Republic of the Philippines

ISABELA STATE UNIVERSITY

City of Ilagan Campus

HOOK WORM INFECTION

Hookworm is a parasitic roundworm of the small intestine that is transmitted through contaminated soil. When hookworm eggs are passed in human feces, they
are shed into the surrounding environment, where the eggs hatch and penetrate through the skin of exposed individuals. Although most patients are
asymptomatic, heavy worm burdens lead to anemia, diarrhea, abdominal pain, weight loss and loss of appetite. While hookworm is associated with a relatively
small number of deaths, chronic anemia caused by the disease is associated with significant morbidity.

CAUSATIVE AGENT
Hookworm is caused by two organisms, Necator americanus and Ancylostoma duodenale. N. americanuscauses 85% of hookworm infections and is found
throughout the Americas, sub-Saharan Africa, Southeast Asia, China, and Indonesia. A. duodenale is restricted to the Middle East, North Africa, and India.

PATHOPHYSIOLOGY
PREDISPOSING FACTORS
 Walking barefoot on soils puts one risk of acquiring the infection.
SIGNS AND SYMPTOMS
 Improper disposal of human feces.  General weakness
 Social status such as people with low monthly income leading  Easily fatigue
to inability to provide needs for self-hygiene.  Inability to perform ADL’s
 People with disability or unable to provide care in own self.
 Shortness of breath in exertion
 In areas where both temperature and rainfall are generally
 Palpitation
suitable for the development of hookworm larvae.
 Dizziness
PRECIPITATING FACTORS  Epigastric pain
 Penetration of the skin by the filariform larvae produces  Blurred vision
a pruritic papules or vesicles (ground itch).
 Children playing barefooted.
 Defecation of wasteland near houses
 Fields and vegetables plot manured with human feces.
 Plantation in farm, laborer of mining and tunnels.
 NCP 2
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective Imbalance After 3 days of Independent: After 3 days of
Data: nutrition: nursing Assess the patient’s dietary history noting To evaluate the occurrence of nursing
Patient reports less than interventions, the the decreased of absorption (e.g., lactose constipation. interventions, the
of fever and body patient: intolerance, Crohn’s disease) patient:
weakness requirements
related to Will demonstrate Assess current weight compared to usual To identify the deviations from the Has Demonstrate
Objective inability to progressive weight and norms for age, gender, and normal and establish baseline progressive weight
Data: ingest food weight gain body size. Measure muscle mass or parameters. gain toward goal
Gender: as evidenced toward goal. And calculate body fats by means of and is free from
Female by weight be free from signs anthropometric measurements. signs of
Age: 33 years loss. of malnutrition. malnutrition.
Height: 5’5” Observe for absence of subcutaneous fat This indicates protein energy
Weight: Will display and muscle wasting, loss of hair, fissuring malnutrition. Has displayed
(admit): 167 lb. normalization of of nails, delayed healing, gum bleeding, normalized
(transfer):142 laboratory values swollen abdomen. laboratory values by
lb. by improved improved albumin
albumin and Auscultate presence and character of To determine ability and readiness of and hemoglobin
 Flush and hemoglobin level. bowel sounds. intestinal tract to handle digestive level.
warm to processes.
touch skin.
 General Weigh regularly and graph results. To monitor effectiveness of efforts.
weakness
Review drug regimen, side effects, and Medication such as antacids is use to
V/S: potential interaction withs other reduce the total acid load in the GI
BT: 38.9°C medications and over the counter drugs. tract and elevate gastric pH to reduce
RR: 21 Assist patient’s SO to learn how to the pepsin activity.
PR: 80 blenderize food and perform tube
BP: 100/80 feeding.
mmHg
O2 Sat: 95%

