Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

GRADING SYSTEM

PARAMETER PERCENTAGE ACTUAL GRADE

Introduction and Objectives 5
Nursing History and Present 5

Health Illness
PEARSON Assessment 15
Diagnostic Procedures 5
Anatomy and Physiology 5
Pathophysiology 15
Management:

a. Medical 5

b. NCP 25

c. Promotive and 5

Preventive
Drug Study 5
Discharge Plan 5
Updates and Organization 2.5
Bibliography 2.5
Total 100

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986
TABLE OF CONTENTS

I. INTRODUCTION

II. PATIENT PROFILE

III. OBJECTIVES

IV. NURSING HISTORY OF PAST AND PRESENT HEALTH ILLNESS

V. PEARSON ASSESSMENT

VI. DIAGNOSTIC PROCEDURES

a. PHYSICAL EXAM

b. URINALYSIS

c. FECALYSIS

d. COMPLETE BLOOD COUNT

VII. ANATOMY AND PHYSIOLOGY

VIII. PATHOPHYSIOLOGY

IX. MANAGEMENT

a. MEDICAL MANAGEMENT

b. NURSING CARE PLAN

c. PROMOTIVE AND PREVENTIVE

X. DRUG STUDY

XI. DSCHARGE PLAN

XII. BIBLIOGRAPHY

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur

College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986
 AMOEBIASIS: A CASE REPORT

__________________________________________________

Presented to:
Ms. Kimberly Mae Rivad-Palacpac, RN, MAN
Clinical Instructor

__________________________________________________

In partial fulfillment of the

Requirements in
Related Learning Experience

__________________________________________________

Presented by:
Labini, Dienizs
BSN 3E

January 4, 2020

I. INTRODUCTION

Amoebiasis is due to invasion of the intestinal wall by the protozoa parasite

Entamoeba hystolytica. Amoebic colitis results from ulcerating mucosal lesions caused by the

release of parasite-derived hyaluronidases and proteases. It refers to infection of man by

Entamoeba hystolytica initially involving the colon but which may spread to other soft tissues
organs by contiguity or by hematogenous or lymphatic dissemination most commonly to the

liver and lungs. (Knott, 2020)

According to the American Internation Mediacal University, Amoebiasis is a

worldwide parasite disease. It creates many medical and surgical problems. About 15 to 20

percent of Indians are affected by the parasite. It can be acute and chronic and can have

intestinal and extra-intestinal manifestations. Amoebiasis is most closely related to poor

sanitation and socioeconomic status than climate it is a worldwide distribution. It is a major

health problem in China, South East and West Asia and Latin America, especially Mexico.

The causative organism is protozoa which remains in the large intestines and can be

transmitted to the other organs like liver, lungs, brain, spleen and skin. It is transmitted

through contaminated food, water and infected human feces.

Amoebiasis can occur at any age. There is no gender or racial difference in the

occurrence of the disease. It is a household infection and the human being is responsible for

spreading the disease. Most of the infected people remain asymptomatic and are called as

healthy carriers. The human carrier can discharge up to 1.4x107 cysts per day.

My patient was suffering from abdominal pain due to the contaminated food he ate

and was diagnosed with Amoebiasis that shoved in her fecalysis.

II. PATIENT PROFILE

Name: John Rey Tapuro

Age: 10 y/o

Gender: Male
Occupation: NA

Educational Attainment: Grade 5 Pupil

Civil Status: Child

Nationality: Filipino

Address: Resurrection San Juan, Ilocos Sur

Religion: Roman Catholic

CC: Abdominal Pain and Diarrhea

Date Admitted: January 25, 2020

Admitting Diagnosis: AGE with Moderate Dehydration, Amoebiasis

Attending Physician: Dr. Maria Alejandra Narcelles

Source of Information: Patient and Mother

III. OBJECTIVES

Patient-centered:

 Maintain adequate fluid volume.

