make stools soft and flexible. Some of this
gel also coats the exterior of the stools and is used by the colon to moisturize the colon
lining. This lubrication helps to ease stool passage through the colon.
Defense against Infection:
Healthy intestinal bacteria help to groom the colon and keep it clean so that
infections do not develop. They also help to fight the growth of infectious bacteria.
Stool Formation:
To form stools, muscles in the colon churn the soupy liquid fecal matter as fluids
are extracted until the particles have the consistency to form a stool.

CEPHALOCAUDAL ASSESSMENT
(June 08, 2010)
DATE AREA/REGION METHOD USED FINDINGS NORMAL FINDINGS INTERPRETATION
/ANALYSIS
06-08-2010 Head
Scalp
Skin
Eyes
Inspection,
palpation
Inspection,
palpation
Inspection,
palpation
Inspection,
palpation
The patient has
black, thin, shiny
hair without
infestation.
Symmetrical and
there is no signs of
tenderness and
lesions.
No lesions and no
signs of tenderness
and symmetrical in
shape
There is no edema
present. The skin is
warm to touch and
the capillary refill is
4 seconds and
returns to original
state slowly.
With clear sclera,
eyes are
symmetrical. The
Black, thin, shiny hair
without any infestations,
lesions, and tenderness
present. It should be
symmetrical in shape, and
no presence of masses.
There should be no signs
of lesions, and tenderness
in the area, and is
symmetrical.
No edema, redness and the
skin is warm to touch.
Capillary refill is less than
3 seconds and returns to its
original state immediately.
The sclera should be clear
in appearance, and the eyes
must be symmetrical.
Normal.
Normal
Abnormal. The
capillary refill is 4
seconds and returns to
original state slowly
due to some signs of
dehydration.
Normal.

Nose
Mouth
Ears
Chest, thorax and
lungs
Abdomen
Inspection
Inspection
Inspection
Inspection,
auscultation,
palpation
Inspection,
patient’s conjunctiva
is pink in color. No
discharges noted.
At the midline of the
face, and
symmetrical.
Dry lips, and
mucous membranes
Reacts when called,
can hear whispered
words clearly.
The patient has no
difficulty of
breathing.
Respiratory rate is
26 cpm, and the
pulse rate is 120
bpm.
Guarding behavior at
Conjunctival sac should be
pink in color. There is no
discharge present.
The nose should be at the
midline of the face,
symmetrical, with patent
airways.
The mouth should be
moist, has no lesions, and
no infection, and no
swelling.
Reacts to noises being
heard, should hear clearly
the words being said.
Breath sounds are resonant,
thorax is rounded, normal
respiratory rate for children
20-30 cpm, normal pulse
rate in children 90-120
bpm, no use of accessory
muscles in breathing.
No abdominal distention.
Normal
Abnormal. The patient
has dry lips and
mucous membrane due
to some signs of
dehydration.
Normal
Normal
Abnormal. The pt. has

Musculoskeletal
and neurological
statu
Genitourinary
Lower
Extremeties
palpation
Inspection
Inspection
Inspection,
palpation
times noted. There is
no presence of
distention in the
abdominal area.
The pt. is alert, and
irritable at times.
The patient felt no
pain when voiding.
Urine output: 1 Soak
Diaper during the
shift (4pm-8pm).
Bowel movement:
3x during the shift
(4pm-8pm), with
loose watery stool,
yellowish in color in
moderate amount.
There is no presence
of protein in the
urine.
No presence of
edema, and
No restriction in activities,
any weakness and alert.
There should no pain felt
when voiding. Protein is
not evident in the urine.
Normal urine output is
500-1,000cc/day or
equivalent to 20-25cc/hr
based on Pott’s and
Mandleco – Pediatric Nsg.
Book.
There should no edema,
been doing guarding
behavior at times due
to stomach ache.
Abnormal. The pt. is
irritable at times due to
uncomfortable
environment.
Normal.
Normal

tenderness on the
pt’s extremities. The
pt’s legs are
symmetrical.
tenderness, or swelling
present on the extremities.
The legs should be
symmetrical.

