103317354 1st caselepro-1docx

I. Homework Help II. https://www.homeworkping.com/ III.IV. Research Paper help V. https://www.homeworkping.com/ VI.VII. Online Tutoring VIII. https://www.homeworkping.com/ IX.X. click here for freelancing tutoring sites XI. INTRODUCTION

A. Background of the StudyLeprosy has been a Public problem in the Philippines for several decades. The

disease unequally distributed throughout the country. In 1987, in the provinces of Ilocos Norte and Ilocos Sur, Abra, Sulu, Palawan Cebu and La Union, Pangasinan and Metro Manila, the prevalence rate changed from 0.40 to 3.01 per thousand populations. In other provinces. The prevalence rate is lower than 0.40/1000 population. The National Prevalence Rate as of 1998 was 0.65/1000. (Community Health Nursing Services in The Philippines. 9th Edition, page 215)

The Nationwide implementation of Multi-drug Therapy (MDT) SINCE 1988 has resulted in the decrease In the prevalence rate of leprosy. The prevalence rate of the disease declined from 7.2/10,000 population in 1986 to 1.2/10,000 population in 1997. Since then, the treatment of leprosy has shifted from institutional care to that home treatment.

Leprosy (Hansen’s Disease; Hansenosis; Lepra; Leontiasis) is a chronic disease with an insidious onset, transmitted from man to man, affecting the skin, mucous membranes and nervous tissue and eventually producing deformities. This chronic, mildly, infectious disease is caused by rod-shaped bacilli, Mycobacterium Leprae pr Leprosy bacilli or Hansen’s Bacillus.

B. Rationale for Choosing the CaseMost of our patient assignments are Non-hansen patient. Meaning they are not

affected with the Mycobacterium Leprae. Since my focus is Patient care management and we are in a Leprosarium, I choose the case of Hansen patient or

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patient affected with the Mycobacterium Leprae because it would help us to have focus study regarding this case- more nursing care would be given.

XII. PATIENT PROFILEA. General Data

Name: Patient XAge: 25 years oldBirth date: January 24, 1979Birth Place: CebuSex: FemaleNationality: Roman CatholicCivil Status: SingleAddress: Caloocan CityWard/Accommodation/Service: Female Ward/Charity/MedicinePatient Category: Non regular HansenDate Admitted: June 16, 2012Time Admitted: 3:00pm

XIII. PHYSICAL ASSESSTMENT

BODY PARTS NORMS ACTUAL FINDINGS

INTERPRETATION AND ANALYSIS

Skin Varies from light to deep brown; from ruddy pink; from yellow overtones to olive (pg. 538 Fundamentals of Nursing by Kozier, 7th Edition)

Skin lesions all over the body. Loss of sensation on the skin lesions.

Not normal. The cardinal signs of leprosy are the ff:--Loss of sensation on the skin lesions--Enlargements of peripheral nerves--Presence OF leprosy bacilli in the skin smear. Loss of sensation can cause further damage to skin.

XIV. Anatomy and Physiology

The skin is the body’s largest organ, covering the entire body. In addition to serving as a protective shield against heat, light, injury and infection, the skin also:a. Regulates body temperatureb. Stores sensory organc. Prevents water lossd. Prevents entry of bacteria

Throughout the body, the skin’s characteristics (thickness, color, texture) vary. For instance, the head contains more hair follicles than anywhere else, while the soles of the feet contain none. In addition, the soles of the feet and the palms of the hand are much thicker. The skin is made up of the following layers, with each layer performing specific functions:a. Epidermisb. Dermisc. Subcutaneous fat layer

Epidermis The epidermis is the thin outer layer of the skin and consists of three parts:

a. Stratum corneum (horny layer)-this layer consists of fully mature keratinocytes which contain fibrous proteins (keratins) The outermost layer is continuously shed. The stratum corneum prevents the entry of most foreign substances as well as the loss fluid from the body.b. keratinocytes (squamous cells)-This layer just beneath the stratum corneum contains living keratinocytes, which mature and forms stratum corneum.c. Basal layer-the basal layer is the deepest layer of the epidermis containing basal cells. Basal cells continually divide, forming new keratinocytes that replace the cells that are shed from the skin’s surfaces. The epidermis also contain melanocytes, which are cells that produces

melanin (skin pigment)

Dermis The Dermis is the middle layer of the skin. The dermis contains the following.

d. Blood vesselse. Lymph vessels f. Hair folliclesg. Sweat glandsh. Collagen bundlesi. Fibroblastsj. Nerves

The dermis is held together by a protein called collagen, made fibroblasts. This layer also contains pain and touch receptors.

