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I. INTRODUCTION

Children with acute gastroenteritis (AGE) have been seen on daily basis in

both the primary care and hospital setting. Majority of them are able to tolerate

this illness without hospital care. For the past decades, it had remained a

common cause of morbidity and mortality throughout the world. But for what

reason? What is really with this disease that makes some members of the

society very vulnerable to it?

Acute Gastroenteritis (Acute Infectious Diarrhea) is a nonspecific term for

a variety of pathologic states of the gastrointestinal tract. It is an acute infectioussyndrome of the stomach lining and the intestines often caused by bacteria,

viruses and/or parasites. The primary manifestation of this disease is diarrhea

but it may be also be accompanied by nausea, vomiting and abdominal

cramping. The severity of this illness may vary from mild and inconvenient to

severe and life threatening depending upon the volume of fluid loss. Appropriate

management requires extensive history taking, continuous assessment and often

etiology-specific treatment.

Each year, more than 3.5 million infants develop acute viral

gastroenteritis, resulting in more than 500,000 office visits, 55,000

hospitalizations, and 30 deaths. Statistics on sporadic cases of adult viral

gastroenteritis are not known; food- and water-borne epidemics of viral

gastroenteritis are monitored by the US Centers for Disease Control and

Prevention (CDC) surveillance programs. The CDC estimates that viruses cause

9.2 million (out of a total of 13.8 million from all causes) cases of food-relatedillness each year.

Noroviruses cause approximately 23 million cases of acute gastroenteritis

each year and are the leading cause of outbreaks of gastroenteritis. They are

responsible for 68-80% of all outbreaks in industrialized countries. The genus

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Norovirus was formerly called the Norwalk-like virus. The genus is in the family

Caliciviridae.

A. Current Trends

An article entitled, A New Vaccine Against Enteritidis Salmonella last

January 7, 2006 was issued. Javier Ochoa Repraz defended his PhD thesis at

the University of Navarre Faculty of Science on the development of an acellular

vaccine against Salmonella enteritidis. This involves a world pandemic

considered to be the most important zoonosis or illness/infection transmissible

salmonellosis by animals to humans under natural conditions. It is estimated that

the incidence of acute worldwide is more than a thousand million cases per

annum and causes three million deaths. The project developed by Javier Ochoa

centered on the investigation of a new vaccine based on the encapsulation of the

components of the Salmonella enteritidis cell sheath. The vaccine has shown

itself to be efficacious in mice infected with this illness and is currently being

employed on experimental farms of Hipra laboratories in Gerona, a company

involved in the control of pathogens in birds.

They had chosen this case study primarily because of interest to gain

further understanding regarding the disease condition. This serves additional

source of information for the researcher and other people to help prevent the

occurrence of such disease. This will also help in providing current and accurate

information concerning the latest approaches to gastroenteritis treatment and

related complications. Information dissemination is very important thus initiates

participation of client, if appropriate, so that critical question regardinggastroenteritis therapy can be addressed and that the significant others play an

important role in the recovery process. This will also help the nurse in ensuring

that the client and family members understand treatment options and provide

clarification when necessary.
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B. Reason/s for choosing this Case Study

As the group started to have our duty at the medicine ward in one of the

hospitals in Bulaon, we found out that AGE is one of the prominent condition

experienced by clients. With this, we have agreed to read different sources that

could help us decide what case we would be presenting in this case study.

After a week of library works and internet researches, our group has finally

agreed to make use of Acute Gastroenteritis for our case study for the following

reasons: first, we became interested why this disease was so prevalent in our

country. Second, is that we think our case would be interesting to read about and

learn for it would give us ideas on the etiology and specific cause of the disease. The third and most important reason why they have chosen Acute

Gastroenteritis was because most of the patients are diagnosed with kind of

disease, thus as members of the health care team, we know that they play an

important role in the management and prevention of our patients condition in

order to increase their life expectancy.

II. NURSING ASSESSMENT

1. PERSONAL DATA

This is the case of baby Ein (not his real name), 8 months of age, male and

natural-born Filipino. He is currently residing at Divisoria, Mexico Pampanga. He

was born on February 16, 2007 in Mexico, Pampanga in a normal spontaneous

delivery. He was delivered to their house. His mother was 21 years of age and a

housewife and his father was 27 years of age and a construction worker. The

patient was admitted last November 10, 2007, 10:15 am with a diagnosis of

Acute Gastroenteritis (AGE) with some signs of dehydration (DHN).

*Informant: _______ parents

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2. PERTINENT FAMILY HEALTH-ILLNESS HISTORY

Sib 1

- heart problem

- kidney problem - hypertension

- ulcer

- AGE

- h-fever - asthma

Sib 5 Sib 6

Sib 4Sib 3

Sib 2

Father

Mother

Dad

Mom

Dad

Mom

Sib 12

Sib 4

Sib 5

Sib 3

Sib 2Sib 1

Sib 8 Sib 9

Sib 7Sib 6

Sib 11Sib 10

Baby Ein

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The family of baby Ein belongs to the extended type of family where in the

nuclear family is living with the parents of the mother or father. Baby Ein is living with his

parents and grandparents. He was delivered via Normal Spontaneous Delivery and his

parents were both happy having him in their life.

The father of Baby Ein works as a construction worker and earns P1300 per

week. This compensation is just enough for their expenses. The family lives in a

bungalow type of house.

The family doesnt believe with herbolarios but uses some known herbal meds

such as guava. They also do self-medication such as giving paracetamol for fever when

someone in their family gets sick. They go to the barangay health center when thecondition gets worst but they resort to the nearest hospital when the BHC is not

available.

3. PERSONAL HISTORY

a) Pre-natal History

The mother had difficulty laboring for baby Ein. He was delivered via normal

spontaneous delivery at home last February 16, 2007. He was full term baby and

had a birth weight of 6.4 pounds. No post partum complications on both the child

and the mother were noted.

B) Feeding

The child had breast milk feeding for 1 month, and then, a milk formula for the

rest of the month onwards. The mother makes use of Bonamil in bottle-feeding her

child.

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D. Growth and Development

Erik Erikson

Baby Ein is under the developmental task trust vs. mistrust. Under this stage,

the infant learns to love and be loved and the most significant person is his mother.

This development stage is evident to baby Ein as he always clings to his

mother as the student nurse does the interview. He feels the sense of security when his

mother is holding him.

Sigmund Freud

Baby Ein is under the Freuds infant period called oral phase. In this

stage, infants are so interested in oral stimulation or pleasure. The infant

explores the world by using mouth, especially the tongue.

This is evident to baby Ein as he stopped crying when his mother gave

him baby bottle that contains water. Her mother also told the student nurse that

whatever baby Ein holds, he put it in his mouth.