 Hct – 39%
 Hgb – 13.2 Dependent:
g/dL Administer pharmaceutical agents, as
 Alb – 3.6 indicated: Digestive drugs or enzymes,
g/dL Vitamins and Minerals (iron) supplements
 Na – 144 Administer antacid as ordered.
mEq/L
 K – 4.0 Administer anticholinergics as ordered.
mEq/L
Administer antidiarrheals as ordered.
Provide dietary modification as indicated:
Optimization of client’s intake of protein,
carbohydrates, fats, calories within needs.
Collaborative:
Collaborate with interdisciplinary team.
Calculate client’s energy and protein
requirements using basal energy
expenditure and the Harris-Benedict
formula.
Consult with dietitian or nutritional
support team as necessary, for long term-
term needs.
Anticholinergics competitively
antagonize the actions of
acetylcholine from causing
involuntary muscle movements in GI
tract.
Bismuth preparations may a mild
water binding capacity, may absorb
toxins, and provide a protective
coating for intestinal mucosa.
Octreotide inhibits secretions of GI
neurotransmitter and hormones to
control diarrheal.
To set nutritional goals when client
has specific dietary needs,
malnutrition is profound, or long-
term feeding problems exist.
Various factors may be considered in
choosing a useful formula, including
age, sex, disease state, stress
associated with current illness, body
size
 Nursing Care Plan
NCP 1
ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Objective Risk of ineffective After 24 hours Note current situation or presence of That could possibly affect systemic After 24 hours
Data: tissue perfusion of nursing conditions. circulation/prefusion. of nursing
Vital Signs related to blood intervention, intervention,
taken as loss as evidenced the patient will Determine history of conditions with To identify client at higher risk for the patient will
follows: by decreased level display thrombus or emboli. venous stasis, vessel wall injury and display
BP: 80/50 of hemoglobin. normalization hypercoagulability. normalization of
RR: 34 of laboratory laboratory
PR: 120 values by values by
improved Identify presence of high-risk factors or It can place patient at higher risk for improved
Low HGB hemoglobin conditions developing peripheral vascular disease hemoglobin
level: 98g/L level. with associated complications. level
(normal 120-
170g/L) Asses skin color, temperature, moisture Helps in determining location and type
and whether changes are widespread or of perfusion problems.
Low HCT level: localized.
30: anemia
(normal 0.37- Asses presence, location, and degree of Useful identifying or quantifying edema
0.54) swelling or edema formation. in involved severity.

 Body Measure capillary refill To determine adequacy of systematic

weakness circulation.
 Restlessness
 Pale Collaborate for treatment of underlying To maximize systemic circulation and
 Edema conditions organ perfusion.
 Confusion
Administer medications such as To improve tissue perfusion or organ
antiplatelet agents, thrombolytics, function.
antibiotics.

Administer fluids, electrolytes, nutrients,

and oxygen, as indicated.
Evaluate blood pressure.
Review pulse oximetry or arterial blood
gases when possible.
Review laboratory studies.
Provide and monitor response to
supplemental oxygen, medications, and
changes in treatment regimen.
Discuss to SO’s about the impact of
unmodifiable risk factors such as family
history, age, race.
Collaborative:
Collaborate in treatment of underlying
conditions as indicated.
Emphasize necessity of routine follow up
and laboratory monitoring, as indicated.
Refer to educational and community
resources, as indicated.
To promote optimal blood flow, organ
perfusion and function.
Low blood pressure or severe
hypotension causes inadequate
perfusion of brain.
Hypoxia is associated with reduced
tissue perfusion.
To identify disorders that increase risk of
clotting or bleeding or conditions
contributing to decreased tissue
perfusion.
Understanding effects and
interrelationship of all risk factors may
encourage client to address what can be
changed to improve general wellbeing
and reduce individual risk.
To improve systemic perfusion and
organ function.
For effective disease management and
possible changes in therapeutic
regimen.
SO may benefit from instruction and
support provided by agencies to engage
in healthy activities (e.g., weight loss,
smoking cessation, exercise)
 Drug Study
Drug Study 1
Drug Name Action Dosage/Route Indication/Uses Contraindication Adverse Reaction Nursing Management