ASSESSMENT SCIENTIFIC
EXPLANATION
PLANNING INTERVENTIO
N
RATIONALE EXPECTED
OUTCOME
SUBJECTIVE:
OBJECTIVE:
• Bowel
movement:
3x with
loose watery
stool,
yellowish in
color in
moderate
amount.>dry
lips &
mucus
membrane
noted.
• delayed
capillary
refill noted
(4 seconds)
• weak in
appearance
Infectious process
Invades the lining of the
intestines
Stimulation of the
SNS/PNS and decrease
water reabsorption
Increase gastrocolic reflex
Diarrhea results
( Active fluid volume
loss)
Fluid Volume Deficiency
Within 1hour of
appropriate
nursing
interventions, the
pt. will be able to
replace fluid
losses with the
help of her
significant others.
INDEPENDENT:
Monitor for the
existence of
factors causing
deficient fluid
volume (diarrhea).
Encourage the pt’s
mother to increase
the oral fluid
intake of her child
as tolerated.
Instruct the parents
to give her child
foods with
complex
carbohydrates such
as potatoes, rice,
bread, cereal,
yogurt, fruits, and
vegetables,
especially the
BRAT diet.
Provide
Early
identification of
risk factors can
decrease the
occurrence and
severity of
complications of
fluid volume
deficit.
To replace the
fluid loss in the
pt’s body.
To provide
sufficient nutrients
needed by her
child.
To moisten the
mucous membrane
and prevent injury
After 1hour of
appropriate nursing
interventions, the
pt. was able to
replace fluid losses
with the help of her
significant others
as evidenced by:
a. Increase
oral fluid
intake in a
tolerable
level.
b. Eating
foods to
give
sufficient
nutrients in
the body.

• pale looking
• Decrease in
urine output
( 1 soak
diaper)
Nursing Diagnosis:
Fluid Volume
Deficit related to
active fluid volume
loss ( diarrhea)
secondary to
infectious process
meticulous oral
care (toothbrush
and mouthwash).
Check voiding and
record amount
Promote a quiet
environment and
bed rest
Regularly assess
client for changes
in conditions (e.g.
mental status,
fatigability,
restlessness etc.)
DEPENDENT
>Administer IV
fluids as
prescribed by the
physician.
from dryness
To check for an
increase or
decrease fluid
losses
To decrease
oxygen demand
thereby resulting
from weakness
To assess for signs
of dehydration and
monitor progress
of client.
For replacement of
fluids and
electrolytes

EXPLANATION
PLANNING INTERVENTION RATIONALE EXPECTED
OUTCOME
SUBJECTIVE:
OBJECTIVE:
• Bowel
moveme
nt: 3x
with
loose
watery
stool,
yellowis
h in color
in
moderate
amount.
• Hyperactive
bowel
sounds
• Abdominal
cramps
Nursing Diagnosis:
Diarrhea related to
invasion of the
lining of the colon
secondary to
Release of enterotoxins by
invading microorganism
Increase secretion of
water and electrolytes
Inhibits the sodium
reabsorption
Large amount of CHON
rich fluids
Diarrhea
Within 1hour of
appropriate
nursing
interventions, the
pt. will be able to
replace fluids and
electrolyte losses
through hydration
and electrolyte
supplement with
the help of her
significant others.
INDEPENDENT:
- Observe and
record amount,
characteristics and
frequency of
bowel movement.
- Increase oral
fluid intake
- Monitor intake
and output
- Assess for signs
of dehydration.
DEPENDENT:
-Administer IV
fluids as
prescribed by the
physician.
To note for degree
of fluid losses.
-To replace fluid
losses due to
frequent bowel
movement
- To assess for
decrease in fluid
volume resulting
to dehydration
-To determine
client’s hydration
status and
determine
dehydration.
-To replenish and
establish hydration
and maintain
After 1hour of
appropriate nursing
interventions, the
pt. was able to
replace fluids and
electrolyte losses
through hydration
and electrolyte
supplement with
the help of her
significant others
as evidenced by:
a. increased in
oral fluid
intake and
maintained
electrolyte
balance.

infectious processes -Administer
antiprotozoal
medication as
prescribed by the
physician.
electrolyte balance
-Inhibits nucleic
acid of the bacteria
there by
eliminating spread
of infection.