Jean Piaget

The infants stage, according to Piaget, is the sensorimotor stage where infants

play with their body. Baby Ein is under this stage of Piaget specifically in the secondary

circular reaction. In this stage, infant learns to initiate, recognize and repeat pleasurable

experiences from environment. Memory traces are present and infant anticipates

familiar events.

This is evident to Baby Ein as he automatically clings to his mother as she

approaches him. He also smiles as his mother plays kikik-bulagawith him.

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E. Immunization Status

Regarding the immunization status, Baby Ein had a complete immunization that

a 7-month old infant must have (BCG, DPT, OPV, Hepa B). This includes 1 dose

Bacillus Calmette Guerin (BCG), 3 doses of Diphtheria, Pertussis, Tetanus (DPT), 3

doses of Oral Polio Vaccine (OPV) and 3 doses of Hepatitis B.

Baby Ein received each vaccine as scheduled at their Barangay Health Center.

Side effects of BCG and DPT, particularly fever, were noted but were relieved after a

day.

4. HISTORY OF PAST ILLNESS

According to the parents of baby Ein, the child had colds and fever before and in

order to get rid of that fever they are usually using antipyretic drug such as Tempra.

Within the day, he was able to recover from sickness. The baby sometimes have

stomach ache and whenever that circumstances happen they give the child herbal

meds such as oregano.

Baby Ein has never been hospitalized before. And according to the parents, the

health center were they reside is not always available. But the baby had his

immunization complete at his 7th month.

5. HISTORY OF PRESENT ILLNESS

November 8 and 9 2007, prior to the admission, the baby started to manifest

vomiting and diarrhea for more than three times. Baby Ein lost his appetite. He also

had fever and colds. Hydrite was given to him to be his supplements. The patient

was given balsamo last November 9 in the morning.

Baby Eins condition continually progressed. Due to these signs and

symptoms, her parents were alarmed. Last November 10, he was referred to

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pediatric ward of bulaon for admission, further evaluation and treatment. Baby Ein

was admitted with diagnosis of AGE.

6. PHYSICAL ASSESSMENT

November 10, 2007

General Survey:

Received patient in a lying position, asleep, with an IVF of D5 0.3 NaCl regulated

at 30 gtts/min infusing well on the right hand

Vital Signs: T: 37.4CPR: 120 bpm

RR: 50 cpm

Skin Brown in color, no altered pigmentation, no edema or swelling upon

palpation, temperature is within normal range and has poor skin

turgor

Head Hair and Scalp: Short hair, black in color, hair equally

distributed on scalp area, No infestation or infection noted

Skull: Rounded, smooth skull contour and no masses

or nodules noted

Face: Symmetrical facial feature, palpebral fissures,

equal in size, symmetric nasolabial folds and symmetric

facial movements

Eyes: Eyebrows and eyelashes hair evenly distributed, eyelids

have no discharge, no discoloration, lids close symmetrically and

withpale palpebral conjunctiva

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Vision: Patient can see objects in the periphery. Illuminated

pupil constricts while non-illuminated dilates. PERRLA

Ear: Color of the auricles same as the facial skin. Symmetrical

and aligned with outer canthus of eye, mobile, firm and not tender,

pinna recoils after it is folded. Patient turns when called by his

mother

Hearing: Patient turns when called by his mother

Nose: Centrally located, uniform in color, no discharges noted, not

tender, no lesions and air moves easily as the patient breathe

through the nares

Sinuses: Not tender

Mouth : Mild drying of lips and oral mucosa, pale

colored lips

Oropharynx: With pink and smooth posterior wall, no

discharge, (+) gag reflex

Neck Head movement is coordinated with no discomfort, no swelling and

no masses noted and no enlargement of lymph nodes upon

palpation

Thorax No tenderness and no masses on the chest skin, skin is intact and

uniform temperature, with regular breathing pattern, normal anterior

and posterior and transverse diameter

Lungs With normal breath sounds upon auscultation

Heart With normal rhythm and rate noted upon auscultation

Abdomen With hyperactive bowel sound, uniform in color, slightly globular,

with grimaces upon palpation, with loose bowel movement

(3x), symmetric movements caused by respiration

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Upper extremities with poor skin turgor, intact nail beds, with normal

capillary refill (

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7. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostic

Laboratory

Procedures

Date ordered

Date results in

Indications or

purposes

Results Normal Values

(Units used in

the hospital)

Analysis and

Interpretation of

ResultsComplete Blood

Count

DO: November

10, 2007

DR: November10, 2007

Complete blood

count is an

analysis of bloodthat provides

much information

about the

hematologic

system and other

organ systems

Hgb: 115 g/L

Hct: 0.37

Total:

WBC: 10.8

Segmenters: 0.68

Lymphocytes:

0.32

Hgb: 140-180 g/L

Hct: 0.42-0.52

WBC: 5-10

thousand/mm3

Segmenters:

0.40-0.60

Lymphocytes:

0.20-0.40

A decrease in Hgb

and Hct are

indicative ofdietary

deficiency

An increase in WBC

is an indicative of

inflammation

An increase in

segmenters is an

indicative of

bacterial infection

Normal count of

lymphocytes

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indicates that the

client is free from

chronic infection and

viral infection

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Nursing Responsibilities:

Before the procedure

1. Check doctors order

2. Explain to the SO the purpose and the procedure of the analysis

3. Provide clean specimen cup

4. Explain to the SO to obtain the midstream urine

During the procedure

1. Collect the urine in a clean catch specimen cup

2. Label the specimen cup properly

After the procedure

1. The specimen should be delivered to the laboratory within 1 hour.

2. Refer the results to the physician.

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Diagnostic

Laboratory

Procedures

Date ordered

Date results in

Indications or

purposes

Results Normal Values

(Units used in

the hospital)

Analysis and

Interpretation of

Results

Fecalysis DO: November

10, 2007

DR: November

10, 2007

Aids in diagnosis

of GI disorders

and screening

test for occultblood

Color: Yellowish

Consistency:

Watery

Parasite: Nointestinal parasite

seen

Others:

Bacteria: Few

There are no

normal values

indicated in the

hospital

It indicates that

the patient is at

risk of

dehydration

It indicates that

the patient is free

from intestinal

parasite

It indicates that

the disease is

due to bacteria

Nursing responsibilities:

Before the procedure

1. Check for doctors order

2. Explain the procedure to the patient

3. Instruct patient to avoid red meat, poultry, fish, turnips and uncooked fruits and vegetables during testing

4. Withhold non-preparations, salicylate, NSAIDs, vitamin C because they may alter test results

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During the procedure

The nurse should give the client or SO the following instructions

1. Defacate in a clean bed pan or commode

2. Do not contaminate the specimen if possible by urine void before the collection

3. Do not place toilet tissue in the bed pan after the defacation, contents of the paper can affect lab analysis

After the procedure

1. Instruct patient of proper hygiene

2. Assist the client going back to the room

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III. ANATOMY AND PHYSIOLOGY

The Human Digestive System

The digestive tract is basically a hollow muscular tube, mucosal epithelium lining the

inner surface, and circular and longitudinal muscle comprising the walls. The mucosa,forming the inner lining of the tract, is supplied with a rich network of blood vessels,

nerve fibres and endocrine cells. Epithelial cells (specialised for both absorption and

secretion depending on their location in the digestive tract) cover this mucosal layer.