Generic: Albendazole is PO  Echinococcosis Hypersensitivity  abdominal pain Patient with

Albendazole a broad- Adult: <60kg: 15  Neurocysticercosis  abnormal liver function test neurocysticercosis, retinal
spectrum mg/kg daily in 2  Ascariasis, Pregnancy  acute liver failure lesions. May cause
Brand: anthelmintic. divide doses. Max: Enterobiasis,  acute kidney failure inflammatory reaction
Albenza The principal 800mg daily >60 kg Hookworm  severe low white blood cell within the brain. Increased
mode of action 400 mg BID. Infection, count risk of bone marrow
for albendazole Duration of Trichuriasis.  dizziness suppressions in patient
is by its treatment: 8-30  Clonorchiasis,  easy bruising or bleeding with liver disease. Hepatic
inhibitory days Opisthorchiasis  fever with chills, body impairment.
effect on  Tapeworm aches, or flu-like symptoms
tubulin Child: same as infections  fever, sore Assess for the mentioned
polymerization  adult  Cutaneous larva throat, headache with cautions and
which results migrans severe blistering, peeling, contraindications (e.g.,
in the loss of Should be taken  Giardiasis and red skin rash known allergies,
cytoplasmic with food. For  low white blood cell count hepatorenal dysfunction,
microtubules. systemic infections,  hair loss pregnancy and lactation,
administer w/ high-  headache etc.) to prevent any
fat meal to  hepatitis untoward complications.
increase  increased intracranial 
absorption. For pressure Perform a thorough
patients w/  meningeal signs physical assessment (other
swallowing medications taken, reflexes
 nausea
difficulty, tab may and muscle strength, skin
 reduction of red blood
be color, temperature,
cells, white blood cells,
crushed/chewed. texture, etc.) to establish
and platelets
baseline data before drug
 rash
Should be taken on therapy begins, to
 spinning sensation (vertigo)
an empty stomach. determine effectiveness of
 low blood platelet count
For intraluminal therapy, and to evaluate
 unusual weakness
infections w/ o for occurrence of any
 hives
systemic adverse effects associated
involvement, take  vomiting with drug therapy.
on an empty
stomach. For Assess the patient’s liver
patients w/ function, including liver
swallowing function tests to determine
difficulty, tab may appropriateness of therapy
be and to monitor for toxicity.
crushed/chewed.
Obtain a culture of stool for
ova and parasites to
determine the infecting
worm and establish
appropriate treatment.

