CASE PRESENTATION

Acute Gastro Enteritis(A.G.E)

PREPARED BY: MARIAMMA JOHNSTAFF NURSE, PEDIA WARD

DEMOGRAPHIC DATA:

Name: Case no.2 MR No.: 195077 Diagnosis: Acute Gastroenteritis

Age: 1 year Gender: Female D.O. A: 23/01/2013 D.O.D: 25/01/2013

PHYSICAL ASSESSMENT: General Assessment:

Chief complaint: Febrile, Lethargic and decreased Activity

  Skin: Dehydrated, Dry, Pale

and mottled, Cold extremities, capillary refill > 3 sec

  Head and Neck: Neck Veins

Flattened, Sunken Eyes, Fontanel Sunken

Thorax: Normally symmetrical in size

Cardiovascular: Tachycardia present, no tachypnoea

Genitourinary: Redness of the perineal area, urine concentrated and dark color

Gastrointestinal: Abdomen is hyperactive and distended. Loose stools more than 7 times per day

Musculoskeletal: No deformities Noted. No joint or muscle pain noted during examination

Neurology: Growth and development is normal according to Erikson’s Psychosocial Stage

PATIENT HISTORY:

Past Medical History : There is no past medical history of any illness

Present Medical History: Now the baby is admitted with the complaints of loose stool, vomiting and fever

MILES STONE CHART: 0-1 YEARCHILD’S AGE and MASTERED SKILLS

1 MONTH Lifts head when lying on tummy.

Respond to sound. Stares at faces.

2 MONTHS Vocalizes: gurgles and coos. Follows

objects across field of vision. Notices his hands. Holds head up for short periods.

3 MONTHS Recognizes your face and scent.

Holds head steady. Visually tracks moving objects.

4 MONTHS Smiles, laughs. Can bear weight on

legs. Coos when you talk to him.

5 MONTHS Distinguishes between bold colors.

Plays with his hands and feet.

6 MONTHS Turns toward sounds and voices

Imitates soundsRolls over in both directions

7 MONTHS Sits without support. Drags objects

toward herself.

8 MONTHS Says ‘mama’ or ‘dada’ to parents.

Passes objects from hand to hand.

9 MONTHS Stands while holding onto

something. Jabbers or combines syllables. Understands object permanence.

10 MONTHS Waves good bye. Picks things up

with pincer grasp. Crawls well, with belly off the ground.

11 MONTHS Says ‘mama’ or ‘dada’ to the correct

parent. Plays patty- cake and peek-a-boo. Stands alone for a couple of seconds.

12 MONTHS Imitates others activities. Indicates

wants with gestures.

TOPIC PRESENTATION:

GASTROENTERITIS

Definition; Gastroenteritis is an

upset stomach. It causes nausea and vomiting. It is

sometimes called stomach flu, caused by viruses and bacteria.

ANATOMY AND PHYSIOLOGY:

The gastrointestinal tract is a muscular tube made by

epithelial cells. The individual components of

the gastrointestinal system are oral cavity, salivary

glands, esophagus, stomach, small intestine

and large intestine.

PHYSIOLOGY: ORAL CAVITY: Mechanical breakdown of food

occurring in mouth. Insalivations and absorption of small molecules such as glucose and water are the functions of oral cavity

SALIVARY GLANDS : 3 pairs of salivary glands present ,which produce saliva

ESOPHAGUS : It is a muscular tube which extend from pharynx to stomach .It acts as a transport medium between compartments.

STOMACH : Stomach is a “j” shaped bag located just left of the midline between the esophagus and small intestine. Its functions are

• The short term storage of ingested food• Mechanical breakdown of food• Chemical digestion of proteins by acids,

enzymes

ETIOLOGY: VIRAL: E.g.; Rotavirus , Adenoviruses, Norovirus , Parvovirus and Astroviruses

BACTERIAL; E.g.; Salmonella, Shigella, E- coli, Clostridium deficit

PARASITES AND PROTZOANS: E.g.; Giardia, Cryptosporidium

PATHOPHYSIOLOGY ACUTE GASTROENTERITIS

Predisposing Factors- Age

- Malnutrition

Precipitating Factors- Contaminated

Food and Water

Direct Invasion of the bowel wall

Ingestion of fecally contaminated food

and water

Endotoxins are released

Stimulation and Destruction of

mucosal lining of the bowel wall

Attempted Defecation

Excessive gas formation

GI Distention

Digestive and Absorptive Malfunction

Secretion of food and electrolytes in the intestinal lumen

Increase Peristaltic Movement

Mild Diarrhea

Fluid and Electrolytes Imbalance

Increased Protein in the Lumen

LI is overwhelmed and unables to reabsorb

the lost food

Intense diarrhea >10times watery

stool

Serious Fluid Volume Deficit

Hypovolemic Shock Death

SIGNS AND SYMPTOMS:

