Bulacan State University

City of Malolos, Bulacan

College of Nursing

Case Study of Patient with Acute

Gastroenteritis

Submitted by:

Calma, Therese Josephine

Censon, Luwalhati

BSN – 3D

Submitted to:

Maribel Valencia, R.N.

I. INTRODUCTION

Acute Gastroenteritis

Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in

acute diarrhea. The inflammation is caused most often by infection with certain viruses, less often by bacteria or their toxins, parasites, or

adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis as foodborne illness are due to norovirus.

Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and

astrovirus.

Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,

Clostridium, Escherichia coli, Yersinia, and others. Each organism causes slightly different symptoms but all result in diarrhea. Colitis,

inflammation of the large intestine, may also be present. Some types of acute gastroenteritis will not resolve without antibiotic treatment,

especially when bacteria or exposure to parasites are the cause. Physicians may want to diagnose the cause by analyzing a stool sample,

when stomach symptoms remain problematic.

Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year and is a leading cause of death among infants

and children under 5. The most common symptoms are diarrhea, vomiting and stomach pain, because whatever causes the condition inflames

the gastrointestinal tract. Another reason to seek medical treatment is that some forms of acute gastroenteritis mimic appendicitis, which may

require emergency treatment. As well, young children run an especially high risk of becoming dehydrated during a long course of the stomach

flu. One should receive directions regarding how to help affected kids or adults get more fluids. Sometimes children, those with compromised

immune systems, and the elderly may require hospitalization and intravenous fluids. Dehydration can actually cause greater nausea, and can

begin to cause organ shut down if not properly addressed.

Acute gastroenteritis is quite common among children, though it is certainly possible for adults to suffer from it as well. While most

cases of gastroenteritis last a few days, acute gastroenteritis can last for weeks and months.

Acute gastroenteritis remains a serious health issue, and is responsible for over 50,000 hospitalizations of children. In developing

countries, acute gastroenteritis is the leading cause of death for infants. Acute gastroenteritis should thus be taken seriously, and people

should not hesitate to seek medical treatment for especially seniors and children who have been ill for more than a day.

In the Philippine Health Statistic, gastroenteritis range as number 10 in the ten leading causes of infant mortality, with the rate of 0.5

and percentage of 4.1 cases in the Philippines by the year 2004 this was updated last February 12, 2008.

Significance of the study:

his study will enable the students to understand better about acute gastroenteritis 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 patient’s comfort and this study will give the students sufficient

knowledge that will help them to plan and implement nursing care plans that will satisfy patient’s needs.

II. OBJECTIVES:

A. General Objectives

This study aims to convey familiarity and to provide an effective nursing care to a patient diagnosed with Acute Gastroenteritis through

understanding the patient history, disease process and management.

B. Specific Objectives

1. To present a thorough assessment, through Nursing Health History, Gordon’s Typology 11 Functional Pattern, Physical Assessment, and

the interpretation of the laboratory examination done on the patient.

2. To discuss the anatomy and physiology, pathophysiology of the patient’s condition, usual clinical manifestations and possible

complications of this condition.

3. To have knowledge to the client medication and be familiar to that medication.

4. To formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to

help the patient recover.

III. PATIENT'S PROFILE

 

A. Biographical Data

Date: July 16, 2009 Clinical Area : Pedia ward room 202

Name                                         :           Ms. BB

Address                                     :           San Isidro II, Paombong, Bulacan

Date of Birth                               :           November 5, 2005

Age                                             :           3 ½ years old

Sex                                             :           Female

Civil Status                                 :           Single

Nationality                                  :           Filipino

Religious Preferences               :           Born Again Christian

Health care financing                 :           Philhealth and Financial health assistance from baranggay health center

Date of Admission                     :           July 15, 2009

  Diagnosis : Acute Gastroenteritis with signs of dehydration

B. Chief Complaint

 

According to the significant others, the client was vomiting and defecating that’s why they rushed her to the hospital.

IV. HEALTH HISTORY

A. History of Present Illness

 

Prior to admission, the client was vomiting and defecating. Her stool was watery and its color is green. At first, they to the baranggay

health center and the midwife gave them medication. According to the midwife, the medication is for LBM, but after drinking the medication,

the client was still defecating and vomiting so the family decided to rush the client at Emilio G. Perez Memorial District Hospital the next day.