Subcutaneous Fat Layer

The subcutis is the deepest layer of the skin. The subcutis, consisting of network of collagen and fat cells, helps conserve the body’s heat and protects the body from injury by acting as shock absorber.

XV. Patophysiology/Schematic diagram of the disease

a. A chronic intracellular infectious disease unique to man usually it is not fatal. The manifestations of the disease depend on the resistance of the host.

Types:

1. Tuberculoid- host is highly resistant, clinical abnormalities limited yo a few peripheral nerves and adjacent skin areas, tuberculoid granuloma

2. Lepromatous- host lacks resistance, all tissues affected from cell granuloma3. Borderline- between tuberculoid and lepromatous

The earliest clinically detectable lesions of leprosy involve the skin and show histologic association with sebaceous glands and hair follicles. From the onset, small cutaneous nerve fibers are involved. With bacillary multiplication, contiguous skin areas including autonomic nerve fibers, dermal appendages, and blood vessels are invaded.

Lymphohemategenous dissemination of bacilli is probably an early phenomenon. An infection spreads along sensory nerves motor fibers within parent nerve trunks are damaged. Leprosy bacilli are unable to penetrate directly into the nervous system proximal to the dorsal root ganglions: central nervous system infection does not occur.When there is dense proliferation of leprosy bacilli, as a lepromatous leprosy, bacteremia is virtually continues, and bacilli are easily demonstrable in many organs. Yet there is little systematic reaction, and tissue destruction occurs mainly in cool superficial locations; the skin (except folds); peripheral nerves in subcutaneous loci; oral and naso pharyngeal mucous membranes (not enteric or vaginal) ; the testes (not the ovaries) and the anterior third of the eye.The clinical manifestations are the indeterminate (1) lesion, which may be the initial manifestation, shows as ordinary-looking skin changes, such as pale oval or rounded macules, papulonodules, wheals or circinate patches. They may be found in the malar area, extremities’ or buttocks. There may be only one or few lesions which may appear and disappear, undergo spontaneous healing or gradually progress through the borderline (BB) form towards the tuberculoid (BT) or lepromatous (BL) forms. The lesions are usually anesthetic but this may be later manifestations. They maybe depigmented or erythomatous. Sensory disturbances as paresthesias, numbness and formication may also be found. There may also be thickening or superficial nerve trunks. Especially the ulnar, as well as lymphadenophaty anhindrosi, ichtyosis and limb weakness. The foregoing manifestations may be seen in nay of the clinical forms particularly in the tuberculoid (TT) which is also characterized by adefinite tendency towards healing. Damage in the following nerves is associated with characteristic impairments in leprosy; ®ulnar and median- clawed hand®posterior tibila- plantar insensitivity and clawed toes®common peroneal- foot drop

Radial cutaneous, facial and greater auricular nerves infiltration by bacteria may lead to destruction of nasal cartilage (lepromatous form) ocular movement and diffuse thickening of the skin. Advanced cases involve the loss of eyebrows and lashes but these deformities are less common.

XVI. Laboratory and Diagnostic Examination

Diagnostic Exam Norms Actual Results Interpretation and Analysis

Urinalysis Reference Values Color: light straw to dark amberAppearance: clearOdor: aromaticPh: 4.5-8.0Specific gravity: 1.005-1.030Protein: 2-8Mg/dl: Negative reagent strip testTrace Glucose: negativeKetones: negative(Handbook of Laborator and Diagnostic Test)

Actual findings Color: YellowAppearance: ClearOdor: aromaticpH: AcidicSpecific gravity:1.030Protein: NegativeGlucose: negativeMicroscopic Examination:RBC: 0-1/hpfPus: 0-3/hpfEpithelial Cells: positiveUrates: postive

Interpretation: The urine color, Ph, specific gravity and microscopic examination (epithelial cells and urates) are not normal while the appearance protein, glucose are normal.

