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)

What are health risks typical within the Filipinos? Describe motivating socio-cultural factors that influence risk and why someone might engage in “risky behaviors” to gain something deemed more important (e.g. gender, status, economic need, moral code). Include any “rites of passage” that might apply that places people from your culture at risk (e.g. initiation into manhood or womanhood (i.e. genital cutting), marriage, and so on.

Identify the greatest health concerns for this cultural group by citing prevalence and incidence rates for health problems.

What can you learn about the Health and Illness in the Philippines or for Filipinos?

If there was one thing you could change in healthcare, what would it be?

John Doe entered ABC Hospital ER with c/o chest pain, SOB, and nausea. The doctor on call

Ordered an EKG, blood work, began a regimen of O2, and prescribed salicylic acid. The initial blood

work had the following findings: WBC 8300; RBC 5.3; normal levels of troponin; HDL 43; LDL 220;

BUN25.

John has a hx of CHF and CKD. John’s VS were as follows: BP 163/88; HR 93; RR 24. John takes medicine

for HTN and Nitro for angina pectoris. John is independent with ADL’s, lives alone, and amb with a WW.

The ER doctor ordered anxiety medication b.i.d. and continued with oxygen at 2mL. After further

Assessment, MI was ruled out.

John’s condition improved and he was sent home to f/u with his GP. He was ordered to begin cardiac rehabilitation and wear a heart monitor. The heart monitor was to assess his heart for a-fib.

Questions

1. Identify which blood tests were abnormal?
2. What did the doctor prescribe in the ER? How does this help?
3. What condition was ruled out? How did they rule this condition out?
4. What did John have prior to his visit to the ER?
5. What does John take medicine for?
6. Why is he wearing the heart monitor? What happens with this condition?
7. How often does he take anxiety medication?
8. What does ADL mean?
9. What do you know about his ability to walk?

briefly describe what assessment and care you provide and when?

CRITICAL THINKING:

1) What is venipuncture?

2) What are some problems that medical assistants may encounter when attempting to draw blood from patients – and particularly from elderly patients?

3) Susan, a medical assistant, is having trouble finding a venipuncture site on the left arm of her patient, Gabel, although Susan has thoroughly assessed and palpated the antecubital veins, including the bigger median cubital vein. Gabel doesn’t want Susan to draw blood from her right arm. What techniques are available to Susan to make the veins on Gabel’s left arm more prominent?

write a script for a podcast that needs to be at least five minutes long and you need to talk about healthy food and unhealthy food.

in your script, you must answer these two main questions :

What are superfoods and what exactly are they used for? Do we need to go to the gym? to stay healthy...

what is healthy and unhealthy food (junk food)

you have to include the advantages and the disadvantages of healthy and unhealthy food.

If we eat badly what disease can we have

I just need the script i will create the podcast by myself.

Explain in detail how the following microbes transmit to humans, escape from our immunity and causing disease. And suggest and explain the rationale on ONE of its therapeutic methods.
SARS-CoV-2 (Virus for COVID-19)

1. Background of the microbes

-What is the structure?

-What is the unique feature?

2. Transmission route

- direct? indirect?

- when the microbe left human body, what is the survival rate?

- what is the basic reproductive member? (e.g. one people being infect, it can spread to two people)

3. Host-pathogen relationships

- The microbe uses what mechanism to escape the immune system (first line, second line, third line) enter body

- what is the method of microbe use and how it enter body (e.g. stick the mucosa...)?

4. Virulence factors and pathogenicity

- what is the virulence factors of this microbes?

- how much virulence factors that the microbes use to damage body?

- how to damage body (e.g. attack the cell and make you easily being sick, )?

-which molecule of body being break down and how it causes disease?

- when body being attack, which disease it will induce, induce which severe disease?

5. Treatment

- suggest one drug to treat Staphylococcus aureus

- introduce the drug

- target step

- how the drug does in body

- how it affects the bacteria