The serosa is a layer of connective tissue covering the tract on the outside.

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In the mouth, food is broken down to small pieces and worked upon by digestive

enzymes in the saliva. After chewing, the food is passed along the digestive tract by

muscular action and mixed with further enzymes. These enzymes digest carbohydrates,

fats and proteins. The end products of digestion include glucose, amino acids, fats,

glycerol and fatty acids. These are absorbed through the gut wall and transported to the

cells by the blood stream. The movement and mixing of food in the digestive tract, and

its elimination, is brought about primarily by the contractions of smooth muscle. Striated

muscle, however, is involved in the mouth, pharynx and upper oesophagus and external

anal sphincter.

The Oral Cavity

Oral mucosa lines the oral cavity. A layer of keratinised cells covers the upper

surface of the tongue and the hard palate. The mucosa lining the cheeks, undersurface

of the tongue and lips is quite thin and delicate. Nutrient absorption does not occur in

the mouth but drugs such as nitroglycerine can be administered via the mucosa inferior

to the tongue. Hard and soft palates form the roof of the mouth. The tongue forms the

floor.Three pairs of salivary glands secrete into the oral cavity. Saliva is mainly water. It

also contains electrolytes, buffers, proteins, antibodies, enzymes and waste products.

Saliva has several functions. These include:

Cleansing of the oral cavity.

Maintenance of pH preventing acid build up produced through bacterial action.

The control of bacterial population. Reduction in saliva can lead to infection.

The Esophagus

The esophagus is a thin walled tube attaching the pharynx to the stomach. Itconsists of striated muscle at the top and smooth muscle at the bottom. When food is

swallowed, the sphincter in the upper portion of the esophagus relaxes and peristalsis

propels food through the esophagus. If food particles remain in the esophagus following

this wave of peristalsis, another wave of peristalsis is stimulated which sweeps food

through into the stomach. The sphincter at the upper end of the stomach prevents the

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regurgitation of food from the stomach back into the esophagus. The final few

centimetres of the esophagus are actually in the abdominal cavity. Therefore, when

abdominal pressure increases e.g. when coughing, this terminal section of the

esophagus is compressed and stomach contents are not forced to enter into the

esophagus.

Stomach

The stomach is divided into three areas:

The fundus

The body

The pyloric antrum.

The fundus and body are quite thin walled and act as a reservoir for ingested

food. The pyloric antrum has thick walls and strong waves of contraction occur during

the digestion of a meal. The food is mixed with gastric juices and then passes from the

stomach to the duodenum via the pyloric canal. A band of smooth muscle circles this

canal and is called the pyloric sphincter.

Following ingestion of a meal, the body and fundus distend. Ripples ofcontraction (occurring about three times a minute) then begin in the middle of the

stomach forcing the food towards the pyloric antrum and pyloric canal. These peristaltic

waves occur approximately three times a minute and become greater in intensity as

they reach the pyloric canal. Therefore, every twenty seconds, a portion of the stomach

contents is pushed towards the pyloric canal. It is then propelled into the intestine. As

the pyloric sphincter contracts, the mixture is pushed back into the body of the stomach.

This mixture becomes reduced into chyme, a semi-fluid substance and each minute, 6-10ml of chyme is emptied into the intestine.

Small Intestine

The small intestine is approximately 6 metres in length and is divided into:

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Duodenum (the section closest to the stomach)

Jejunum

Ileum (the last segment of the small intestine)

Nearly all the nutrient absorption occurs in the small intestine. Segmentation,

rather than peristalsis, is seen in the small intestine. As a result of the contraction of

circular muscle at several points along this structure, the small intestine is divided into a

number of sacs. The circular muscles then contract at different places and this causes

the chyme to be pushed backwards and forwards and mixed with digestive enzymes.

Longitudinal muscles also contract and relax and massage the contents of the intestine.

The movement of chyme through the small intestine is very slow. This allows digestion

and absorption of food. The first food residues reach the end of the small intestine aboutthree to four hours following ingestion.

Large Intestine

The large intestine is approximately 1.5 m long and 7.5cm wide. It is comprised

of three parts:

Caecum

Colon

Rectum

The ascending colon travels up the right side of the abdomen towards the inferior

surface of the liver. It then turns sharply to the left and becomes the transverse colon.

As the transverse colon reaches the left side of the body, and nears the spleen, it turns

down the left side of the abdomen and becomes the descending colon. This then

becomes the pelvic colon, the rectum and finally the anus. Each day approximately500ml of food material, or chyme, enter the caecum. The longitudinal muscle of the

large intestine forms three strips. These muscles are not as long as the colon itself.

Therefore, the wall of the intestine becomes puckered and pouches called haustra are

formed. Peristaltic movements of the large intestine tend to be slow, and non-

propulsive. This aids absorption and storage functions. Haustral contractions, occurring

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at intervals of approximately thirty minutes, shuffle the contents of the intestine back

and forth. Large contractions called mass movements occur three to four times a day.

This drives the colonic contents forward for storage in the rectum.

The large intestine actively absorbs sodium from the ascending and transversecolon. This is then followed by the passive absorption of chloride and water. About

350ml is absorbed from the 500ml of chyme entering the colon, 150g of faecal material

then has to be eliminated. This includes 100g of water and 50g of solids. The length of

time the food residue remains in the large intestine will determine the amount of water

absorbed.The large intestine also secretes an alkaline mucus. This lubricates the

faeces and facilitates their passage through the intestine. The mucus also contains

bicarbonate which maintains colonic pH. The mucosa is also protected by thebicarbonate, which neutralises acids produced by bacterial fermentation..

Defecation

Stretch receptors of the rectal walls are stimulated as a result of mass

movements. This initiates the defaecation reflex. Defecation occurs when relaxation of

the smooth muscle of the internal anal sphincter, and relaxation of the skeletal muscle

of the external anal sphincter occurs. Voluntary control of the skeletal muscle of theexternal sphincter allows an individual to prevent defeacation.