Analysis: Color of the urine changes can results from diet. Drugs and much disease. (pg. 395, Diagnostic Test) When water loose from the body exceeds water intake, the kidneys need to consume water making the urination more concentrated with waste products and subsequently dark in color. Yellow colored urine is possible of pyuria, and infection. (Medical Surgical Nursing by Bare and Smeltzer pg. 1263) A normal pH is 7. A pH < 7 indicates alkaline urine. Acid urine pH is associate with renal tubercolosis, pyrexia, phenylketonuria, alkaptonuria and acidosis. (Diagnostic

Tests. A prescriber’s Guide to Selection and Interpretation by Lippincott Williams and Wilkins, p. 395) due to carbohydrate malabsorption, fat malabsorption and disaccharides deficiency. (A manual of Laboratory and Diagnostic Tests, 7th Edition by Lippincott William and Wilkins, p.279) Normally, freshly voided urine has a faint odor owing to the presence of volatile acids. It is not generally offensive. Fresh urine from most persons has a characteristics aromatic odor (pg. 396 Diagnostic Test) Specific gravity is an indication of the relative proportions of dissolved solid components to the total volume of the specimen and reflects the relative degree of concentration or dilution of the specimen. (www.intensive caring.com) In a healthy renal and urinary tract system, urine contains no protein or only trace amount (pg. 191, A Manual Laboratory

and Diagnostic Test) Sugar, usually absent from the urine may appear under normal conditions (pg.329 Handbook of Diagnostic Test 3rd Edition) A high number of white blood cells in the urine is usually a symptom of urinary tract infection. A large number of cells from tissue lining (epithelial cells) indicate damage to the small tubes that carry material into out of the kidneys. (www.healthatoz.com)

Hematology Reference Values:WBC: 5-10x 10’ g/dlNeutrophils:0.40-0.60Lymphocytes: 0.20-0.40 (Diagnostic Testing and Nursing Implications, 4th edition)

Actual findings: WBC: 12.6Neutrophils: 0.71

Interpretation: Not normal. Analysis: increased Leukocytosis, an increase in circulating leukocytosis in all types occur, if it is usually a result of hem concentration (A Manual of Laboratory and Diagnostic Tests, 7th Edition By Lippincott William and Wilkins p.49) Increase in neutrophils: severe bacterila disease, diabetic acidosis, infarctions, increase in acute, severe inflammation malignancies (Diagnostic Testing and Implications 4th

edition)

XVII. DRUG STUDY

Generic/Trade Name/Drug Class

Mode of Action

Dosage/RouteFrequency

Indications Contraindications Side Effects Nursing Consideration

RifampinRifadin, Rimactane, Rofact (CAN)AntibioticAntituberculotic (First line)

Inhibits DNA-dependent RNA polymerase activity in susceptible bacterial cells.

Adults: 10mg/kg/day; no to exceed 600mg in a single daily dose PO or IV

Treatment of Pulmonary TB in conjunction with atleast one other effective antituberculotic.Neisseria Meningitidis carriers, for asymptomatic carriers to eliminate meningococcemia from naso pharynx; not for treatment of meningitis

Contraindicated with allergy to any rifamycin, acute hepatic disease, lactation.Use cautiously with pregnancy

Headache,Drowsiness,Fatigue,dizzy-ness, Rash, urticuria, flushing, epigastric distress, nausea, vomiting gas, cramps, diarrhea,

Administer to an empty stomach, 1hr before or 2 hr after meals.

Administer in a single dose only

Consult pharmacist for rifampin supension.

Report fevers, chills, muscle and bone pain.

Generic/TradeName/Drug Class

Mode of Action

Dosage/RouteFrequency

Indications Contraindications SideEffects

Nursing Considerations

DapsoneAczone GelLerostaticTreatment of Hansen’s diseaseTreatment of herpetiformis

Topical drugs

Contraindicated with allergy to these drugs, open wounds or abrasions.

Local irritation, stinging, burning, dermatitis, toxic effects if absorbed systematically.

Apply sparingly to the affected area as directed. Do not use with open wounds or broken skin. Avoid contact with eyes. Report any local irritation, allergic reaction,

worsening of condition being treated.

XVIII. NURSING CARE PLAN PRIORITIZATIONA.

RATE Nursing Problems Identified

Justification

1 Ineffective airway breathing pattern related to excessive mucus secretion

According to Abraham Maslow of Hierarchy of needs, physiologic needs come in priority. This is an actual problem that requires immediate attention. It is the chief complaint of the patient and the other nursing problems occur in relation to the presence of this problem

2 Impaired skin integrity related to presence of skin lesion.

Fur2ther damage to skin may cause other infections. This is an actual problem which is an effect of the prioritized problem above interventions are available and possible for this problem.