EXPLANATION
OUTCOME
SUBJECTIVE:
“sumasakit po
paminsan – minsan
ung tiyan ko” PS of
6/10
OBJECTIVE:
• Recurrent
abdominal pain
• Guarding
behavior at
times
• Slight facial
grimace
• Weak and
pale in
appearance
• Irritable at
times
• hyperactive
bowel
sounds
Nursing Diagnosis:
Acute pain r/t
inflammatory
responses.
Damage to the intestinal
tissue
Increase vascular
permeability
Vasodilation
Swelling
Edema
Compression of nerve
endings
Pain Perception
Within 30 minutes
of appropriate
nursing
intervention the
patient’s
significant others
will be able to
report a decrease
in pain perception
of the patient
through providing
methods to
alleviate pains.
Establish rapport to
the patient.
Place patient to a
comfortable
position
Encourage patient
to have adequate
period of rest.
Provide comfort
measures (e.g. back
rub, proper
positioning etc.)
Encourage deep
breathing exercise
To gain the trust of
the patient
To provide
comfort for the
patient
To promote
relaxation as to
prevent fatigue
To decrease pain
through
stimulation of
release of
endorphins
To assist in muscle
and generalized
relaxation
After 30 minutes
of appropriate
nursing
intervention, the
patient was able to
report a decrease in
pain perception
through providing
methods to
alleviate pains as
evidence by
decrease in pain
scale from 6/10 to
5-10

EXPLANATION
OUTCOME
SUBJECTIVE:
OBJECTIVE:
• Weight of
9kg
• Appears thin
• Weal and
pale in
appearance
• Decreased
energy level
• Irritable at
times
Nursing Diagnosis:
Imbalance nutrition
less than body
requirements
related to loss of
appetite due illness
Chronic damaged of
intestinal tissue
Inflammatory response
Compression of nerve
endings
Pain perception
Narrowed focus
Preoccupation to pain
perceived
Loss of appetite
( Anorexia)
Imbalanced Nutrition
less than body
requirements
After 1 hour of
appropriate
nursing
intervention, the
patient and
significant others
will be able to
understand the
need to eat a well
balanced diet both
in quality and
quantity as to
improved
nutritional status
through health
teaching and
demonstration.
the patient and S.O.
Assess client’s
condition such as
energy levels and
feeling of body
weakness
Encourage to eat a
well balanced meal
and proper
hydration by citing
some health
benefits that could
build strong line of
defense.
To gain the trust of
the patient
To determine
client’s
physiologic
response to food
intake as with
regards to quality
and quantity.
Balanced diet and
adequate hydration
are known to
contribute to a
good nutrition.
After 1 hour of
appropriate nursing
intervention, the
patient and
significant others
was able to
understand the
need to eat a well
balanced diet both
in quality and
quantity as to
improved
nutritional status
through health
teaching and
demonstration.

Encourage bed rest
during acute phase
of illness
Provide foods that
are high in calories,
proteins and
carbohydrates
Give a health
teaching on the
importance of a
balanced diet and
adequate hydration
that it helps in
building strong
immune system.
Administer
vitamins and
supplements as per
Decrease
metabolic needs
aids in preventing
caloric depletion
and conserves
energy
Decrease
metabolic needs
aids in preventing
caloric depletion
and conserves
energy
To determine
health knowledge
of client that needs
to be modified or
to enhance
regarding food
management
To build strong
immune system

doctors order and body
resistance to
diseases

DRUGS
Name of Drugs
Date administered
Route of
administration,
dosage and
frequency of
administration
Genera action /
Mechanism of
Action
Indication /
purpose
Clients response to
Medication
Zinc Sulfate Syrup June 5, 2010
2.5 ml, once a day
Bactericidal for a
variety of gram-
positive and gram-
negative organisms.
It interferes with
bacterial cell wall
synthesis by
inhibition of the
regeneration of
phospholipid
receptors involved
in peptidoglycan
synthesis.
Zinc is important
for growth and for
the development
and health of body
tissues.
-is used to treat and
to prevent zinc
deficiency.
The patient’s
significant others
understood the
importance of
medications needed
by the patient.

