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Saint Paul University Quezon City

Nursing Department

Disseminated
Cadidiasis
Fe Del Mundo Medical Center

Submitted By:
BSN IV
Tanchuan, Toni
Roque, Ryan

I.

Introduction
Cadidiasis is an infection caused by Candida fungi, especially Candida albicans. These
fungi are found almost everywhere in the environment. Some may live harmlessly along
with the abundant "native" species of bacteria that normally colonize the mouth,
gastrointestinal tract and vagina. Usually, Candida is kept under control by the native
bacteria and by the body's immune defenses. If the native bacteria are decreased by
antibiotics or if the person's immune system is weakened by illness (especially AIDS or
diabetes), malnutrition, or certain medications (corticosteroids or anticancer drugs),
Candida fungi can multiply to cause symptoms. Candida infections can cause occasional
symptoms in healthy people. Candidiasis can affect many parts of the body, causing
localized infections or larger illness, depending on the person and his or her general
health.
Patient LDR is a 77 year old man who was admitted in Fe Del Mundo Medical Center on
June 26, 2010 due to itchy skin rashes on inguinal area. He was later diagnosed with
disseminated candidiasis on the same day of his admission. This is a detailed study about the
patient, Mr. LDR and his disease as well as the nursing management done and health teaching
involved during hospital stay.

II.

Objectives
A. General
1. To analyze and interpret the past and present condition of the client in order to construct a
comprehensive nursing care plan.
B. Specific
1. To assess the needs of the client
2. To provide nursing interventions suitable to the clients needs
3. To recognize how the disease affects the normal body functions
4. To analyze the progress and development of the disease
5. To evaluate the effectiveness of the nursing intervention
6. To create sufficient and adequate health teaching plan that promotes wellness

III.

Personal Data
Name: L.D.R
Age: 77
Sex: Male
Nationality: Filipino
Place of Birth: Bulacan
Date of Birth: June 23, 1933
Civil Status: Married
Address: Sibul San Miguel Bulacan
Religion: Catholic
Date of Admission: June 26, 2010
Attending Physician: Dr. Baldomero
Chief Complaint: skin rashes, itchiness, skin lesions
Final Diagnosis: Disseminated candidiasis all over secondary to prolonged steroid use

IV.

Nursing Assessment
A. History of present Illness
Two weeks prior to admission the patient noted hyperurecemia over ingiinal area, dry but
no association with itchiness. This later spread over other skin fold areas in the body associated
with puritus. Patient LDR came to Fe del Mundo Medical center on June 26 where he was
consulted and admitted by Dr. Baldomero with a diagnosis of disseminated candidiasis.
B. Past and Present Medical History
Patient has asymptomatic abdomen aortic neurysm and is current on Metoprolol 50mg
tab BID

 He has hypertension.
Recently treated for Steven Johnsons and is currently taking Prednisone 20mg tab BID
C. Current Health Status
The patient is allergic to Gemfibrosil.
The patient has been fully immunized.
He lives in a clean and safe environment.
D. Family History
The patients grandfather has hypertension and arthritis.
E. Personal History
Mr. LDR has been a smoker for 30 year.
He is also a previous alcoholic drinker.
F. Nursing Theory
KOLCABA'S COMFORT THEORY
The theoretical structure of Kolcaba's comfort theory has real potential to direct the work and
thinking of all healthcare providers within one institution.
Comfort as a concept
During the development of the comfort theory, Kolcaba conducted a concept analysis of comfort
that examined literature from several disciplines including nursing, medicine, psychology, psychiatry,
ergonomics, and English. This review confirmed that comfort is a positive concept and is associated with
activities that nurture and strengthen patients.
Forms of comfort
Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. If specific
comfort needs of a patient are met, for example, the relief of postoperative pain by administering
prescribed analgesia, the individual experiences comfort in the relief sense. If the patient is in a
comfortable state of contentment, the person experiences comfort in the ease sense, for example, how
one might feel after having issues that are causing anxiety addressed. Lastly, transcendence is described
as the state of comfort in which patients are able to rise above their challenges. An example of comfort in
this form is evident in the patient who is involved in a physical therapy or rehabilitation program. While
these types of programs are often associated with physical discomfort, Kolcaba and Kolcaba asserted
that they eventually lead to a state of transcendence or renewal, in which the individual has moved past
the initial discomfort with the end result being increased individual strength.
Kolcabas theory is relevant to patient LDR because his illness causes him plenty of discomfort
which includes pain and itchiness on the affected parts. The nurse must formulate care plans structured
on this theory to alleviate the discomfort the patient is experiencing.
G. Physical Examination

Vital Signs as follows:

- Temperature: 36.3C
- Pulse Rate: 73BPM
- Respiratory Rate: 21CPM
- Blood Pressure: mmHg

Height: 55

Weight: 66 kilos
Physical examination was done on June 26, 2010
Conscious, coherent, afebrile
HEENT
Pink conjunctiva, anicteric sclera
Chest/lungs
symmetric with clear breath sounds
CNS
Adynamic precordium
(-) murmur

Abdomen
Extremities
Skin

V.