Bacterial activity

Many bacterial species colonise the large intestine and form a symbiotic

relationship with man each deriving some benefit from the other. However, this natural

flora can become pathogenic if introduced into other parts of the body. Thus, their

presence distorts the normal functioning of the digestive tract which may lead to the

development of the symptoms of gastrointestinal disorders such as nausea, vomiting,

diarrhea, etc

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IV. THE PATIENTS ILLNESS

A. PATHOPHYSIOLOGY (BOOK-BASED)

Human intestinal flora protects the bowel from colonization of pathogens,however the intestinal flora can be disrupted by harmful bacteria and viruses that cause

tissue damage and inflammation or depressed by antibiotic therapy, administered either

orally or parenterally. Antibiotics most often implicated in the depression of normal flora

are clindamycin, penicillins, cephalosporins, and aminoglycosides.

Pathogens cause tissue damage and inflammation by releasing endotoxins that

stimulate the mucosal lining of the intestine, resulting in greater secretion of water andelectrolytes into the intestinal lumen. The active secretion of chloride and bicarbonate

ions in the small bowel leads to inhibition of sodium reabsorption. To balance the

excess sodium, large amounts of protein-rich fluids are secreted in the bowel,

overwhelming the large bowels ability to reabsorb the fluid and leading to diarrhea.

Pathogens also cause damage and inflammation by invading and destroying the

mucosal lining of the bowel, resulting in bleeding and ulceration. When the integrity of

the GI tract is impaired, its ability to carry out digestive and absorptive function can be

affected.

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a. Schematic Diagram (Client-centered)

Non modifiable Modifiable

- Age (1yr) -Food

Ingestion of gastric irritants

Disruption of the epithelium of the intestine due to microbial or viral

microorganism

Microorganism attack and irritates the cell on the GIT

results in exudation of serum and blood into the lumen, with widespreaddestruction of absorptive epithelium.

Diarrhea

Negative fluid balance decreased intake, increased output

The decrease in total body water causes reductions in both the intracellular and

extracellular fluid volumes.

Dehydration

Tissue damage and inflammation

Bodys defense mechanism is activated and alerted

Stimulation of the inflammatory response

Hypothalamus release pyrogens (internal or external)

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Internal pyrogens releases cytokines (such as interleukin 1) are a part of the

innate immune system,

produced by phagocytic cells, and cause the increase in the thermoregulatory

set-point in the hypothalamus

Fever

Tissue damage is detected by the nociceptors

Nociceptor sends messages in the form of electrical impulses along a peripheral nerve

to your spinal cord and brain

Pain
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b. Synthesis of the Disease

b.1. Definition of the disease

Gastroenteritis is an inflammation of the stomach and intestinal tract that

primarily affects the small bowel. It occurs throughout the world, often in epidemic

outbreaks. Contaminated food and water are major sources of these diseases and

caused thousands of deaths yearly. The incidence of infections is caused by food-borne

diseases.

Acute gastroenteritis could be more simply called a long, and potentially lethalbout of stomach flu. The most common symptoms are diarrhea, vomiting and stomach

pain, because whatever causes the condition inflames the gastrointestinal tract. 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.

Numerous things may cause acute gastroenteritis. Bacterial infection is

frequently a factor, and infection by parasites like giardia can cause acutegastroenteritis to last for several weeks. Viruses can also cause lengthy stomach flu,

particularly rotaviruses and noroviruses. Accidental poisoning or exposure to toxins may

also instigate acute gastroenteritis as well.

Pathogens that cause GI disease are transmitted by the fecal-oral route, from

person, and through ingestion of fecally contaminated food and water. GI infections are

often referred as food poisoning because food is frequently the vehicle for

transmission of actively growing microbes or their toxins. Common bacterial sources of

contaminated foods are eggs (Salmonella), raw or undercooked meat (E. coli), and

chicken (Campylobacter jejuni). Outbreaks of food-borne viral infections are almost
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entirely caused by fecally contaminated shellfish. Unpasteurized milk, apple juice, ice

cream and mayonnaise are also sources of food-borne infection.

Other causative organisms are Vibrio cholerae (cholera), Shigella bacilli

(dysentery), and Staphylococcus aureus (staphylococcal poisoning). The incubation

period for all viral and bacterial infections ranges from 6 hours to 4 or 5 days.

The main contributing factors include poor feeding in infants. Diarrhea is

common, and may be (but not always) followed by vomiting. Viral diarrhea usually

causes frequent watery stools, whereas blood stained diarrhea may be indicative of

bacterial colitis. In some cases, even when the stomach is empty, bile can be vomitedup.

A child with gastroenteritis may be lethargic, suffer lack of sleep, or run a low

fever and have signs of dehydration, which include dry mucous membranes,

tachycardia, reduced skin turgor, skin color discoloration, sunken fontanels and sunken

eyeballs and darkened eye circles, poorperfusion and ultimately shock.

The main contributing factors include poor feeding in infants. Diarrhea iscommon, and may be (but not always) followed by vomiting. Viral diarrhea usually

causes frequent watery stools, whereas blood stained diarrhea may be indicative of

bacterial colitis. In some cases, even when the stomach is empty, bile can be vomited

up.

A child with gastroenteritis may be lethargic, suffer lack of sleep, or run a low

fever and have signs of dehydration, which include dry mucous membranes,

tachycardia, reduced skin turgor, skin color discoloration, sunken fontanels and sunkeneyeballs and darkened eye circles, poorperfusion and ultimately shock.
http://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Turgorhttp://en.wikipedia.org/wiki/Fontanelleshttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Shock_(medical)http://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Turgorhttp://en.wikipedia.org/wiki/Fontanelleshttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Shock_(medical)http://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Turgorhttp://en.wikipedia.org/wiki/Fontanelleshttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Shock_(medical)http://en.wikipedia.org/wiki/Colitishttp://en.wikipedia.org/wiki/Bilehttp://en.wikipedia.org/wiki/Lethargichttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Tachycardiahttp://en.wikipedia.org/wiki/Turgorhttp://en.wikipedia.org/wiki/Fontanelleshttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Shock_(medical)

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b.2. Predisposing/ Precipitating Factors

Non-modifiable

Age- Children in child care centers and older adults living in nursing homes are

especially vulnerable. That's because children's immune systems aren't mature until

about age 6, and adult immune systems tend to become less efficient later in life

(mayoclinic.com)

Modifiable

Food- viral gastroenteritis can begin when you eat or drink contaminated food or

water, or if you share utensils, towels or food with someone who's infected.

b.3. Signs and Symptoms with Rationale

The universal manifestation of gastroenteritis is diarrhea which occurs in varying

intensity, depending on the organism involved and the health status of the individual

client. The diarrhea may be mild (two to three stools per day or intense (more than 10

watery stools per day). Nausea, vomiting, and anorexia may occur from abdominaldistention caused by increased fluid content and undigested food. Abdominal pain,

cramping, and borborygmi may occur from gas released from undigested food, irritation

of bowel mucosa, and distention of the intestines. The client may have a fever,

depending on the causative organism. The stool may test positive for leukocytes and

may contain the causative organism as well as mucus and varying amounts of blood.