Nursing Responsibility:
- Check the doctors order
- Prepare the medication
- Identify the client
- Explain what medication to be give.
- Assist patient during drug administration
- After giving medication, assess patient for the adverse reaction of drugs
Name of Drugs
Date administered
Route of
administration,
dosage and
frequency of
administration
Genera action /
Mechanism of
Action
Indication /
purpose
Clients response to
Medication
Metronidazole June 5, 2010 125mg/5ml
5ml ,three times a
day
Bactericidal-
Inhibits synthesis in
specific (obligate)
anaerobes causing
cell death;
antiprotozoal –
trichomanicidal,
amebicidal.
Biochemical action
not known.
- Acute
infection
with
susceptible
bacteria.
- Acute
instestinal
amoebiasis
- Amebic liver
abcess
The patient’s
significant others
understood the
importance of
medications needed
by the patient.

-Monitor liver function test results carefully in elderly patients
- Give oral forms with meals
-Observe patient for edema, especially if taking corticosteroids; Flagyl IV may cause
Sodium retention
-Record number and character of stool
Name of Drugs
Date administered
Route of
administration,
dosage and
frequency of
administration
Genera action /
Mechanism of
Action
Indication /
purpose
Clients response to
Medication
Paracetamol June 5, 2010 250mg/5ml
2ml q4 for temp of
> 37.8 C
Decrease fever by a
hypothalamic effect
leading to sweating
and vasodilation.
Also inhibits the
effect of pyrogens
or the hypothalamic
heat-regulating
center. May causes
analgesia by
For fever The patient’s
significant others
understood the
importance of
medications needed
by the patient.

inhibiting CNS
prostaglandin
synthesis, however
due to minimal
effects on peripheral
prostaglandin
synthesis
acetaminophen has
no inflammatory or
uricosuric effect
-Assess patient’s fever or pain: type of pain, location, intensity, duration, temperature.
-Assess allergicreactions: rash,urticaria; if theseoccur, drug may have to bediscontinued
-Assess for chronic poisoning: rapid, weak pulse, dyspnea: cold, clammy extremities.

Diagnostic and Laboratory Procedure
Diagnostic/
Laboratory
Procedures
Date Ordered and
Date results
Indications and
purposes
Result/s Normal Values
(Units used in the
hospital)
Analysis and
Interpretation of
results
Fecalysis 06-05-2010 Fecalysis is used to
determined whether
there is a presence of
blood and parasites
in the stool
Color-green
Consistency- watery
With parasites of
Entamoeba
histolitica cyst 0-2
tropozites 1-3
present
Yellow-Brown
formed
The stool in color
must be in
yellow-brown
and the pt. stool
has presence of
parasites.
Before: Collect the specimen for the client and assist the client when assistance is needed.
During: Specimen must be free from any contamination.
After: Make sure that the specimen is labeled & the laboratory requisition carry the correct information & attached them securely to
the specimen.

Diagnostic/
Laboratory
Procedures
Date Ordered and
Date results
Indications and
purposes
Result/s Normal Values
(Units used in the
hospital)
Analysis and
Interpretation of
results
Urinalysis 06-05-2010 Urinalysis is used to
determined the
color, transparency
and if there is a
presence of blood
Color-Yellow
Transparency-hazy
Yellow-amber
Clear
The urine color
must be in yellow
amber the pt. urine
is yellow and hazy
Before: Collect the specimen for the client and assist the client when assistance is needed.
During: Specimen must be free from any contamination.
After: Make sure that the specimen is labeled & the laboratory requisition carry the correct information & attached them securely to
the specimen.

