NURSING CARE PLAN - amoebiasis2 - Nursing Crib

NURSING CARE PLAN
ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE:
“Sumasakit and
tiyan ko at
madalas akong
dumumi” (I have
been having severe
diarrhea and
abdominal pain) as
verbalized by the
patient.
OBJECTIVE:
♦ Restlessness
♦ Irritability
♦ Facial
grimace
♦ Dry skin
♦ V/S taken as
follows:
T: 37.4
P: 79
R: 19
BP: 110/70
♦ Risk for
deficient
fluid volume
related to
excessive
losses
through
frequent
diarrhea.
♦ Amoebiasis is a
infectious
disease caused
by the parasite
Entamoeba
histolytica. It is
a parasitic
infection of the
large intestine
and
characterized
by non specific
diarrhea with
loose, semi
formed, foul
smelling stools,
or dysentery
with mucous,
traces of blood
and small
quantities of
stools passed
repeatedly.
Often there is
an ineffectual
urge to
defecate again
and again, with
very little stool
actually being
passed. There
is much
flatulence with
After 8 hours of
nursing
interventions,
the patient will
maintain
adequate fluid
volume as
evidenced by
good skin
turgor and
balance intake
and output.
INDEPENDENT:
♦ Monitor intake and
output, character,
and amount of
stools; estimate
insensible fluid
losses. Measure
urine specific gravity
and observe for
oliguria.
♦ Assess vital signs
(BP, pulse,
temperature).
♦ Observe for
excessively dry skin
and mucous
membranes,
decreased skin
turgor, slowed
capillary refill.
♦ Weigh daily.
♦ Provides
information
about overall
fluid balance,
renal function,
and bowel
disease control,
as well as
guidelines for
fluid
replacement.
♦ Hypotension
(including
postural),
tachycardia,
fever can
indicate response
to or effect of
fluid loss.
♦ Indicates
excessive fluid
loss or resultant
of dehydration.
♦ Indicator of
overall fluid and
nutritional
status.
After 8 hours of
nursing
interventions,
the patient was
able to maintain
adequate fluid
volume as
evidenced by
good skin
turgor and
balance intake
and output.

abdominal
cramps. In
severe cases,
the liver and
other organs
may get
affected,
causing specific
conditions
related to
organ, e.g.,
hepatitis, cysts,
abscess, etc.
The most
common
symptoms of
amoebiasis are
diarrhea (which
may contain
blood), stomach
cramps and
fever.
♦ Maintain oral
restrictions, bed rest
and avoidance of
exertion.
♦ Observe for overt
bleeding and test
stool daily for occult
blood.
♦ Note generalized
muscle weakness or
cardiac
dysrhythmias.
COLLABORATIVE:
♦ Administer
parenteral fluids as
indicated.
♦ Administer
medications as
indicated:
Antidiarrheal and
antibiotics.
♦ Colon is placed
at rest for
healing and to
decrease
intestinal fluid
losses.
♦ Inadequate diet
and decreased
absorption may
lead to vitamin K
deficiency and
defects in
coagulation,
potentiating risk
for hemorrhage.
♦ Excessive
intestinal loss
may lead to
electrolyte
imbalance.
♦ Maintenance of
bowel rest
requires
alternative fluid
replacement to
correct losses.
♦ To reduces fluid
losses in the
intestine and to
prevent further
spread of the
bacteria.