The gold standard for C. difficile is the cytoxin neutralization test that confirms the

presence of toxins in the stool. Other stool tests for confirming the diagnosis of C.

difficile are the latex agglutination test, which is less sensitive than the previous test,

and the newest test, enzyme-linked immunosorbent assay (ELISA), which is rapid and

reliable. An endoscopic examination will reveal a bowel mucosa that is inflamed

edematous, and containing numerous plaques. Diagnosis can be confirmed by biopsy

of the intestine.

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Diarrhea

Disruption of the epithelium of the intestine due to microbial or viral pathogens is

a very common cause of diarrhea in all species. Destruction of the epithelium results not

only in exudation of serum and blood into the lumen but often is associated with

widespread destruction of absorptive epithelium. In such cases, absorption of water

occurs very inefficiently and diarrhea results.

Stomach pain

Visceral pain occurs when noxious stimuli affect a viscus, such as the stomach or

intestines. Tension, stretching, and ischemia stimulate visceral pain fibers. Tissue

congestion and inflammation tend to sensitize nerve endings and lower the threshold forstimuli.

Dehydration

The negative fluid balance causing dehydration results from decreased intake,

increased output (renal, gastrointestinal, or insensible losses), or fluid shift (ascites,

effusions, and capillary leak states such as burns and sepsis). The decrease in total

body water causes reductions in both the intracellular and extracellular fluid volumes.

Clinical manifestations of dehydration are most closely related to intravascular volume

depletion.

Fever

Fevers are the bodys way of letting us know that something is wrong. They are

also the bodys way of combating viruses and infection. Normal body temperature is

around 98.6F (37C). If the body has a fever, temperature will steadily rise higher than

this. When infections invade the bodys system, toxins are produced. This usually

results in a temperature rise. The response by the body is to activate the immune

system. White blood cells combat bacteria by raising the temperature.
http://www.wisegeek.com/what-is-the-immune-system.htmhttp://www.wisegeek.com/what-is-the-immune-system.htmhttp://www.wisegeek.com/what-is-the-immune-system.htmhttp://www.wisegeek.com/what-is-the-immune-system.htm

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HEALTH PROMOTION AND PREVENTIVE ASPECT

Health promotion actions for avoiding such GI infections involve instructing

clients about good handwashing technique after defacation and before handling food

and obtaining available vaccinations against bacterial and viral gastroenteritis.

Encourage cleanliness and sanitation as well as proper food handling, preparation and

storage techniques, such as cooking meats to 150F, cooking chicken to 170F, and not

allowing food to sit at room temperature for long periods. Warn clients not to eat food

containing raw eggs and refrain from buying cans, boxes, or jars that are damaged.

Advise clients to avoid the use of antibiotics over a long time. Health restoration

interventions involve client of self-management of manifestations. Instruct client to

follow their medication regimen and to call their health care provider if manifestations

continue for several days, if the client is dehydrated, or if body temperature is higherthan 100F. Promote bowel rest and replacement of fluids and electrolytes as needed.

When you're traveling in other countries, you can become sick from

contaminated food or water. To help reduce your risk:

Drink only well-sealed bottled or carbonated water.

Avoid ice cubes, because ice cubes may be made from contaminated water.

Use bottled water to brush your teeth.

Avoid raw food including peeled fruits, raw vegetables and salads that has

been touched by human hands.

Avoid undercooked meat and fish.

Get vaccinated. A vaccine against gastroenteritis caused by the rotavirus is

available in some countries, including the United States, and appears to be

effective in preventing severe symptoms of gastroenteritis.

Unfortunately, there's often no specific medical treatment for gastroenteritis.

Antibiotics aren't effective against most viruses, and overusing them can contribute to

the development of antibiotic-resistant strains of bacteria. To help keep yourself more

comfortable and prevent dehydration while you recover, try the following:

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Let your stomach settle. Stop eating and drinking for a few hours.

Try sucking on ice chips or taking small sips of water. You might also try

drinking clear soda such as 7UP or Sprite, clear broths, or noncaffeinated sports

drinks such as Gatorade. Affected adults should try to drink at least eight to 16glasses of liquid every day, taking small, frequent sips.

Ease back into eating. Gradually begin to eat bland, easy-to-digest foods such

as soda crackers, toast, gelatin, bananas, rice and chicken. Stop eating if your

nausea returns.

Avoid certain foods and substances until you're feeling better. These

include dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned

foods.

Get plenty of rest. The illness and dehydration may have made you weak and

tired.

Use medications such as ibuprofen (Advil, Motrin, others) sparingly, if at

all. They can make your stomach more upset. Use acetaminophen (Tylenol,

others) cautiously. It sometimes can cause liver toxicity, especially in children.

When your child has an intestinal infection, the most important goal is to replace

lost fluids and salts. These suggestions may help:

Give your child an oral rehydration solution such as Pedialyte. Don't use

water in children with gastroenteritis, water isn't absorbed well and won't

adequately replace lost electrolytes. You can find oral rehydration solutions in

most grocery stores. Talk to your doctor if you have questions about how to usethem. Avoid giving your child apple juice for rehydration it can make diarrhea

worse.

Get back to a normal diet slowly. Gradually introduce bland, easy-to-digest

foods, such as toast, rice, bananas and potatoes.

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Avoid certain foods. Don't give your child dairy products and sugary foods,

such as ice cream, sodas and candy. These can make diarrhea worse.

Make sure your child gets plenty of rest. The illness and dehydration may

have made your child weak and tired.

Don't give children or teenagers aspirin. It may cause Reye's syndrome, a

rare, but potentially fatal, disease. Avoid giving your child over-the-counter anti-

diarrheal medications such as Imodium unless advised by your doctor. They

can make it harder for your child's body to eliminate the virus.

If you have a sick infant, let your baby's stomach rest for 30 to 60 minutes, then offer

small amounts of liquid. If you're breast-feeding, let your baby nurse. If your baby isbottle-fed, offer a small amount of an oral rehydration solution or regular formula.

Although your baby may be dehydrated, never dilute formula

(http://www.emedicine.com/med/topic2946.htm).

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V. THE PATIENT AND HIS CARE

A. MEDICAL MANAGEMENT

a. IVF

Medical

management/

Treatment

Dare ordered/

Date

performed/

Dare changed

General

Description

Indication(s)

Or

Purpose(s)

Clients

response to

the treatment

Nursing

Responsibilities

IVF D5 0.3 NaCL

500 cc 30gtts/min

Date ordered:

11-10-07

11-11-07

Date

performed:

11-10-07

11-11-07

A hypertonic

solution. Each

100ml contains

300mg of NaCL

and 5 gram of

dextrose

monohydrate.

As a route of

administration of

IV meds and used

to replace lost

sodium and

chloride ions in the

body and tomaintain fluid and

electrolyte

balance.