 Improve nutritional pattern

  Decrease potential diarrhea

 Reduce complications

 Maintain good hygiene

Family- centered:

 To inform the family the risks to the different risks factors of

Amoebiasis

 To be able to guide them throughout the care

 The parents will be able to determine what is good and bad for the

patient

IV. HISTORY OF PRESENT ILLNESS (HPI)

Mr. Tapuro is a 10-year-old male who presented to the ER after 1 day of severe

abdominal pain, vomiting, and diarrhea. He stated that on Saturday morning after he ate

“isaw and barbecue” he began to experience sharp lower abdominal. The pain waxed and

waned and was about a 6/10 and more intense than his past experiences of abdominal pain.

The pain was sudden and he did not take any medications to alleviate the discomfort. The

abdominal pain was quickly followed by two episodes of diarrhea and soft stool that was tan

in color with no signs of blood. His abdominal pain continued and he vomited for almost 3

times in that afternoon. On the same day, his abdominal pain worsened as he experiences

again another episode of diarrhea and vomiting. The pain had intensified 10/10 and he was

brought to the ER along with his mother.

Upon arrival to the ER, Mr. Tapuro was admitted and attended by Dra. Narcelles and

was ordered for diagnostic tests of a fecalysis, CBC and urinalysis. Based on the result of the
fecalysis, the attending doctor diagnosed that the client has Amoebiasis. After he was

admitted the patient was given prescribed medication to ease the pain. Still, the symptoms

persist but with decrease in severity.

PAST ILLNESS

No known past medical and surgical history. Drug history with no known drug

allergies. No history of food allergies known. Mother side has history of hypertension. The

patient practice healthy lifestyle, sometimes playing of gadgets specifically tablet, eating

vegetables and drinks clean water. Living with his parents. No history of head injuries.

Patient denied any fall injuries.

V. PEARSON ASSESSMENT

ASESSMENT HOSPITAL DATE

(January 27, 2020)

Physiological Hair and Scalp
 Evenly distributed and has a variable amount of distributed
hair. No presence of scalp lesions, lice and dandruff.
Face and Skull
 Rounded, smooth skull contour, absence of nodules and
masses, symmetric or slightly asymmetric facial features.
Skin
 Absence of rashes, skin is warm to touch, and when is
pinched it doesn’t go back to previous state immediately (2
seconds).
Eyes
 Symmetrically aligned with equal movements.
Ears
 Symmetrically in shape and aligned in the outer canthus of
the eye.
Nose
 No discharge, no lesion and no tenderness, and no
obstruction.
Lips
 The lips are slightly pink and equal in size. There are cracks
because of drying.
Tooth and Gums
  Enamels are slightly yellow, no damage, no retraction of
gums and no lesions in the gums.
Tongue
 Centered, no lesions and smooth movements.
Neck
 No palpable nodules, no lesions, no enlargement of the
lesions
Thorax and Lungs
 Spine is vertically aligned. No tenderness, pain and unusual
mass upon palpation. Clear breath sounds.
Heart
 Has regular rate and rhythm.
Abdomen
 Uniform in color, no swelling noted, tympanic sound upon
auscultation.
Extremities
 No edema, deformities, clean finger nails and toenails.
Elimination Gastrointestinal:
Stool:
Frequency: 2 times Consistency: Watery stool
Color: Yellow
Bleeding: No bleeding

Renal:
Urine:
Frequency: 3 times (morning), 2 times (afternoon)

Activity and Rest Most of the time, the patient sleep at 9 PM in the evening, and
waking up as early as 5 AM in the morning. The average sleep hour
of the patient is 8 hours.
Safety and Security The patient is having a walking exercise wearing slippers.
Oxygenation He has a normal respiration of 20 cpm and oxygen saturation od

97%.
Nutrition He barely eats fruits and vegetables. He often eats meat and street
foods like isaw and barbecue.

VI. DIAGNOSTIC PROCEDURES

a. Physical Exam

Patient Tapuro presented to the ER after 1 day of severe abdominal

pain, vomiting, and diarrhea. He stated that on Saturday morning after he ate
 “isaw and barbecue” he began to experience sharp lower abdominal pain that

radiated throughout all four quadrants. The pain waxed and waned and was

about a 6/10 and more intense than his past experiences of abdominal pain. The

pain was sudden and he did not take any medications to alleviate the

discomfort. The abdominal pain was quickly followed by two episodes of

diarrhea and soft stool that was tan in color with no signs of blood. His

abdominal pain continued and he vomited for almost 3 times in that afternoon.