Globular, soft, non-tender

(-) organmegaly
No edema with good pulses
(+) dry, hyperemic areas over inguinal areas, acute
cubital areas, nape area, waistline, and upper back

Anatomy and Physiology

The Skin

The skin is an organ because it consists of different tissues that are joined to perform specific activities. It
is one of the largest organs of the body in surface area and weight. In adults, the skin covers an area of
about 2 square meters, and weighs 4.5 to 5 kg. It ranges in thickness from 0.5 to 4.0 mm, depending on
location. The skin is not just a simple, thin coat that keeps the body together and provides protection. It
performs several essential functions. Dermatology is the medical specialty that deals with diagnosing and
treating skin disorders.

Anatomy of the Skin

Structurally, the skin consists of two principal parts. The outer, thinner portion, which is composed of
epithelium, is called the epidermis. The epidermis is attached to the inner, thicker, connective tissue part
called the dermis. Beneath the dermis is a subcutaneous (subQ)
layer. This layer, also called the superficial fascia or hypodermis, consists of areolar and adipose tissues.
Fibbers from the dermis extend down into the subcutaneous layer and anchor the skin to it. The
subcutaneous layer, in turn, attaches to underlying tissues and organs.
Physiology of the Skin
Skin serves several functions, which are introduced here.
Regulation of body temperature.
In response to high environmental temperature or strenuous exercise, the evaporation of sweat from the
skin surface helps lower an elevated body temperature to normal. In response to low environmental
temperature, production of sweat is decreased, which helps conserve heat. Changes in the flow of blood
to the skin also help regulate body temperature.

Protection.
The skin covers the body and provides a physical barrier that protects underlying tissues from physical
abrasion, bacterial invasion, dehydration, and ultraviolet (UV) radiation. Hair and nails also have
protective functions.
Sensation.
The skin contains abundant nerve endings and receptors that detect stimuli related to temperature, touch,
pressure, and pain.
Excretion.
Besides removing heat and some water from the body, sweat also is the vehicle for excretion of a small
amount of salts and several organic compounds.
Immunity.
Certain cells of the epidermis are important components of the immune system, which fends off foreign
invaders.
Blood reservoir.
The dermis of the skin houses extensive networks of blood vessels that carry 8 to 10% of the total blood
flow in a resting adult. In moderate exercise, skin blood flow may increase, which helps dissipate heat
from the body. During hard exercise, however, skin blood vessels constrict (narrow) somewhat, and more
blood is able to circulate to contracting muscles.
Synthesis of Vitamin D.
Vitamin D is a group of closely related compounds. Synthesis of vitamin D begins with activation of a
precursor molecule in the skin by ultraviolet (UV) rays in sunlight. Enzymes in the liver and kidneys then
modify the molecule, finally producing calcitriol, the most active form of vitamin D. Calcitriol contributes to
the homeostasis of body fluids by aiding absorption of calcium in foods. According to the synthesis
sequence just described, vitamin D is a hormone, since it is produced in one location in the body,
transported by the blood, and then exerts its effect in another location. In this respect, the skin may be
considered an endocrine organ.
Reference: http://www.wildcrafted.com.au/Articles/Anatomy_and_Physiology/The_Skin.html

VI.

Pathophysiology

Precipitating factors:
drugs (antibiotics,
corticosteroids, birth
control pills
pregnancy
being overweight
bacterial infection
several health conditions
(weakened immune
system, diabetes,
psoriasis

Compromised normal
body mechanism

Predisposing
factors:
Age
Sex

Penetration of organism
by direct contact
(Candida albicdans)

Colonization and
Reproduction in skin
(scaly, erythematous, papular rash, sometimes covered with exudates)
VII.

Medical Management
a. Laboratory Results

Hemoglobin
Hematocrit
RBC count
MCV
MCH
MCHC
Platelets
WBC
Eosinophil

Result
14.7
43.8
4.49
89.6
30.1
33.6
275
7.6
7

Neutrophil
Lymphocyte
Monocyte
RDW

47
40
6
14.8

Hematology
Date: June 26, 2010
Normal Range
Interpretation
12-15 g/dL
Normal
36-46 %
Normal
4-4.5 x 10^6/L
Normal
80-100 fl
Normal
27-31 pg
Normal
32-36%
Normal
150-400 x 10^3/L
Normal
4.5-11 c 10^3/L
Normal
1-4%
Above normal range
Increase may indicate asthma, hay fever, parasitic
infections, chronic myelocytic leukemia, Hodgkins
disease, metastasis
36-66%
Normal
22-40%
Normal
4-8%
Normal
8.5-15
normal

Urinalysis
Macroscopic
Color
Transparency
Specific Gravity
pH (reaction)
Glucose (sugar)

Blood
Bilirubin

Date: June 26, 2010

Result
Normal
Yellow
Straw to dark
yellow
Hazy
Slightly turbid to
clear
1.025
1.016-1.025
5
4.6-6.5
Negative
Negative
Chemistry
+3
Negative