The patient

experienced

discomfort

brought about

by the needle

insertion.

- read the doctors

order before infusing

IV solutions.

- inform the clients

before the procedure.

- tell the client that

there will be a milddiscomfort upon

insertion of the IVF.

- explain to the client

the importance and

uses of such

treatment.

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- check if IVF is

infusing well.

- check for the patency

of IV tubings and

adjust the flow rate as

ordered.

- monitor patient for

any irritation in the site.

- change IVF bottles

aseptically.

- select suitable vein to

permit easier access to

a vessel.

- Thoroughly cleanse

the area of insertion.

- checked for theintegrity of the line and

infusion.

- monitored flow rate

energy every 2hrs. for

accuracy.

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Medical

Management/

Treatment

Date ordered/

Date

performed/

Date changed

General

description

Indication(s)

Or Purpose(s)

Clients

response to

the treatment

Nursing

responsibilities

IVF D5 IMB

500 cc @

30-35 gtts/min

Date ordered

11-11-07

Date performed:

11-11-07

D5 IMB is a

hypertonic solution

which makes the

cell shrinks. It is

composed of water

and carbohydrates

as source of

energy and both

cation and anion.

It is used to

supply the

necessary

nutrients to the

patient and used

to restore bodys

energy and

replace fluid

losses.

The patient had

maintained

good hydration

status.

- read the doctors

order before infusing

IV solutions.

- inform the clients

before the procedure.

- tell the client that

there will be a mild

discomfort upon

insertion of the IVF.

- explain to the clientthe importance and

uses of such

treatment.

- check if IVF is

infusing well.

- check for the

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patency of IV tubings

and adjust the flow

rate as ordered.

- monitor patient for

any irritation in the

site.

- change IVF bottles

aseptically.

- select suitable vein

to permit easier

access to a vessel.

- thoroughly cleanse

the area of insertion.

- checked for the

integrity of the line and

infusion.- monitored flow rate

energy every 2hrs. for

accuracy.

b. Drugs

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Name of the drug Date ordered/

Date given/ Date

changed

Route/ Dosage/

Frequency

General Action/

Mechanism of

Action

Indication(s)

Or Purpose(s)

Clients

response to the

treatment

Paracetamol

Drops

Date ordered:

11-10-07

11-10-07

Date given:11-10-07

11-11-07

11-10-07

PO, 0.5 cc q 4

11-11-07PO, 0.5 cc PRN

Analgesic,

Antipyretic

Specific Action:Procedure by

blocking of brain

impulses. His

action is probably

caused by

inhibition of the

synthesis of action

of other

substances that

synthesize pain

receptor to

mechanical or

chemical

stimulation. It

relieves fever by

central action in

Antipyretic in

patients with

aspirin allergy,

haemostaticdisturbances,

bleeding

diatheses, GI

disease, gouty

arthritis.

-common cold, flu,

other viral and

bacterial infection

with fever and

pain.

Clients

temperature

declined gradually

to normal range.

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the hypothalamic

regulating system.


1. Avoid using multiple preparations containing acetaminophen.

2. Give drug with food if GI upset occur.

3. Do not exceed recommended dose; do not taste for longer than 10 days4. Report rash, minimal bleeding or bruising, yellowing of the skin and changes in voiding pattern.

Name of the drug Date ordered/

Date given/ Date

changed

Route/ Dosage/

Frequency

General Action/

Specific Action

Indication(s)

Or Purpose(s)

Clients

response to

treatment

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Cephradine

(Velosef)

Date ordered:

11-10-07

11-11-07

Date given:

11-10-07

11-11-07

150mg IV q 6 Antibiotic,

Cephalosporin (1st

generation)

Specific Action:

The

cephalosporins

interfere with the

final step in the

formation of the

bacterial cell wall,

resulting in the

unstable cell

membranes that

undergo lysis.

Also cell divisionand growth are

inhibited. The

cephalosporins

are most effective

against young,

rapidly dividing

GU infections due

to E. coli, Proteus

Mirabilis, or

Klebsiella species.

The patient

experienced

irritation into the

injection site

during the

infusion.

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organisms and

are considered

bactericidal.


1. Culture infection and arrange for sensitivity test before and during therapy if expected response is not seen.

2. Do not mix cephradine in solution with other antibiotic.

3. Have Vitamin K available in case hypoprothrombinemia occurs.

4. Avoid alcohol while taking this drug and for three days after because severe reactions after may occur.

5. You may experience these side effects: stomach upset and diarrhea.

6. Report severe diarrhea, DOB, unusual fatigue, pain at injection site.

Name of the

drug

Date ordered/

Date given/ Date

changed

Route/ Dosage/

Frequency

General Action/

Specific Action

Indication(s) or

Purpose(s)

Clients

response to the

treatment

Cotrimoxazole Date ordered: PO, tsp, BID Antibiotic >Acute otitis media in

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11-12-07 children.

>Travelers diarrhea

in adult caused by

E.coli.

>Prophylaxis in P.

carinii pneumonia in

immunocompromised

clients.


1. Each 5mL vial should be diluted to 125 mL with D5W and used within 6 hour.

2. Administer IV infusion over 60-90 minutes period.

3. If the diluted IV infusion is cloudy or precipitate after mixing, discard and prepare a new solution.

4. Report any symptoms of persistent fever, inflammation/swelling of veins/ lymph glands, N&V, rash, joint pain/swelling,

mental disturbances or lack of response.

c. Diet

Type of diet Date ordered/

Date started/

Date changed

General

description

Indication(s)

or Purpose(s)

Specific food

taken

Clients

response/

reaction to

the treatment

Nursing

Responsibilities

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DAT (Diet As

Tolerated)

Date ordered:

11-10-07

11-11-07

11-12-07

Date started:

11-10-07

Its a good

meal balance

and it is

designed to

achieve

optimum status

of the client. A

nearly normal

diet based on

the basic six

food groups.

For ambulatory

or bed pt.

whose

conditions do

not necessitate

or modified.

-Instructed SO to

add potassium

rich foods to the

meal of the

patient.

-Encouraged pts

SO to increase

intake of oral

fluid to of the

patient to replace

fluid losses.

-Advice clients

SO to avoid

giving milk and

milk products to

the patient toavoid

aggravation of

his condition.

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d. Activity/ExerciseType of Activity Date ordered/

Date started/

Date changed

General

description

Indication(s) or

Purpose(s)

Clients

response to the

activity

Nursing

responsibilities

Ambulatory Date Ordered:

11-10-07

11-11-07

Date started:

The patient is

allowed to do

tolerable activities

of daily living.

To encourage

mobility.

The client stayed

on bed even if he

can do ADL s

because he is

>Assist patient in

performing

activities.

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11-10-07 restless.