B.   Past History

 

                  The client had fever, cough and colds. She had completed all vaccinations including BCG, DPT, Oral Polio Vaccine, MMR and

Hepatitis B vaccine. The patient had never been any of the childhood disease such as measles, mumps and chicken pox. The patient had no

history of accident or any injury. She does not have allergy in any food or drug. She was not hospitalized before and she does not take any

medication or supplements to maintain her health.

C. Family History

According to the significant others of BB they have a familial disease of asthma, both on her father and mother's side. And an incident

of hypertension on his father's side.

Genogram:

Legends

EC

55 y/o

HPN

LB

54 y/o

VB

33 y/o

LP

32 y/o

ASTH

KM

31 y/oMB

29 y/o

LO

35 y/o

ASTH

PC

31 y/o

JB

28 y/o

HE

23 y/o

ASTH

EB 56y/o HPN

RC

57 y/o

HPN

Paternal Maternal

CB

1 y/o

BB

3 ½ y/o

JC

20y/o

AC

22 y/o

ACTIVITIES OF DAILY LIVING

 

Functional Health Perception Prior to Hospitalization During Hospitalization

 

Nutritional Metabolic Pattern

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ø      The client eats four times a day

including breakfast, lunch, merienda and

dinner. According to the significant

others, she always eats rice and soup.

She can drink 4 glasses of water in a

day. She has no eating discomforts. She

does not have any dental problems

because she has a complete set of teeth.

3 days food recall

July 11

 

3 cups rice

3 cups soup

4 glasses of

water

July 12

 

3 cups rice

1 piece of

egg

½ piece

paksiw na

bangus

3 glasses of

July 13

 

3 cups rice

3 cups soup

2 pices of

bread

4 glasses of

water

 

> The client seldom eats at the hospital. She

does not have appetite for eating. She seldom

drinks water or other fluids.

 

3 days food recall

July 14

 

2 cups rice

1 bowl of

sinigang

soup

2 glasses of

water

July 15

 

1 glass of

water

July 16

 

2 pieces

ponkan

½ glass of

water

 

 

 

 

 

 

 

Elimination Pattern

 

 

 

 

 

Activity-exercise Pattern

 

 

 

 

 

 

 

 

Sleep-rest Pattern

 

 

 

water

 

 

Ø      The client defecates everyday and her stool is soft but formed and its color is brown and has a foul odor. She urinates five times a day and is yellowish in color. She has no discomfort in defecating and urinating.

Ø      The client has sufficient energy for

completing her desired required

activities.

 

0-     feeding

0-     clothing

II- bathing

II- grooming

 

 

Ø      The client sleeps about 10 hours a

day. From 8pm to 6am. She has no

problem falling asleep and does not take

sleep medications. Her sleep is always

 

  

 

Ø      The client defecates three times a

day. Her stool is watery and its color is

green. She urinates twice a day and it is

yellowish in color.

 

Ø      The client does not have sufficient

energy for completing her desired

required activities.

 

II- feeding

II- clothing

 

II- bathing

II- grooming

 

Ø      The client still sleeps 10 hours a day.

She only wakes up when her

medications are due. She has no problem

falling asleep and does not take any

 

 

 

 

Cognitive-Perceptual Pattern

 

 

 

 

 

 

Role-relationship Pattern

 

 

 

 

 

 

  Value-belief Pattern

 

 

continuous especially when she is tired.

She takes a nap during afternoon. From

12:30pm to 3pm.

Ø      The client does not have difficulty in

hearing and has no hearing aid.

According to the significant others,

whenever the client feels pain or any

discomfort, they always give her

medications.

 

Ø      The client lives with her mother,

father and grandparents. The structure of

her family is extended. And just like the

typical family, their family has problems

wherein they have difficulty in handling,

as stated by the grandmother.

 

Ø      The client is a born again Christian.

According to the significant others, they

attend mass every Sunday.

sleep medications. She does not take

naps.