On the same day, his abdominal pain worsened as he experiences again another

episode of diarrhea and vomiting. The pain had intensified 10/10 and he was

brought to the ER along with his mother.

ANALYSIS: The diagnosis of the amoebiasis begins with a throughout history

and physical examination. There is usually a moderate abdomen tenderness and

hyperactive bowel sounds when the physician palpates the abdomen.

b. Urinalysis

COMPONENT RESULT NORMAL VALUES

(January 27, 2020)
Color Yellow Yellow(light, pale to
dark/deep amber)
Transparency Clear Clear or cloudy
Reaction 6.0 4.5-8
Specific Gravity 1.010 1.005-1.025
Albumin NEGATIVE ≤150 mg/d
Sugar NEGATIVE <130 mg/d
Bacteria FEW NONE
Pus Cells 0-1/HPF 1-4 pus cells/hpf
RBC 0-1/HPF ≤2 RBCs/hpf
Amorphous Urates FEW Normal
Triple Phosphates FEW Normal
SQ. Epith. Cells FEW ≤15-20 squamous
epithelial cells/hpf
Mucus Threads MODERATE Normal
Indications: Urinalysis shows normal urine and clear a decrease urine specific

gravity it is less precise than urine osmolality and reflects both the quantity and
 the nature of particles. Mucus threads moderate in amount. Bacteria few in

amount. Epithelial cell few in amount.

c. Fecalysis

COMPONENT RESULT NORMAL VALUES

Color Dark Green AMBER-YELLOW
Consistency Watery Mucoid FORMED
Leukocytes 5-10/hpf 0
RBC 5-10/hpf 0
Fat Globules FEW NEGATIVE
Parasite/ova Entamoeba hystolytica NEGATIVE
CYSTS: 2-4/hpf
ANALYSIS: Stool exam shows a dark green in color. The consistency is a watery

mucoid which is not normal and indicates diarrhea. There is a presence of a

parasite in the stool which is the Entamoeba hystolytica which causes amoebiasis

to the patient.

d. Complete Blood Cell Count

COMPONENT RESULT NORMAL VALUES

WBC 30.6 HIGH 4.0/12.0
LYM 2.7 1.0/5.0
MON 1.6 HIGH 0.1/1.0
GRA 26.3 HIGH 2.0/8.0
LYM% 8.9 LOW 25.0/50.0
MON% 5.1 2.0/10.0
GRA% 86.0 HIGH 50.0/80.0
ANALYSIS: The result of the exam of the CBC, the result of the WBC shows a

high value than the normal values which is 30.6, the GRA shows a high value of

26.3 than the normal values and also LYM shows a low value of 86.9 than the

normal values. It means that there is an infection.

VII. ANATOMY AND PHYSIOLOGY

The Gastrointestinal or Digestive System is consisting of the oral structures,

esophagus, stomach, small intestines, large intestines and associated structures. The GI

performs two major functions: digestion and elimination.

Mouth

The mouth is the beginning of the digestive tract. In fact, digestion starts here as soon as

you take the first bite of a meal. Chewing breaks the food into pieces that are more easily

digested, while saliva mixes with food to begin the process of breaking it down into a form your

body can absorb and use.

Throat

Also called the pharynx, the throat is the next destination for food you've eaten. From

here, food travels to the esophagus or swallowing tube.

Esophagus

The esophagus is a muscular tube extending from the pharynx to the stomach. By means of a

series of contractions, called peristalsis, the esophagus delivers food to the stomach. Just before

the connection to the stomach there is a "zone of high pressure," called the lower esophageal

sphincter; this is a "valve" meant to keep food from passing backwards into the esophagus.

Stomach

The stomach is a sac-like organ with strong muscular walls. In addition to holding the

food, it's also a mixer and grinder. The stomach secretes acid and powerful enzymes that continue

the process of breaking down the food. When it leaves the stomach, food is the consistency of a

liquid or paste. From there the food moves to the small intestine.