B. Nursing Management

1. NCP

Problem No: 1 Diarrhea r/t inflammation of the intestinal tract or presence of toxins 2 to AGE

Cues Nursing

diagnosis

Scientific

explanation

Objectives Interventions Rationale Expected

outcome

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S=

O= Patient

manifested:

> with poor

skin turgor

> appears

weak

> restless

> irritable

> hyperactive

bowel sounds

> abdominal

pain

> dry mucous

membranesPatient may

manifests:

> slow

capillary refill

> pale

palpebral and

Diarrhea r/t

inflammation

of the

intestinal tract

or presence of

toxins 2 to

AGE

Normally

human

intestinal flora

protects the

bowel from

colonization of

pathogens;

however, the

intestinal flora

can be

disrupted by

harmful

bacteria and

viruses that

cause tissuedamage and

inflammation.

Pathogens

cause tissue

damage and

inflammation

Short term:

After 2- 4

hours of

nursing

intervention

the patients

s.o. will

demonstrate

understanding

of appropriate

behaviors to

assist with the

resolution of

the causative

factors suchas proper food

handling and

avoidance of

irritating foods.

Long term:

> Establish rapport.

> Monitor and record

vital signs.

>Provide am/pm care

>Assess patientscondition especially

onset and pattern of

diarrhea.

> Auscultate abdomen

for presence, location

> To obtain trust

and cooperation of

the patient.

> To gather

baseline data for

comparison

purposes.

>To provide comfort

to the patient and

render our dearest

care.

> To ascertain theexistence of the

problem.

> To determine

related factors

Short term:

After 2-4 hours

of nursing

intervention

patients s.o.

shall have

demonstrated

understanding o

appropriate

behaviors to

assist with the

resolution of the

causative factor

such as proper

food handlingand avoidance o

irritating foods.

Long term:

After 2-4 days o

nursing

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bulbar

conjunctiva

by releasing

endotoxins

that stimulate

the mucosa

lining of the

intestine,

resulting in

greater

secretion of

h2o and

electrolytes

into the

intestinal

lumen. The

active

secretion ofchloride and

bicarbonate

ions in the

small bowel

leads to

inhibition of

After 2-4 days

of nursing

interventions

the patient will

reestablish

and maintain

normal pattern

of bowel

functioning.

and characteristics of

bowel sounds.

>Determine recent

exposure to the

environment change in

drinking water/ food

intake and others.

> Review results of

laboratory testing on

stool specimens.

> Promote use ofrelaxation techniques.

> Monitor IVF regularly.

which are in

connection with the

diagnosis.

> To identify

causative

environmental

factors which

attribute to the

patients condition.

> To assess for fat,

blood or any signs

of infection.

> To decreasepatients stress or

anxiety.

> To replace fluid

and electrolyte loss.

interventions the

patient shall

have

reestablished

and maintained

normal pattern o

bowel

functioning.

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sodium

reabsorption.

To balance

excess

sodium, large

amounts of

protein and

fluids are

secreted in the

bowel. Rapid

expulsion of

intestinal

contents

through the

small bowel,

overwhelmingthe large

bowel's ability

to reabsorb

the fluid leads

to diarrhea

> Encourage BRAT

diet.

> Instruct s.o. to

change patients diaper

when soaked.

> Encourage s.o. to

provide patient

adequate or increase

fluid intake and return

to the diet prescribed.

> Emphasize

importance of properfood handling and

handwashing.

> Administer

medications as

ordered.

> To have adequate

calories and

nutrients.

> To provide

comfort and prevent

itchiness.

> To comply with

the treatment

regimen and

prevent the severity

of the disease

condition.

> To refrain further

occurrence of thedifferent

microorganisms.

> To minimize the

underlying

conditions.

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Problem no. 2

Fluid volume deficit r/t LBM & vomiting AEB Hyperthermia 2 existing condition

Assessment Nursing

diagnosis

Scientific

Explanation

Objectives Intervention Rationale Expected

OutcomeS=

O=

>Patient manifest:-sunken eyeballs

-dry lips and

mucous

membranes.

-BM: 5

-Vomiting for 4

times

>Patient may

manifest:

-generalized body

malaise

-

hemoconcentration

Fluid volume

deficit r/t LBM

& vomitingAEB

Hyperthermia

2 existing

condition

Studies say

that children

loss more fluidrapidly during

stress

because of

their large

body surfaces.

That is why

persistent

vomiting and

loose bowel

movement in

children even

in little amount

could cause

dehydration

and could be

fatal if

Short term:

After 4 ofnursing

interventions,

patients SO

will be able to

verbalize

understanding

on health

teachings

given &

demonstrate

technique on

how to

improve

patients fluid

volume deficit

> Establish

rapport

> Assess

patients

condition

> monitor &

record VS

> reposition

client once in

a while

> Encourage

increase fluid

intake

> Emphasize

> To gain

patients trust

& cooperation

> To assess

causative

factors

> To establish

baseline data

> To promote

goodcirculation

> To replace

losses

> To provide

knowledge to

Short term:

Patients SOshould be able

to verbalize

understanding

on health

teachings

given &

demonstrate

technique on

how to improve

patients fluid

volume deficit

Long Term:

Patient should

be able to

maintain

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untreated.Long Term:

After 3 days of

nursing

interventions,

patient will

maintain

normal pattern

of bowel

functioning

health

teaching to

SO regarding

patients

condition,

care, &importance of

medications

> Emphasize

the

importance of

hand washing

> Encourage

to provideadequate rest

period

> Instruct to

provide

diarrheal diet

rule out

worsening of

underlying

condition

> To prevent

contamination

> To prevent

fatigue

> To reduce

intestinalworkload

> To evaluate

degree of fluid

volume deficit

> To treat

normal pattern

of bowel

functioning.

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> Review

laboratory

data

> Give

medications

as ordered

> Administer

IV fluids as

indicated

infections

process,

decrease

motility and/or

absorb water

> To replace

losses

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Problem no. 3 Hyperthermia

Assessment Nursing

diagnosis

Scientific

explanation

Objectives Intervention Rationale Expected

Outcome

S>

O> Pt

manifested:

>increased inbody

temperature

above normal

range

> flushed skin

> skin is warm

to touch

Hyperthermia Hyperthermia

may be related

to inflammatory

process,possibly

evidence by

increased in

temperature,

flushed warm

ski, tachycardia

and tachypnea

Short term:

After 4 hrs of

NI, the pts

bodytemperature

will decrease

within normal

range

Long term:

After 2-3 days

of NI, the pts

SO will

demonstrate

behaviors to

maintain pts

body

temperature

within normal

range

> establish

rapport

>monitor and

record VS

>identify

underlying

cause

>promote

surface cooling

by means of

TSB

>keep pt. warm

and back, dry

> to gain

comfort

feelings from

the pt

> to provide

baseline data

>to assess

causastive

factor

>to promote

heat loss by

conduction and

evaporation

>for pt to

become

comfortable

Short term:

The pts body

temperature

shall havedecrease within

normal range

Long term:

The pts SO

shall have

demonstrated

behaviors to

maintain pts

body

temperature

within normal

range

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>administer

anti-pyretics as

ordered

> to assist with

measures to

reduce bodys

temperature

Problem no. 4 ineffective Tissue Perfusion r/t impaired transport of oxygen AEB decreased hgb level

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Assessment Nursing

diagnosis

Scientific

explanation


outcome

S>

O> Patient

manifested:> pale

palpebral

conjunctiva

> capillary refill

test within 2

seconds

> with good

poor turgor

> dry lips and

oral mucous

membrane

> decrease

hemoglobin

level of 115

Patient may

Ineffective

tissue

perfusionrelated to

impaired

transport of

the oxygen

across

alveolar and

capillary

membrane as

evidence by

decrease

hemoglobin

level.