 

 

 

Ø      The client takes medications to

relieve any discomforts.

 

 

 

 

 

Ø      The Family of the patient especially

her parents are supportive and more

caring.

 

 

 

 

 

V. DEVELOPMENTAL TASK

Erik Erikson-Psychosocial development

The patient is currently in the early childhood stage (3-6 y/o) wherein the central task is Initiative vs. Guilt. During this stage, initiative

adds to autonomy the quality of undertaking, planning, and attacking a task for the sake of being active and on the move. The child is learning

to master the world around him or her, learning basic skills and principles of physics; things fall to the ground, not up; round things roll, how to

zip and tie, count and speak with ease. Guilt is a new emotion and is confusing to the child; he or she may feel guilty over things which are not

logically guilt producing, and he or she will feel guilt when his or her initiative does not produce the desired results. At this stage the client

wants to begin and complete her own actions for a purpose.

Interpretation: Positive Resolution

Jean Piaget’s Cognitive Development

The patient is under the Pre-operational stage. In this period intelligence is demonstrated through the use of symbols, language use

matures, and memory and imagination are developed, but thinking is done in a nonlogical, nonreversible manner. Egocentric thinking

predominates. The patient was able to do make believe play and able to imitate others, like her mother doing some household chores as

verbalized by the "SO".

Interpretation: Positive Resolution

VI. PHYSICAL ASSESSMENT

Date: July 16, 2009 Clinical Area : Pedia ward room 202

BODY PARTS

ASSESSEDTECHNIQUES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

1.Skin

a. Moisture Palpation Moisture in skin folds and axillae Dry skin Deviated due to slight

dehydration

b Texture Palpation Smooth Rough Deviated due to slight

dehydration

c. Turgor Inspection and

Palpation

Springs back immediately to

previous state

Moves back slowly Deviated due to slight

dehydration

2. Mouth

a. LipsInspection Pink in color, soft moist, smooth

texture, symmetrical no

tenderness, no lesions

Dry lipsDeviated due to slight

dehydration

b.Mucosa Inspection and

Palpation

Uniform pink color Dry and slightly pink in color Deviated from normal due

to slight dehydration

c. Gums Inspection and Pink gums, moist, firm texture Pink gums, dry, firm texture Deviated from normal due

Palpation to slight dehydration

3. Abdomen

Bowel sounds Auscultation Audible bowel sounds Hyperactive bowel sound Deviated due to diarrhea

VII. REVIEW IF SYSTEM

Digestive System

The primary function of the digestive system is to break down the food we eat into smaller parts so the body can use them to build and

nourish cells and provide energy. There occurs propulsion which is the movement of food along the digestive tract. The major means of

propulsion is peristalsis, a series of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs and

that forces food to move forward. It secretes digestive enzymes and other substances liquefies, adjusts the pH of, and chemically breaks down

the food. Mechanical digestion is the process of physically breaking down food into smaller pieces. This process begins with the chewing of

food and continues with the muscular churning of the stomach. Additional churning occurs in the small intestine through muscular constriction

of the intestinal wall. This process, called segmentation, is similar to peristalsis, except that the rhythmic timing of the muscle constrictions

forces the food backward and forward rather than forward only. Chemical digestion which is the process of chemically breaking down food into

simpler molecules. The process is carried out by enzymes in the stomach and small intestines. Then absorption or the movement of molecules

(by passive diffusion or active transport) from the digestive tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the

digested food into the body. And lastly, defecation which is the process of eliminating undigested material through the anus.

But because of acute gastroenteritis the normal functions were altered. The infectious agents that cause acute gastroenteritis causes

diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production.

These mechanisms result in increased fluid secretion and/or decreased absorption leading to diarrhea. This produces an increased luminal

fluid content that cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients.

VIII. ANATOMY AND PHYSIOLOGY

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:

The start of the process - the 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 break down starches into smaller

molecules).

On the way to the stomach: the 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 (called peristalsis) to force food from the throat

into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down.

In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the

stomach that is partly digested and mixed with stomach acids is called chyme.

In the small intestine - After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum

and then the ileum (the final part of the 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.

In the large intestine - After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water

and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus,

Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the

appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the

transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon.

