A case study of

erratic parasitism
BSN3Y2-2
Group2A

General Objective:
To be familiarized and to provide an effective nursing care to a patient
diagnosed with Erratic Parasitism through understanding the patient history,
disease process and management.

Specific Objective:
I.
II.

Classify the parasite that infects the patient.

Discuss the anatomy and physiology, pathop hysiology,
usual clinical manifestations and possible complications of this
condition.

III.

To have knowledge and be familiarized to the client

medications.

IV.

To formulate a workable nursing care plan on the subjective

and objective datas gathered through nursepatient interaction to be able to help the patient recover.

Introduction:
The word erratic means having no certain or definite course;
wandering or moving while parasitism is a nonmutual symbiotic relationship between species, where one species,
the parasite, benefits at the expense of the other, the host, in this
relationship the parasite do not kill its host. In contrast there is also a nonmutal symbiotic relationship called parasitoids in where the parasite kill its
host.
There are so many types of parasites but such as Pediculus humanus
capitis, Schistosoma mansoni. Parasites that live on the outside of the host,
either on the skin or the outgrowths of the skin, are called ectoparasites
while those that live inside the host are
called endoparasites Endoparasites can exist in one of two
forms: intercellular parasites (inhabiting spaces in the hosts body)
or intracellular parasites (inhabiting cells in the hosts body)
intracellular parasites, such as protozoa, bacteria or viruses. Our case can be
classified as invasion of intercellular parasites.

According to the World Health Organization (WHO), the most common

intestinal parasitic worms are roundworms (Ascaris lumbricoides),
whipworms (Trichuris trichiura), and hookworms (Necator americanus and
Ancylostoma duodenale). All these are soil-transmitted helminths.
Erratic parasitism is a condition in which the parasite (i.e. Ascaris
lumbricoides) moves along the body during larvae stage and will remain on a
certain part of the body when finally mature.
As a student nurse this study will enable us to understand better about
Erratic Parasitism and will explain the different risk factors for developing the
disease, including consumption of improperly prepared foods or
contaminated water and travel or residence in areas of poor sanitation. Since
we are client-centered, we really should consider our patients comfort and
this study will give the students sufficient knowledge that will help us to plan
and implement nursing care plans that will provide patients needs.

Demographic Profile
Patients name: MLM
Gender: Male
Birthday: March 17, 2012
Age: 2 years-old
Hospital #: 723910
Religion: Catholic
Citizenship: Filipino
Place of Birth: Malabon City
Height: 89cm
Weight: 19kg
Date of Admission: January 20, 2015
Time of Admission: 12:20PM

Chief Complaint:
Vomiting
Admitting Diagnosis:
Erratic parasitism with moderate signs of dehydration

History of Present Illness

6 hours PTA patient vomited approximately 1 cup, watery in consistency,
with two intestinal parasites described as thin, whitish color. Subsequent
vomiting revealed no intestinal parasites, vomitus described as watery,
amounting to half cup per episode. Persistence of symptoms prompted
consult.
Past Medical History
+) Pneumonia 2012
+) vomited 4 intestinal parasite 2013 1 week hospitalize
+) Completely Immunized

Anatomy and Physiology:

Digestive system:
The human digestive system is a complex series of organs and glands that
processes food. In order to use the food we eat, our body has to break the
food down into smaller molecules that it can process; it also has to excrete
waste. Most of the digestive organs (like the stomach and intestines) are
tube-like and contain the food as it makes its way through the body. The
digestive system is essentially a long, twisting tube that runs from the mouth
to the anus, plus a few other organs (like the liver and pancreas) that
produce or store digestive chemicals.

The Digestive Process

Mouth:
The digestive process begins in the mouth. Food is partly broken down
by the process of chewing and by the chemical action of salivary enzymes
(these enzymes are produced by the salivary glands and breakdown starches
into smaller molecules).
Esophagus

After being chewed and swallowed, the food enters the esophagus. The
esophagus is a long tube that runs from the mouth to the stomach. It uses
rhythmic, wave-like muscle movements (peristalsis) to keep the food moving
along the digestive tract.
Stomach
The stomach is a large, sack-like organ that churns the food and bathes
it in a strong acid (gastric acid). Food in the stomach that is partly digested
and mixed with stomach acids is called chyme.
Small Intestines
After being in the stomach, food enters the duodenum, the first part of
the small intestine then it enters jejunum and then the ileum (terminal part
of small intestine). In the small intestine, bile (produced in the liver and
stored in the gall bladder), pancreatic enzymes, and other digestive enzymes
produced by the inner wall of the small intestine help in the breakdown of
food.
Large Intestines
After passing through the small intestine, food passes into the large
intestine. In the large intestine, some of the water and electrolyte are
removed from the food. Many microbes in the large intestine help in the
digestion process. Food then travels upward in the ascending colon then
across the transverse colon, goes down to the descending colon, and then
through the sigmoid colon.
Rectum and Anus
End of the digestion process solid waste is then stored in the rectum
until it is excreted via anus.