Book Based

Diarrhea Nausea Crampy

abdominal pain Vomiting

 

Patient Manifested

Nausea Diarrhea Vomiting Fever Dehydration Tachycardia

INTERVENTION:

Maintain hydration  Promoting intake of nutrients  Reduce hyperthermia  Monitoring and preventing potential

complications

Promoting family knowledge   

TREATMENT:BOOK BASE A.G.E is usually an acute

and self limiting disease that does not require medication

The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy, metaclopromide or ondansteron if needed

If it is viral : soft anti diarrheal diet Oral rehydration IV Fluids

Bacterial: Antibiotics

PATIENT TREATMENT Treated with IV Fluids, ORS solution, Inj. Perfalgan 200mg

iv prn, Voltaren suppository

12.5mg prn

COMPLICATIONS:

Pseudomembraneous enterocolitis ( usually only seen in those who are taking antibiotics) 

Gastro intestinal bleeding  Dehydration Electrolyte Imbalance (Hypokalemia,

Hypernatremia)  Shock  Sepsis ( secondary bacterial

infection ) 

PRIORITIZATION OF NURSING PROBLEMS:

Altered fluid volume deficit due to diarrhea and vomiting

Altered electrolyte imbalance due to diarrhea and vomiting

Imbalanced nutrition less than body requirement due to less food intake

Hyperthermia related to infection

Lack of skin integrity due to severe loose stool

NURSING CARE PLAN:

ASSESSMENT NURSING DIAGNOSIS

PLANNING IMPLEMENTATION

RATIONALE EVALUATION

SUBJECTIVEPatient’s Mother Complaints Of Increase No Of Loose Stools And VomitingOBJECTIVELoose Stool More Than 7 Times Per Day1. Dry Skin2. Cracked Lips

Altered fluid volume deficit related to active fluid loss

Within 12hrs of nursing intervention patient will Hydrated Normal lipsNo vomiting

1. Encouraged oral intake of fluids

2. Given nutritionally enrich drinks with more taste enrich with electrolyte (e.g. Pedialyte)

3. Administered IV Fluids 5% dex in ½ NS + 5 ml kcl at 60ml / hour

4. Provided rest with calm and quiet environment

5. Monitored intake and output chart

6. Provided soft Anti-Diarrheal diet

1. Helps to promote hydration

2. To avoid dehydration

3. Helps to provide fluids , calories and electrolytes

4. To maintain electrolyte imbalance

5. Will determine if output exceeds input

6. Fiber and solid food may cause gastric irritation

After 12 hours of nursing intervention the goals was partially met as evidenced by : Frequency

of diarrhea decreased

Still dehydration

No fatigue No vomiting

NURSING CARE PLANS

ASSESSMENT NURSING DIAGNOSIS

PLANNING IMPLEMENTATION

RATIONALE EVALUATION

SUBJECTIVEPatient mother complaints baby feel hot while touchingOBJECTIVEFever ( 39 – 40 c)DrowsyTachycardiaWeakness

Hyperthermia related to infection

Within 24 hours patient will completely relieved from fever

1. Removed excessive clothing

2. Provided tepid sponge bath

3. Encouraged fluid intake

4. Administer IV Fluids 5% dex in ½ NS + 5 ml kcl at 60ml / hour

5. Administered Antipyretics (e.g. Inj.perfalgan 200mg IV PRN, Rofenac suppository 12.5mg PRN )

1. Excessive clothing may elevate temperature

2. High temperature causes coagulation of cell protein and cell die. High temperature leads to brain damage

3. To prevent dehydration

4. To prevent electrolyte imbalance

5. To reduce body temperature

After 2 days of nursing intervention the goals are fully met. No fever No

weakness Fully

nourished

NURSING HEALTH TEACHING: Encourage the mother to feed the

baby with a nutritious diet which is not harmful to the stomach

Advise to increase the activities gradually

Advise the mother to prepare the food in a hygienic manner

Advise the mother to maintain the personal hygiene of the baby

Encourage rest to the baby

CONCLUSION:

Patient relieved from signs and symptoms.

Discharge medications: Pedialyte and voltarin suppository 12.5mg prn. Review after 1

week 

BIBLIOGRAPHY

Brunner & Suddarth’s. Test book of Medical Surgical Nursing. 12thEdition.

Lippincott Manual of Nursing Practice. 9th Edition.

KHALASShukran for listening…