The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.

Digestive System Glossary:

anus - the opening at the end of the digestive system from which feces (waste) exits the body.

appendix - a small sac located on the cecum.

ascending colon - the part of the large intestine that run upwards; it is located after the cecum.

bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the small intestine.

cecum - the first part of the large intestine; the appendix is connected to the cecum.

chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for further digestion.

descending colon - the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon.

duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum.

epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. When you swallow, the

epiglottis automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the windpipe.

esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements (called peristalsis) to force food from the

throat into the stomach.

gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in the liver)

into the small intestine.

ileum - the last part of the small intestine before the large intestine begins.

jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.

liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks down fats) and

some blood proteins.

mouth - the first part of the digestive system, where food enters the body. Chewing and salivary enzymes in the mouth are the beginning of

the digestive process (breaking down the food).

pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes from the pancreas help in the

digestion of carbohydrates, fats and proteins in the small intestine.

peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is involuntary - you

cannot control it. It is also what allows you to eat and drink while upside-down.

rectum - the lower part of the large intestine, where feces are stored before they are excreted.

salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into

smaller molecules.

sigmoid colon - the part of the large intestine between the descending colon and the rectum.

stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in the stomach.

When food enters the stomach, it is churned in a bath of acids and enzymes.

transverse colon - the part of the large intestine that runs horizontally across the abdomen.

IX. PATHOPHYSIOLOGY

Etiology: Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,

Clostridium, Escherichia coli, Yersinia,Norovirus, adenovirus

Person to person (hands) Contaminated food and/or water

Ingestion of Pathogens

Stimulation and destruction of mucosal lining of the bowel wall

Non-modifiable Factor: AgeModifiable Factors: Lifestyle; Diet; Hygiene

Direct invasion of the bowel wall Endotoxins are released

Digestive and absorptive malfunction Excessive gas formation GI Distention

Nausea & vomiting

Secretion of fluid & electrolytes in the intestinal lumen

Increased peristaltic movement

Increased secretion of Cl & HCO3 ions in the

bowel

Inhibition of Na reabsorption

Diarrhea

Fluid and electrolytes imbalance

Dehydration

Dry lips, dry mouth, flushed skin, fatigue,

irritability

X. LABORATORY FINDINGS

Complete Blood Count:

Blood Test Standard Range Actual Findings Interpretation

WBC 5.10 x 109/L 22.3 x 109/L The body is fighting against an infection

RBC 3.80-5.80 1012/L 5.53 x 1012/L Normal

HGB 110-165 g/L 136 g/L Normal

HCT .350-.500 1/l 0.441 1/l Normal

PLT 150-390x 109/liter 156 x 109/liter Normal

PCT.100-.500 10-2/l

.133 10-2/l Normal

MCV80 – 97 fL

80 fL Normal

MCH26.5 - 33.5 L

24.6 L An indication of microcytic, hypochromic anemia

MCHC315-350 Lg/l

308 Lg/l An indication of iron deficiency anemia

RDW10.0-15.0 %

15.1% An indication of iron deficiency anemia

MPV6.5-11.0 fL

8.5 fL Normal

% LYM17-48 L %

15.7 L% Normal

%MON4-10 L%

8.3 L % Normal

% GRA43-76 H%

81.0 H% Indicates presence of infection

# LYM1.2-3.2 109/L

3.5 109/L Indicates presence of infection

#MON0.3-0.8 109/L

0.7 109/L Normal

#GRA1.2-6.8 109/L

18.1 109/L Indicates presence of infection

Blood type: O

RH : +

Fecalysis:

  Microscopic Findings Normal Values Actual Findings Analysis/Interpretation

Ova/ parasite NOPS Entamoeba Invasion of microorganismRBC 0-5/hpf 3-5/hpf Normal

Mucus 0- + Invasion microorganismsBacteria Negative(-) ++++ Invasion microorganisms

Pus Cells 0 8-12/hpf Invasion of microorganisms

XI. DRUG STUDY

DRUG NAME DOSAGE, ROUTE,

FREQUENCYINDICATION / ACTION CONTRAINDICATIONS ADVERSE EFFECTS

NURSING

RESPONSIBILITIES

1. Cefuroxime 250 mg

TIV

(q 8 hrs.)