Assess the abdomen to

evaluate for any changes
from baseline related to
the infection, identify
possible adverse effects,
and monitor for
improvement.
 Drug Study 2
Drug Action Dosage/Route Indication / Uses Contraindication Adverse Reaction Nursing
Name Management
Generic: Description: Ivermectin is a Oral:  Onchocerciasis Hypersensitivity Significant: Educate patient
Ivermectin semisynthetic anthelmintic Adult –  Intestinal  Mazzotti reaction (e.g. to avoid contact
derived from 150mcg/kg as a strongyloidiasis lymphadenitis, oedema, with eyes and
Brand: the ivermectin’s. It has a single dose; may  Head pediculosis arthralgia, synovitis, lips.
Stromectol strong affinity and binds repeat  Inflammatory tachycardia, fever,
selectively to treatment every lesions of pruritus, urticaria) and Evaluate
glutamate-gated chloride 3-12 months rosacea. ophthalmic reaction pregnancy
ion channels of invertebrate until symptoms particularly in patients status before
nerve and resolved. undergoing treatment for use in patients
muscle cells resulting in Child - >15kg: onchocerciasis; transient who may
increased permeability of same as adult aggravation of rosacea become
cell membrane dose. (topical cream). pregnant.
to chloride ions with  Blood and lymphatic
hyperpolarization of the Topical: system disorders: Assess for loiasis
nerve or muscle cell, Adult: As 0.5% Transient eosinophilia, before and after
thereby causing the death of lotion: apply leucopenia, anemia. therapy
the parasite. The mechanism sufficient  Eye disorders: (especially in
of action in amount up to 1 Conjunctival hemorrhage patient with
the treatment of rosacea is tube to (if treated for significant
still unknown but may be completely coat onchocerciasis); exposure to Loa
associated with dry hair and conjunctivitis, ocular loa endemic
the anti-inflammatory scalp thoroughly, hyperemia, eye irritation areas of West
effects of ivermectin and then leave on for (topical lotion). and Cenral
antiparasitic action 10 minutes.  Ear and labyrinth Africa). Obtain
that causes the death of Rinse off the disorders: Vertigo. skin and eye
Demodex mites reported to scalp and hair  Gastrointestinal microbial
contribute to skin well with warm disorders: Abdominal counts; periodic
inflammation. water; use a pain, constipation, ophthalmic
fine-toothed diarrhea, nausea, exams.
Pharmacokinetics: comb to remove vomiting.
Absorption: Well, absorbed nits as needed.  General disorders and Perform follow-
from the gastrointestinal For single use administration site up stool
tract (fasted state).
Increased bioavailability
with a high-fat meal. Time to
peak plasma
concentration: Approx. 4
hours (oral); approx. 10
hours (topical cream).
Distribution: High
concentration in the liver
and adipose cell. Enters
breast milk (small amounts).
Volume of distribution:3.1-
3.5 L/kg. Plasma
protein binding: Approx.
93% mainly to albumin
(oral); >99% (topical).
Metabolism: Metabolized in
the liver mainly by CYP3A4
isoenzyme.
Excretion: Via feces; urine
(<1%). Elimination half-life:
Approx. 18 hours
(oral); approx. 6 days
(topical cream).
only. conditions: Asthenia,
fatigue. examination (for
Child - >6 intestinal
months as 0.05% Investigations: strongyloidiasis).
lotion: same as  Increased AST, ALT, and
adult dose. bilirubin.
 Metabolism and nutrition
disorders: Anorexia.
 Nervous system
disorders: Dizziness,
tremor, seizures.
 Psychiatric disorders:
Somnolence.
 Respiratory, thoracic and
mediastinal disorders:
Worsening of bronchial
asthma.
 Skin and subcutaneous
tissue disorders: Rash,
Stevens-Johnson
syndrome, toxic
epidermal necrolysis
(oral); dandruff (topical
lotion); skin burning
sensation, irritation,
pruritus, dry skin (topical
cream/ lotion).
 Vascular disorders:
Orthostatic hypotension.
 Potentially Fatal: Rarely,
encephalopathy
(especially if the patient
with onchocerciasis is co-
infected with Loa loa).
`
When the invasive filariform larvae penetrate the
Penetration of skin skin they may cause a stinging sensation, followed by
irritation, erythema, oedema and a papulovesicular
eruption the so-called ground itch.

Small hemorrhages and leukocytosis or

eosinophilic infiltrations may occur where larvae
Migration of larvae pass through the alveolar walls of the lungs.
Migration of larvae through the respiratory tract
may cause coughing, due to irritation of the
bronchial and tracheal mucous membranes.

In the duodenum and jejunum, hookworms attach themselves

to the intestine by engulfing a part of the intestinal mucosa in
their buccal cavities. There they feed blood from cut vessels
Established intestinal
and on mucosal tissue. At the points of attachment there is
infection usually some bleeding and inflammatory reaction. Those
infected may have epigastric duodenal type of pain, indigestion,
loss of appetite or diarrhea.

The most serious consequences of

hookworm infection are chronic blood loss
from the duodenum and jejunum. If the
Chronic blood loss infection is not adequately treated blood
loss may continue for many years, leading to
depletion of body iron stirs and the
development of iron deficiency anemia.