Question

SCHISTOSOMIASIS

A. Patient’s Profile

Name: R.B.S.

Age: 51

Gender:Male

Date of Birth: January 21, 1968

Religion: Iglesia ni Cristo

Occupation: Security Guard

Marital Status: Married

Date of Admission: September 01, 2020

Time of Admission: 1:00 PM

Chief Complaint: Vomiting of blood and melena

Final Diagnosis: Anemia secondary to upper gastrointestinal bleeding, secondary to 1) bleeding esophageal varices; 2) chronicliver disease; 3) schistosomiasis; 4) bleeding peptic ulcer

History of Present Illness: Patient R.B.S. is known to have chronic liver disease, had upper gastrointestinal bleeding, portal hypertension, schistosomiasis but he claimed to have stopped treatment due to personal reasons. Until 1 day prior to admission, he had black tarry stool for four times day with 2-3cups/bout associated with vomiting of blood with 3-4cups/bout for four times. A few hours prior to admission patient R.B.S. had body weakness, persistence of vomiting which prompted consultation, leading to admission.

Past Medical History Patient R.B.S. has chronic schistosomiasis and chronic liver disease. He was hospitalized in 2013 and 2018 because of peptic ulcer disease. He has no allergy to food and medication.

Family History (+) Schistosomiasis -father side

Personal and Social History Patient R.B.S. smokes half (½) pack of cigarettes per day (18.5 pack years). He drinks alcohol occasionally. He likes to eat fatty foods. He worked as a jail guard since 1978 and as a security guard from 1998 up to the present.

Admission Order Patient R.B.S. was admitted on September 01, 2020at around 1PM at VMC with a chief complaint of vomiting of blood and melena. He was maintained on NPO and hooked to PNSS 1L x 100 cc/hr. He was ordered to undergo for CBC, FBS, whole abdominal ultrasound, chest x-ray, urinalysis, fecalysis, SGOT, SGPT, and ALP. Informed consent was secured. Transfused at least 2 units packed RBC, properly checked and cross matched. Intake and output to be monitored every 8 hours every shift. The following medications were given: omeprazole 8g TIV as bolus, metoclopramide 10mg every 8 hours, praziquantel 1 day 2x a day for 3 months, tranexamic acid 500mg q8 and 500cc to run for 6 hours; latest VS as follows: BP: 90/50, PR 104, RR 22, Temp 36. 5. The following day, upon assessment, patient R.B.S. was awake, conscious and coherent, not in distress; vital signs were taken. He had no edema, but with melena and hematemesis. He was placed on bed comfortably and hooked on PNSS 1L x 80cc/hr. He was advised to have soft-diet followed by diet as tolerated. Facilitated blood transfusion of 1 packed RBC then secured 3 more units of packed RBC, properly typed and cross matched. For follow-up whole abdominal ultrasound and EGD schedule. CBG monitoring was done. The following medications were added and given: ciprofloxacin 500mg BID, insulin sliding scale and vitamin K 10mg IV, every 8 hours and continued medications as ordered. He was endorsed for continuity of care and management. On the third day, at 10:00AM, patient R.B.S. was still in Male Medical Ward. Upon taking a physical assessment patient was awake, conscious and coherent; vital signs checked and recorded as follows: BP: 100/70, PR: 84, RR: 18, Temp. 36°C. He had no edema, but appeared weak, looked pale, and had epigastric pain. Facilitated giving of medications; continued all medications as ordered previously. Health teachings imparted and emphasized the importance of maintaining good hygiene and healthy lifestyle. Advised the patient to take a bath regularly, have time to do simple exercise, eat healthy food and kept safe and comfortable.

GIVE 3 MAIN FOCUS OF NCP PF THE PATIENT.

(Assessment, Nursing diagnosis, Background knowledge/Scientific explanation, Planning, Intervention and Rationale, Evaluation)

Answer 1

Assessment of anaemia

Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood.

Nursing diagnosis

• Fatigue related to decreased hemoglobin and diminished oxygen-carrying capacity of the blood.
• Altered nutrition, less than body requirements, related to inadequate intake of essential nutrients.
• Altered tissue perfusion related to insufficient hemoglobin and hematocrit.

Planning- the goals of treatment is-

• Decreased fatigue
• Attainment or maintenance of adequate nutrition.
• Maintenance of adequate tissue perfusion.
• Compliance with prescribed therapy.
• Absence of complications.

Nursing interventions are based on the data assessed by the nurse and on the symptoms that the patient manifests.

To manage fatigue:

• Prioritize activities. Assist the patient in prioritizing activities and establishing balance between activity and rest that would be acceptable to the patient.
• Exercise and physical activity. Patients with chronic anemia need to maintain some physical activity and exercise to prevent the deconditioning that results from inactivity.

To maintain adequate nutrition:

• Diet. The nurse should encourage a healthy diet that is packed with essential nutrients.
• Alcohol intake. The nurse should inform the patient that alcohol interferes with the utilization of essential nutrients and should advise the patient to avoid or limit his or her intake of alcoholic beverages.
• Dietary teaching. Sessions should be individualized and involve the family members and include cultural aspects related to food preference and preparation.

To maintain adequate perfusion:

• Blood transfusion monitoring. The nurse should monitor the patient’s vital signs and pulse oximeter readings closely.

To promote compliance with prescribed therapy:

• Enhance compliance. The nurse should assist the patient to develop ways to incorporate the therapeutic plan into everyday activities.
• Medication intake. Patients receiving high-dose corticosteroids may need assistance to obtain needed insurance coverage or to explore alternative ways to obtain these medications.

Evaluation

The patient should be assessed for following outcomes

• Reports less fatigue.
• Attains and maintains adequate nutrition.
• Maintains adequate perfusion.
• Absence of complications.