 

-          It interferes with the

final step in the

formation of the bacterial

cell wall.

-          Lower respiratory

tract infection

-          Hypersensitivity

to cephalosphorins

 

N and V, anorexia,

abdominal cramps or

pain and headache.

-          Protect drug

from sunlight

-          Instruct the

client to take with

food to enhance

absorption

 

2. Ranitidine 12mg

TIV

(q 6 hrs.)

-          Inhibits gastric acid

secretion by blocking the

effect of histamine on

histamine H2 receptors.

-          GERD

-          Cirrhosis of the

liver

-          Impaired renal or

hepatic function

Abdominal pain,

headache, dizziness,

malaise, N and V

 

-          Take as

directed with

immediately

following meals

-          Store at room

temperature

3.

Metronidazole     

125mg/ 3.5 ml

PO

(q 8 hrs.)

 

-          Inhibits growth of

amoebae by binding to

DNA, resulting in loss of

helical structure, strand

breakage, inhibition of

-          Active organic

disease of the CNS

-          Blood dyscrasias

- nausea, dry mouth,

vomiting, diarrhea

 

-          Take with food

or milk to reduce

GI upset

-          Drug may turn

urine brown, don’t

nucleic acid synthesis

and cell death.

-          Amoebiasis

be alarmed.

 

XII. NURSING CARE PLAN

ASSESSMENT DIAGNOSIS BACKGROUND

STUDY

PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:

Objective:

>Hyperactive

bowel sounds

>vomiting

>BM (4x),

watery and

greenish in

color

     

Diarrhea

related to

physiological

factors

(parasites)

Introduction of bacteria into the GI

tract

Release of bacterial toxins

Disrupts the mucus lining of the

stomach

 Release of HCl cause gastric

irritation

Increase gastric motility/peristalsis

 

Increase gastric

After 8 hours of

Nursing Intervention,

client will be able to

reestablish and

maintain normal

pattern of bowel

functioning.

Independent:

>Monitor I/O.

>Restrict solid food

intake.

> Increase oral

fluid intake and

return to normal

diet as tolerated.

Dependent:

> Administer

antidiarrheal

medications as

indicated.

>These assessments

are used to monitor

volume status.

>To allow for bowel

rest/ reduced

intestinal workload

> To ensure

adequate amt. of

fluid is taken by the

pt.

> To decrease

gastrointestinal

motility and minimize

fluid loses

Goal met

After 8 hours of

Nursing Intervention,

client will be able to

reestablish and

maintain normal

pattern of bowel

functioning.

motility

Frequent defecation

(DIARRHEA)

ASSESSMENT DIAGNOSIS BACKGROUND

STUDY

PLANNING INTERVENTION RATIONALE EXPECTED

OUTCOME

Subjective:

Objective:

>watery stool

>vomiting

Risk for

deficient fluid

volume r/t

excessive

loss of fluids

and

electrolytes.

Digestive and

absorptive

malfunction

Increased secretion

of fluid and

electrolytes in the

lumen

Increased water

content of the stools

acompanied by

vomiting

Imbalanced fluid and

electrolytes

Risk for deficient fluid

volume

Reference:

After 2 hrs of nursing

intervention the ct with

the help of the "SO"

will be able to

demonstrate behaviors

to prevent

development of fluid

volume deficit.

Independent

>Monitor I/O

balance, being

aware of altered

intake or output.

>Offer fluids

between meals &

regularly

throughout the day.

> Promote intake of

high-water content

foods and/or

electrolyte

replacement drinks.

Dependent:

>Provide

supplemental fluids

as indicated.

>To ensure accurate

picture of fluid status.

>To prevent

occurrence of deficit

>To facilitate

hydration

> Fluids may be

given if the ct. is

unable to take oral

fluid, or when rapid

fluid resuscitation is

required.

Goal Meet

After 2 hrs of nursing

intervention the ct

with the help of the

"SO" was able to

demonstrate

behaviors to prevent

development of fluid

volume deficit.