Pathophysiology: PET
Larvae develop
Inside the Egg

Egg hatched in the

small intestine

Larvae penetrate
intestinal wall and
migrates to the
pulmonary vascular
beds and to the
Child ingested the
food/soil together
with the egg

Eggs will probably

found in stool.

Coughing and wheezing

Migrates up to the
URT

Swallowed

Risk factors:

Pathophysiology:

Fertilized eggs
in feces/ soil

Larvae matures,
copulate and lay
eggs in the small
intestine

Physical Assessment: (ER) Need to Improve Gordons/ IPPA?

Temp: 36.9C
CR: 145
RR: 30
O2 Sat: 96%
>anicteric sclerae, Pink palpebral conjunctivae
>Skin Pinch <2 secs
>w/ good skin turgur
moist lips
>not difficult to feed
>alert, awake
Eager to drink, Thirsty

Course in the ward:

Date and Time
1-20-15
12:20pm

Physicians Order
>Admit to ward
>Secure consent for
>Admission
>Inform Nurse on
duty __ for ward?
>NPO except meds
>IVF D5IMB 1L X
48cc/HR
>Lab diagnostics on
the ward
CBC
UA
Fecalysis
NA, K
>Therapeutics
Paracetamol
125mg/5ml q4
prn temp
>37.8C
OHS as volume
per volume
replacement for
GI loses. (Ano
ibig sabihin ng
Volume per
volume?)
>Monitor VS q4
>I&O q shift
>Refer

Nurses notes

Date and Time

1-20-15
5:15pm

Physicians Order
>Shift IVF to PLR 1L
X 70cc/HR
>Diet: Brat diet, NPO

Nurses notes

Date and Time

1-21-15
8:00am

if w/ reoccurrence of
vomiting.
>Zinc sulfate syrup
4ml OD
>Diphenhydramine
12.5mg/ 5ml. 4ml
stat then q8
>Pls. carry out other
orders
>Refer
Physicians Order

Nurses notes
>Patient is awake
and coherent sitting
on bed
>Zinc sulphate 4ml
given
>Diphenhydramine
4ml q8
>Physical
assessment pa
> Vital signs taken
Temp : 36.8
PR
: 102
RR
: 34

LAB:
CBC
o
o
o
o
o
o
o
o
o

Results
WBC
22.23 H
RBC
5.24 H
Hgb
129 L
Hct
0.380
MCV
74.8 L
MCH
24.6 L
MCHC
32.8 L
Platelet count
550 H
RWD
15.8 H
Neutrophils 73.50 H
o Lymphocyte
19.50
o Eosinophils 2.90
o Monocytes 3.60
o Basophils 0.40

Ref. value
4.8- 10.8
4.1-5.1
140 - 175
0.359-0.445
82-98
29-33
33-36
150-400
11.4-14.0
40-70
19-48
2-8
0-15
0-5

Serum Electrolytes
o Na
o K

139.10
4.74

139-149
3.5-5.5

An increased production of white blood cells indicates infection caused

by bacteria, viruses, fungi or parasites, Inflammation, allergies or
Immune disorders. Elevated neutrophils indicate bacterial infection, in
some cases elevated neutrophils are seen in some parasitic infections.

Drug Study:
DRUG NAME

CLASSIFICATION

INDICATION

ADVERSE
EFFECTS

Generic Name:
Diphenhydramine

Antihistamine

Brand Name:
Benadryl

Hypersensitivity to antihistamines.
Diphenhydramine
is used to sedate
the parasitic worms
Also has anti

Dose:

Sleepiness
,fatigue,
dizziness,
headache,
dry mouth,
Drowsiness

12.5mg/5ml
4ml q8
Route:
Oral

DRUG
NAME
Generic
Name:
Paracetam
ol
Brand
Name:

CONTRAINDICATION

Breathing problems
(such as asthma,
emphysema), high
pressure in the eye
(glaucoma), heart
problems, high blood
pressure, liver disease,
seizures,
stomach/intestine
problems (such as
ulcers, blockage),
overactive thyroid
(hyperthyroidism),
difficulty urinating (for
example, due to
enlarged prostate).