SUBJECTIVE OBJECTIVE ANALYSIS PLANNING INTERVENTION EVALUATION
Ø >Bowel movement:
3x with loose watery
stool, yellowish in
color in moderate
amount.>dry lips &
mucus membrane
noted.
>delayed capillary
refill noted (4
seconds)
>weak in appearance
>pale looking
>Decrease in urine
output ( 1 soak
diaper)
Fluid Volume
Deficit related to
active fluid volume
loss ( diarrhea)
secondary to
infectious process
Within 1hour of
appropriate nursing
interventions, the
pt. will be able to
replace fluid losses
with the help of her
significant others.
INDEPENDENT:
Monitored for the
existence of factors
causing deficient
fluid volume
(diarrhea).
Encouraged the pt’s
mother to increase
the oral fluid intake
of her child as
tolerated.
Instructed the
parents to give her
child foods with
complex
carbohydrates such
as potatoes, rice,
bread, cereal,
yogurt, fruits, and
After 1hour of
appropriate nursing
interventions, the pt.
was able to replace
fluid losses with the
help of her
significant others as
evidenced by:
a. Increased
oral fluid
intake in a
tolerable
level.
b. Eating foods
to give
sufficient
nutrients in
the body

vegetables,
especially the
BRAT diet.
Provided
meticulous oral care
(toothbrush and
mouthwash).
Checked voiding
and record amount
Promoted a quiet
environment and
bed rest
Regularly assessed
client for changes in
conditions (e.g.
mental status,
fatigability,
restlessness etc.)
DEPENDENT
>Administered IV
fluids as prescribed
by the physician.

Ø >Bowel movement:
3x with loose watery
stool, yellowish in
color in moderate
amount.
>Hyperactive bowel
sounds
>Abdominal cramps
Diarrhea related to
invasion of the
lining of the colon
secondary to
infectious
processes
Within 1hour of
appropriate nursing
interventions, the
pt. will be able to
replace fluids and
electrolyte losses
through hydration
and electrolyte
supplement with
the help of her
significant others.
INDEPENDENT:
- Observed and
recorded amount,
characteristics and
frequency of bowel
movement.
- Increased oral
fluid intake of the
patient as tolerated.
- Monitored intake
and output
- Assessed for signs
of dehydration.
DEPENDENT:
After 1hour of
appropriate nursing
interventions, the pt.
was able to replace
fluids and
electrolyte losses
through hydration
and electrolyte
supplement with the
help of her
significant others as
evidenced by:
a. Increased in
oral fluid
intake and
maintained
electrolyte
balance.

-Administered IV
fluids as prescribed
by the physician.
-Administered
antiprotozoal
medication as
prescribed by the
physician.

Ø >Weight of 9kg
>Appears thin
>Weal and pale in
appearance
>Decreased energy
level
>Irritable at times
Imbalance nutrition
less than body
requirements
related to loss of
appetite due illness
Within 1 hour of
appropriate nursing
intervention, the
patient and
significant others
will be able to
understand the need
to eat a well
balanced diet both
in quality and
quantity as to
improved
nutritional status
through health
teaching and
demonstration.
the patient and S.O.
Assess client’s
condition such as
energy levels and
feeling of body
weakness
Encourage to eat a
well balanced meal
and proper
hydration by citing
some health
benefits that could
build strong line of
defense.
Encourage bed rest
during acute phase
After 1 hour of
appropriate nursing
intervention, the
patient and
significant others
was able to
understand the need
to eat a well
balanced diet both
in quality and
quantity as to
improved
nutritional status
through health
teaching and
demonstration.

of illness
Provide foods that
are high in calories,
proteins and
carbohydrates
Give a health
teaching on the
importance of a
balanced diet and
adequate hydration
that it helps in
building strong
immune system.
Administer
vitamins and
supplements as per
doctors order

“sumasakit po
paminsan – minsan
yung tiyan ko” PS
of 6/10
>Recurrent abdominal
pain
>Guarding behavior
at times
>Slight facial grimace
>Weak and pale in
appearance
>Irritable at times
>hyperactive bowel
sounds
Acute pain r/t
inflammatory
responses.
Within 30 minutes
of appropriate
nursing
intervention the
patient’s significant
others will be able
to report a decrease
in pain perception
of the patient
through providing
methods to
alleviate pains.
the patient.
Place patient to a
comfortable
position
Encourage patient
to have adequate
period of rest.
Provide comfort
measures (e.g. back
rub, proper
positioning etc.)
After 30 minutes of
appropriate nursing
intervention, the
patient was able to
report a decrease in
pain perception
through providing
methods to alleviate
pains as evidence
by decrease in pain
scale from 6/10 to
5-10