Negative

Interpretation
Normal
Normal
Normal
Normal
normal

Normal

Uribilinogen
Ketone
Nitrite
Leucocyte

Pus cells
Red cells
Epithelial cells
Mucous threads
Bacteria

Negative
Negative
Negative
Negative

0.1-1
Negative
Negative
Negative

Microscopic
0-2/HPF
Too numerous to count
Few
Small amounts
Plenty
rare
none
Microbiology Report
June 26, 2010

Request: KOH smear

Specimen: skin scraping at inguinal area
Microscopic findings: positive for fungal elements

Normal
Normal
Normal
Normal

Normal
Normal

b. Drug study

Generic Name
1. hydrocortsione
100 mg IV q4

2. hydroxyzine

Brand
Name
Cortizan
Cortef

Altaraz,
Iterax,
Vistrasil

Action
Glucocorticoid with anti
inflammatory effect because
of its ability to inhibit
prostaglandin synthesis
Unknown, may suppress
activity in key regions of
subcortical areas of CNS

Indication
Treatment of
rheumatic
disorders, allergic
diseases, adrenal
cortex
insuffeciency
Ictrogenic allergic
reactions

Side/adverse effects

Nursing Consideration

Flushing, sweating,
headache, hypertension,
embolism, acne, poor wound
healing

Assess patients condition first

before starting therapy
Monitor weight, input and output
Monitor plasm and control levels

Involuntary motor activity,

mylagia, myoritis, myopathy

Monitor for adverse reactions

Monitor weight and blood
pressure
Assess patients condition
before starting therapy and
reassess regularly

Assessment
Name: L.D.R
Age: 77
Sex. M
Subjective:
Masakit itong kanang
kamay ko as verbalized by
the patient
- with pain scale of 6/10
Objective
Vital signs as follows:
BP: 130/80
PR: 78
RR: 25
T: 35.9 C
With IVF on right
metacarpal vein
Redness on IV site
Observed evidence
of pain
Restlessness

Nursing
Diagnosis
Alteration in
comfort:
Acute pain
related to
physical injury
caused by the
infiltration on IV
site

Inference

Planning

Nursing Interventions

Infiltration on IV site

Redness and
swelling

Stimulation of
nociceptors

Sending electrical
impulses to the
spinal cord

Which travels to the

brain

Causing pain

After 30
minutes
to 1 hour
of nursing
interventions,
the pain
scale will
be
reduced
from 6/10
to 3/10.

Independent:
1.
Monitor vital
signs
2.

Asses pain
characteristics

3.

Evaluate what
the pain means to the
individual
4.
Eliminate
additional stressors or
sources of discomfort
when possible
5.

6.

Respond
immediate to complaint
of pain
Apply warm
compress on injured
area

Dependent:
1. Change IV site

VIII.

Nursing Care Plan

Rationale

Evaluation

- To note alterations and

baseline data
- the meaning of the pain will
directly influence the
patients response

The goal was

partially met. After 2
hours of nursing
interventions, the
pain scale was
reduced from 6/10
to 2/10.

- Patients may experience

an exaggeration to
pain/decreased ability to
tolerate painful stimuli if
environmental intrapersonal,
intraphsychic factors are
future stressing them.
-prompt response to
complaint may result in
decrease anxiety in patient
- to alleviate pain and
promote blood circulation
- If condition worsens
change iv site to promote
comfort

Di na masyadong
masakit.
- as verbalized by
the patient

IX.

Health Teaching
a. Medicines

Prednisone 20mg tab BID

Hydroxyzyme 25mg tab BID

Fluconazole 150 mg OD
b. Exercise and Activities

Encourage the patient to do light aerobic exercise

(walking, biking, swimming, golfing, and jogging) at least three times a week.

Inform the client that he must refrain from sexual

activity to prevent spread of the disease at least until one week after alleviation of signs and
symptoms or as directed by doctor.
c. Treatment
Most localized cutaneous candidiasis infections may be treated with any number of
topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole,
nystatin). If the infection is a paronychia, the most important aspect of therapy is drainage of the
abscess, followed by oral antifungal therapy with either fluconazole or itraconazole.
In cases of extensive cutaneous infections, infections in immunocompromised patients,
folliculitis, or onychomycosis, systemic antifungal therapy is recommended. For Candida
onychomycosis, oral itraconazole (Sporanox) appears to be most efficacious. Two treatment
regimens are available: the daily dose of itraconazole taken for 3-6 months or the pulsed-dose
regimen that requires a slightly higher daily dose for 7 days, followed by 3 weeks of no drug
administration. The cycle is repeated every month for 3-6 months.
d. Health Teaching
Inform patients and their families about the risk factors associated with mucosal and
systemic candidiasis. In addition, inform them that the systemic form of the disease is extremely
serious and is associated with high morbidity and mortality rates unless aggressive action is
undertaken.
e. Out-Patient
Instruct the patient to follow up after one week.
f. Diet
Regular diet
g. Spiritual
Encourage patient to spend more time with God through prayer, going to church.