Small Intestine

Made up of three segments, the duodenum, jejunum, and ileum, the small intestine is a

long tube loosely coiled in the abdomen (spread out, it would be more than 20 feet long). The

small intestine continues the process of breaking down food by using enzymes released by

the pancreas and bile from the liver. Bile is a compound that aids in the digestion of fat and

eliminates waste products from the blood. Peristalsis (contractions) is also at work in this organ,

moving food through and mixing it up with digestive secretions. The duodenum is largely

responsible for continuing the process of breaking down food, with the jejunum and ileum being

mainly responsible for the absorption of nutrients into the bloodstream.

Three organs play a pivotal role in helping the stomach and small intestine digest food:

Pancreas
 Among other functions, the oblong pancreas secretes enzymes into the small intestine.

These enzymes break down protein, fat, and carbohydrates from the food we eat.

Liver

The liver has many functions, but two of its main functions within the digestive

system are to make and secrete bile, and to cleanse and purify the blood coming from the small

intestine containing the nutrients just absorbed.

Gallbladder

The gallbladder is a pear-shaped reservoir that sits just under the liver and stores bile. Bile

is made in the liver then if it needs to be stored travels to the gallbladder through a channel called

the cystic duct. During a meal, the gallbladder contracts, sending bile to the small intestine.

Once the nutrients have been absorbed and the leftover liquid has passed through the small

intestine, what is left of the food you ate is handed over to the large intestine, or colon.

Colon (Large Intestine)

The colon is a 5- to 6-foot-long muscular tube that connects the cecum (the first part of

the large intestine to the rectum (the last part of the large intestine). It is made up of the cecum,

the ascending (right) colon, the transverse (across) colon, the descending (left) colon, and the

sigmoid colon (so-called for its "S" shape; the Greek letter for S is called the sigma), which

connects to the rectum.

Stool, or waste left over from the digestive process, is passed through the colon by means of

peristalsis (contractions), first in a liquid state and ultimately in solid form as the water is

removed from the stool. A stool is stored in the sigmoid colon until a "mass movement" empties

it into the rectum once or twice a day. It normally takes about 36 hours for stool to get through

the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several
useful functions, such as synthesizing various vitamins, processing waste products and food

particles, and protecting against harmful bacteria. When the descending colon becomes full of

stool, or feces, it empties its contents into the rectum to begin the process of elimination.

Rectum

The rectum (Latin for "straight") is an 8-inch chamber that connects the colon to the anus.

It is the rectum's job to receive stool from the colon, to let you know there is stool to be

evacuated, and to hold the stool until evacuation happens. When anything (gas or stool) comes

into the rectum, sensors send a message to the brain. The brain then decides if the rectal contents

can be released or not. If they can, the sphincters (muscles) relax and the rectum contracts,

expelling its contents. If the contents cannot be expelled, the sphincters contract and the rectum

accommodates, so that the sensation temporarily goes away.

Anus

The anus is the last part of the digestive tract. It consists of the pelvic floor muscles and

the two anal sphincters (internal and external muscles). The lining of the upper anus is specialized

to detect rectal contents. It lets us know whether the contents are liquid, gas, or solid. The pelvic

floor muscle creates an angle between the rectum and the anus that stops stool from coming out

when it is not supposed to. The anal sphincters provide fine control of stool. The internal

sphincter keeps us from going to the bathroom when we are asleep, or otherwise unaware of the

presence of stool. When we get an urge to go to the bathroom, we rely on our external sphincter

to keep the stool in until we can get to the toilet.

Chewing of food in the mouth

Esophagus
 Stomach: Secretion of gastric juice, containing
hydrochloric acid

Mixing and churning through peristaltic action

Chyme passes the duodenum

Nutrient absorption in the small intestine

Large Intestines

Passage of stool

(Normal Functioning of the Gastrointestinal System)

VIII. PATHOPHYSIOLOGY OF AMOEBIASIS

Predisposing Factors Precipitating Factors

Tropical and subtropical countries Ingestion of contaminated foods and drinks
Urban areas Poor environmental sanitation
 Etiologic Agent
Entamoeba histolytica