3 Anxiety (Mild) related to changes in health status

Sudden in her way of living

B. NURSING CARE PLAN.

ASSESSTMENT

DIAGNOSIS

PLANNING INTERVENTION

RATIONALE EVALUATION

Subjective: “Hindi naman na masakit itong mga sugat ko, matagal na rin naman na itong mga sugat ko”

Objective:-presence of skin lesion all over the body-black color lesions

Impaired skin integrity realted to presence of skin lesions all over the body

Independent: After nursing intervention with collaborative nursing intervention, the client will be able to have improved skin integrity as evidenced by:

a. Exhibited no further skin breakdown

b. Healed skin lesions

Objectives: After 8 hours shift the client will be able to:

1. Exhibit evidence of skin breakdown

a. Inspect patient’s skin every shift, describe and document skin condition and report changes.

b.Perform and teach patient prescribed treatment regimen for skin condition involved and monitor

a. This provides evidence of effectiveness of skin regimen. (Nursing Diagnosis CARD 9TH Edition by Taylor and Sparks card 158)

b. to maintain or modify current therapy. (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

Goal met.

2. Communicate understanding, verbalizes intent to use skin protection measures, demonstrates skin inspection technique and performs skin care continue

progress. Report response to treatment regimen.

c.warm the patient against tampering with wound.

d.explain therapy to patient.

a.instruct patient in skin care regimen

c.to avoid spread of infection and decreased chance of further skin damage (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

d. to aid compliance (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

a.to encourage compliance (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

b.to improve skill of the

3. Communicate feelings about change in the body image

b.supervise patient in skin care management

a.allow patient to express feelings regarding skin problem

b.refer patient to psychiatric liaison nurse, social services or other support groups.

patient (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

a.this helps allay anxiety and develop coping skills (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

b.this provide additional support for patient (Nursing Diagnosis card 9th edition by Taylor and Sparks, Card 158)

XIX. DISCHARGE PLANNING

MEDICATION

● Multi-drug Therapy (Dapsone, Rifampicin and Clofazimine)

EXERCISE

●The client should have a daily routine exercises ●Encourage client to have regular exercise such as performing range of motions exercises●Encourage the client to follow an exercise to follow a appropriate exercise program. Exercise is also a useful way to lose weight, ease stress and maintain a feeling of well-being. It is also good for wound healing.

TREATMENT

●Medications as prescribed by the physician●Educating both patient and family●Provides and arranges for provisions of nursing care of patients at home

HEALTH TEACHINGS

●Control measures such as immunizations●Practice personal hygiene●Health education of patients, families, and the community on the nature of the disease, symptomatology and its transmission●Advocates healthful living through proper nutrition, adequate rest, sleep, exercise and good environment.●Health teaching to prevents secondary injury●Teach the client that she/he should not fail to complete treatment within the prescribed duration.●The Nurse should give health teachings like information about how to prevent and protect his skin from wounds and lesions. If there’s such, teach how will be the proper way of addressing the wound and taking good care of it.

OUT PATIENT FOLLOW UP

●Refers patient to other health and allied workers

●refers patient to other persons/agencies who can help inhis/her physical, mental and social rehabilitation.●Monthly outpatient follow up is recommended during treatment, although weekly visits may be necessary if the patient experience leprosy reaction.

DIET●Diet as tolerated

SPIRITUAL TEACHINGS●Mental and emotional support by encouraging self-confidence and self reliance.●Providing counseling and guidance

References:

Fundamentals of Nursing by Kozier, 7th Edition

Handbook of Laboratory and Diagnostic Test)

www.intensive caring.com

Nursing Diagnosis card 9th edition by Taylor and Sparks

Diagnostic Testing and Nursing Implications, 4th edition)

Diagnostic Tests. A prescriber’s Guide to Selection and Interpretation by Lippincott Williams and Wilkins

Medical Surgical Nursing by Bare and Smeltzer

Handbook of Diagnostic Test 3rd Editon

www.healthoz.com

http://www.healthoz.com/

TABLE OF CONTENTS

I. INTRODUCTION

A. Back ground of the Study

B. Rationale for Choosing the Case

II. PATIENT PROFILE

A. General Data

III. PHYSICAL ASSESSTMENT

IV. ANATOMY AND PHYSIOLOGY

V. PATHOPHYSIOLOGY/SCHEMATIC DIAGRAM OF THE DISEASE

VI. LABORATORY AND DIAGNOSTIC EXAMINATION

VII. DRUG STUDY

VIII. NURSING CARE PLA PRIORITIZATION

A. NURSING CARE PLAN

IX. DISCHARGE PLAN

X. REFERRENCE

CENTRAL LUZON COLLEGE OF SCIENCE & TECHNOLOGY

College of Nursing

A CASE STUDY ON

LEPROSY

In Partial Fulfillment for

Related Learning Experience

Presented by:

Adelina Pinero

BSNIII

Presented to:

Mrs. Ma. Rowena Dimapilis RN, Man

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