CLASSIFICAT
ION

INDICATIO
N

ADVERSE
EFFECTS

CONTRAINDICAT
ION

NURSING
CONSIDERATI
ON

Analgesic
anti-pyretic

Symptoms
of fever

increased
sweating

Hematologic:
hemolytic
anemia,
neutropenia,
leukopenia,
pancytopenia.
Hepatic: Jaundice

In children,
dont exceed
five doses in
24 hours.

loss of
appetite

Warn the
mother that

Metabolic:
Hypoglycemia

Tempra
Dose:

Skin: rash,
urticaria.

125mg/5ml
q4 prn
temp
>37.8C
Route:

high doses or
unsupervised
long term use
can cause
liver damage.

Hypersensitivity
to drug

Oral

DRUG
NAME
Generic
Name:
Zinc
Sulfate
Brand
Name:
E-Zinc
Dose:
4ml OD
Route:
Oral

CLASSIFICAT
ION

INDICATIO
N

Dietary
supplement

As an
adjunct in
the
manageme
nt of acute
diarrhea
To help
boost
immune
function

ADVERSE
EFFECTS

CONTRAINDICAT
ION

Nausea
and
vomiting

Hypersensitivity
to drug

Fever

NURSING
CONSIDERATI
ON
Give as
prescribed;
avoid
excessive
dosage.

Metallic
taste
Lethargy

Ask the
mother if the
patient has
allergies to
drug

NCP: 2
Risk for injury
Risk for Fluid volume Deficit
Imbalanced nutrition
Assessm
ent
Subjectiv
e:

Diagnosi
s

Risk for
fluid
madamin volume
g beses na deficit r/t
siya
to active
sumuka
fluid
halos hindi volume
ko na
loss as
mabilang
manifeted
kung ilan by
as
episodes of
verbalized vomiting.
by the
mother

Planning

Intervent
ion

Rationale

Evaluatio
n

Within 8
hours of
nursing
interventio
n the
patient
will
Experienc
e
adequate
fluid
volume as
evidenced
by urine

Continuou
s VS and I
&O
monitoring
.

To facilitate
accurate
measurement
and avoid
complications.

After 8
hours of
nursing
interventio
n the
patient
experienc
ed
adequate
fluid
volume as
evidenced
by
increased

Monitor
active fluid
loss from
To avoid
episodes
circulatory
of
overload
vomiting
Administer

output
>30 ml
per hr,
moist skin,
and
minimal
episodes
of
vomiting

Objective
s:
>Thirsty
>Dry Skin
>Dec.
urine
output
25ml/hr

parenteral
fluids as
ordered
Maintain IV
flow rate
Explain
importance
of
maintaining
proper
nutrition and
hydration.
Encourage
patient to
drink
prescribed
fluid
amounts

>Episodes
of
vomiting

To promote
proper
nutrition and
hydration

To keep the
patient well
hydrated.

urine
output,
moist skin,
and
minimal
episodes
of
vomiting.
The goals
are met.

Diphenhydra
mine has Antiemetic
property

Give
medications
as ordered
by the
physician

Assessme
nt

Diagnosis

Planning

Risk for
injury related
to
psychomotor
agitation as
manifested
by pulling of
IV tubing.

Within 8
hours of
nursing
intervention
the patient
will not
experience
physical
injury.

Interventi
on

Rationale

Maintain a
closed
central IV
system by
taping of all
connections

Inadvertent
disconnectio
n of central
IV system
can result in
lethal air
emboli.

Evaluatio
n

Subjective:
Hinahatak
nya yung
linya ng
dextrose As
verbalized by
the mother.

Objectives:
.

Inspect
peripheral IV
site routinely

Irritation may
develop

After
8 hours of
nursing care
the patient
remains free
of injuries

>IV
contraptions

Instruct to
keep the bed
side rails
raised, and
lock the
wheels.

>Agitated
>Pulling of IV
tubing
>Toddler

Ask family to
stay with
client to
prevent
client from
accidentally
falling or
pulling out
tubes.
Remove all
possible
hazards in
environment
such as
razors,
medications,
and matches.

Assessme
nt
Subjectiv
e:
May

Diagnosis

Planning

Interventio
n

Imbalance
d nutrition
less than

Wit

Determine daily
calorie needs are
realistic and

hin 8
hours of

Rationale Evaluatio
n

dalawang
bulate
akong
nakita sa
suka niya
as
verbalized
by the
mother.

body
requireme
nt related
to
vomiting
and

nursing
intervent
ion the
patient
will consume
adequate
nourishment.

adequate.
Explain the
importance of
adequate nutrition
.
Instruct mother to
feed her child on
time.

Objective
s:
>Episodes
of
vomiting
>lack of interest
in food

Discharge Plan / Recommendations: (Recommendations lang ba

tayo kasi di pa ididischarge?)