Mode of Transmission
Oral Route

Ingestion of cyst of the infecting

microorganisms

Enters the stomach

Survives the acid environment

Enters the small intestines

Excystation occurs

Emergences of trophozoites

Tropozoites migrate in the large intestines

Tropozoites multiply by means of

binary fission

Contact with the intestinal mucosa

Lytic digestion occurs

Invades the epithelium cells of the colon

Release of enterotoxins Decrease integrity of the intestinal wall

Increase secretion of water

Stimulation of the
and electrolytes Decrease absorption
sympathetic/parasympathetic
responses
 Inhibits sodium
reabsorption
Stimulation of the
Increase Gastro colic reflex
emetic center
Large amount of CHON
rich fluids Nausea/Vomiting Increase peristalsis

Diarrhea

Deficient fluid volume

Dehydration
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 therapy.

Amoeba cause tissue damage and inflammation by releasing toxins (enterotoxin) 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.

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 splanhic nerves, which is

located at the proximal duodenum, thus stimulates emetic center resulting to vomiting.

IX. MANAGEMENT

a. Medical Management
 The patient was admitted at Pira Hospital last January 27, 2020 in the morning @

5:00 am. Severe abdominal pain was experienced by the patient and diagnosed with

Amoebiasis. The patient undergo different medical treatment such as:

Lab Test

 Fecalysis

 Urinalysis

 Complete Blood Cell Count

IV Fluids

 D5LRS 1000 ml

Medications

 Omeprazole 20 mg OD

 Chlorphenamine maleate ½ amp q 6

 HNBB 100 mg Q4

DIET.

 A BRAT diet is prescribed which means bananas, rice applesauce, and toast. Avoid foods

that may irritate the stomach. After this prescribed diet, the patient can be go back to his

normal diet.

b. NCP
c. Promotive and Preventive

 Tell to the patient the importance of personal hygiene

  Tell to the patient the importance of hand hygiene after defection and

before preparing or eating foods

 Tell to the patient the importance of boiling the water in endemic areas

 Protect the food from contamination

 Tell the patient to exercise daily and take vitamin C

 Tell the patient to reduce eating street foods from local food premises.

X. DRUG STUDY
XI. DISCHARGE PLAN

MEDICATION  Instructed to take the following take

 home medications at the right dose, right
time, right frequency and right route;
o Metronidazole 750 mg orally, 3
times a day
o Omeprazole 20 mg, 1 tablet once
a day in 8 am in the morning
EXERCISE  Bed rest upon arrival from the
hospital
 Light exercise every morning like
walking
 Avoid heavy work
 Eventually patient can return to its
normal activities of daily living
TREATMENT  Continuous follow up care – a
schedule of follow up check up
HEALTH TEACHINGS  Wash hands with soap after going to
the toilet and before eating
 Cut and keep you nails clean
 Avoid sharing hygienic thing with the
infected persons like towels
 Keep your environment clean
OUT PATIENT  Immediate action to go to the hospital
or call your doctor if there is a
presenting signs and symptoms with
the existing disease.
DIET  Clear liquid such as water and tea
 Avoid solid food because they can
cause cramps
SAFETY AND SECURITY  Avoidance of drinking unboiled water
SPIRITUAL in endemic areas
 Uncooked food such as fruits and
vegetables that may not have been
wash should also not be consumed.
 Wash hands properly
 Prepare food properly and keep it safe
in a storage to prevent contamination.

 Provide comfort to the patient

especially with your family for faster
recovery

XII. BIBLIOGRAPHY
D, C. (2009). “Case of Amoebiasis”. Retrieved from Scribd:
www.scribd.com/doc/23417032/Case-of-Amoebiasis
El-Dib, N. (2017). “Entamoeba histolytica: An Overview”. Retrieved from Research Gate:
https://www.researchgate.net/publication/313681444_Entamoeba_hystolytica_an_Overview.
McKesson Corp. (2014). “Gastrointestinal Amebiasis (FOOD POISONING)”. Retrieved from
Summit Medical Group:
www.summitmedicalgroup.com/library/adult_health/aha_gastrointestinal_amebiasis
Zibaei, M. (2002). “Infantile Amoebiasis: A Case Report”. Retrieved from Rsearch Gate:
https://www.researchgate.net/publication/229018166_Infantile_Amoebiasis_A_Case_Report.