Encourage deep
breathing exercise

III. Conclusion
As a student nurse’s, it is important that we are equipped with enough information
and knowledge on how to prevent further complication that may arise. We found out
ways on how we can acquire and prevent having this kind of a disease.
Through this case study, our knowledge in this particular disease becomes
broader. We are confident that the next time we are going to handle a patient with a
Amoebiasis with some signs of Dehydration in order to provide better nursing
interventions.
Proper dissemination of information is needed to be able to increase the
awareness of people especially in children because early detection is very important in
order to prevent further complication of the disease.

IV. Recommendations:
When we assessed the patient we advise the mother to let her daughter continue her
Continue medications as prescribed
Prescribed medication must be taken on time
Strenuous exercise should be avoided
Encouraged to take enough rest to regain strength
Take home medications as doctors’ order
Report unusual signs and symptoms
Advised the client to have enough bed rest
Upon discharge patient education should emphasize the importance of close
follow up care
Encourage to practice personal hygiene properly like washing of foods
thoroughly before cooking and if raw, wash their hands also before and after
using the rest room and before eating. or handling any objects , wash
kitchen utensils before using them
Follow her diet, increase fluid intake
Eat foods which are rich in calcium like the BRAT Diet.

Pathopysiology-book-base
Ingestion of bacteria –entamoeba histolytica
Multiplication in mucosa
Endotoxin production affecting the lining of
the small intestines colon and capillary
Necrosis of the mucosal
layer
ulceration
• Acute amoebic dysentery
• Chronic amoebic dysentery
• Extraintestinal forms
1. hepatic
toxemia
gangren
e

pathopysiology patient base
Multiplication in mucosa
Ingestion of bacteria –entamoeba histolytica
ulceration
Endotoxin production affecting the lining of
the small intestines colon and capillary
Necrosis of the mucosal layer
gangrene
toxemia
watery and foul smelling stool often containing blood streaked
mucus, colic and gaseous distention of the lower abdomen,
nausea, flatulence, anorexia, weight loss and weakness

PATHOPHYSIOLOGY OF AMOEBEASIS
Normally human intestinal flora protects the bowel from colonization of pathogens; however, the intestinal flora can be
disrupted by harmful bacteria and viruses that cause tissue damage and inflammation or depressed by antibiotic c therapy.
Amoeba cause tissue damage and inflammation by releasing toxins (enterotoxins) that stimulates the mucosal lining of the
intestine, resulting greater secretion of water and electrolytes into the intestinal lumen. The active secretion of chloride and
bicarbonate ions in the small bowel leads to inhibition of sodium reabsorption. To balance the excess sodium, large amounts of protein
rich fluids are secreted in the bowel, leading to diarrhea
The metacystic trophozoites or their progenies reach the cecum and those that cone contact with cecal mucosa penetrate or
invade the epithelium by the lytic digestion if condition is favorable. The trophozoites burrow deeper with tendency to spread
laterally by flask shape ulcers. There may several points of penetration. From the primary site of invasion, secondary lesions may be
produced at the lower levels of the large intestines. Progenies of the initial colonies are squeezed out of the neck of the ulcer and
carried to the lower portion of the bowel, thus have opportunity to invade and produce additional ulcers. Eventually the whole colon
may be involved.
When the integrity of the GIT impaired its ability to carry out digestive and absorptive functions can be affected as well as the
sympathetic and parasympathetic afferent nerve will be stimulated thru the vagus, glossopharyngeal, vestibular and splanhnic
nerves, which is located at the proximal duodenum, thus stimulates emetic center resulting to vomiting.
As inflammation occurred, inflammatory response happened, chemical mediators are released in he injured tissue causing
blood dilation of the blood vessels which is beneficial because it increases the speed with which blood cells and other important for r
fighting infections and repairing the injury and brought to the injury site.It also increase permeability of the blood vessels and fluid
leaves the capillaries, producing swilling of the tissue. WBC and RBC leave the dilated and move to the site of infection, where they
begin to phagocytize foreign microorganisms and other debris.

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