Primarily,

hemoglobin is

the oneresponsible for

the transport

of oxygen on

to the various

parts of the

body. Oxygen

transport is

accomplished

by hemoglobin

which consists

of four protein

chains and

four heme

groups. A total

of 98.5% of

the oxygen is

Short term:

After 4 hours

of nursingintervention

patients s.o.

will verbalize

understanding

of the existing

condition and

therapy

regimen.

Long term:

After 1-3 days

of nursing

interventions

patient will

demonstrate

increase

> Establish rapport.

> Monitor and record

vital signs.

> Assess patients

condition especially

signs of ineffective

tissue perfusion such

as paleness.

> Note presence of

dyspnea, chest pain

and other symptoms.

> To gain comfort

feelings from the pt

> To gather

baseline data for

comparison

purposes.

> To determine the

existence of the

disease.

> To identify

different

precipitating factors

Short term:

After 4 hours of

nursingintervention

patients s.o.

shall have

verbalized

understanding o

the existing

condition and

therapy regimen

Long term:

After 1-3 days o

nursing

interventions the

patient shall

have

demonstrated

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manifests:

> abdominal

pain

> abdominal

distention

> skin

temperature

changes

transported in

the blood.

Because of

these, if there

is markedly

decrease level

of hemoglobin

in the blood

there will be

surely

impairment on

the perfusion

of tissues.

perfusion

> Elevate the head of

the patient.

> Monitor and regulate

IVF regularly.

> Review laboratory

results such as

hemoglobin andhematocrit.

> Encourage quiet,

restful atmosphere.

in order to formulate

accurate strategies

to be given.

> To promote

circulation within the

parts of the body.

> To ensure that the

patient will be

properly hydrated.

> To be sure of the

problem and allows

what teachings tobe rendered.

> To conserve

energy and may

lower tissue oxygen

demands.

increase

perfusion

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> Encourage s.o. to

provide adequate rest

periods and refrain

from strenuous

activities.

> Encourage patients

s.o. to loosen patients

clothing.

> Identify changes

related to systemic or

peripheral alteration

such as vital signs.

> To decrease

cardiac workload

that may precipitate

to the problem.

> To allow adequate

perfusion inside the

body.

> To be

knowledgeable of

the underlying

conditions in

connection with the

situation.

Problem no.5 Acute pain

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AssessmentNursing

diagnosis

Scientific

explanationObjectives Interventions Rationale

Expected

outcomes

S>

O> pt

manifested:

>with facial

grimaces

>appears

weak

>with sleeping

disturbances

>with on/off

cramping pain

on the

abdomen

Acute pain Acute pain may

be related to

irritation/inflam

mation of

gastric mucosa,

possibly

evidenced by,

guarding/distrac

tions behaviors,

and autonomic

responses

Short term:

After 2-3 hrs of

NI, the SO will

report that pain of

the patient is

seen

relieved/controlle

d

Long term:

After 2-3 days of

NI, the SO will

help the patientdemonstrate use

of relaxation skills

and diversional

activities as

indicated for

individual

situation.

>establish

rapport with

the SO

>monitor VS

>perform pain

assessment

each time pain

occurs

> provide quietenvironment

>provide

comfort

measures

>to gain comfort

feelings from

the patients SO

>to gain

baseline data

>to assess

etiology

>to somehowhelp client to

relieve the pain

he is feeling.

>for aesthetic

purposes and

tohelp alleviate

Short term:

The SO shall have

reported that the

pain of the patient

is somehow seen

relieved/controlled

Long term:

The pt shall have

helped

demonstrated

usage of relaxation

skills anddiversional

activities as

indicated for

individual situation

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such arranging

of linens

clients feeling of

pain.

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Problem no.6 Risk for imbalanced nutrition: Less than body requirement

Assessment Nursing

diagnosis

Scientific

explanation


outcomes

S>

O> pt

manifested:

> withhyperactive

bowel sounds

> diarrhea

>pale

conjunctiva

and mucous

membrane

>with poor skin

turgor

>with dry lips

pt may

manifest:

>decreased

muscle mass

Risk for

imbalanced

nutrition: Less

than bodyrequirements

Risk factors

may include

inability to

ingestadequate

nutrients

(prolonged

vomiting,

anorexia and

epigastric pain

Short term:

After 3-4 hrs of

NI, the pts SO

will verbalizeunderstanding

of causative

factors when

known and

necessary

interventions

Long term:

After 3-4 days

of NI, the pt will

maintain stable

weight

>establish

rapport

>assess

weight, age,

body mass,

strength,

activity/rest

level; ascertain

stage of

disease

process and its

effects on

clients

nutritional

status

>evaluate

clients appetite

>to gain

comfort

feelings from

the pt> provides

comparative

baseline

>appetite may

be suppressed

because of

Short term:

The pts SO

shall have

verbalizedunderstanding

of causative

factors when

known and

necessary

interventions

Long term:

The pt shall

have

maintained

stable weight

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>recommend

rest before

meals

>provide oral

hygiene

>serve foods in

a well

ventilated,

pleasant

surroundingswith unhurried

atmosphere,

congenial

company

diarrhea

>quiet

peristalsis and

increase

available

energy for

eating

> a clean

mouth can

enhance the

taste of food

>pleasant

environment

aids in

reducing stress

and is moreconducive to

eating

2. Actual SOAPIE

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VI. CLIENTS DAILY PROGRESS IN THE HOSPITAL

DAYS Nov. 10 Nov.11

Nursing Problems:

1.Diarrhea r/t inflammation ofthe intestinal tract or presence oftoxins 2 to AGE

2.Fluid volume deficit r/t LBM &vomiting AEB Hyperthermia 2existing condition

3.Hyperthermia 4.ineffective tissue perfusion

5. Acute pain

6.Nutrition Imbalance: Less thebody requirements

Vital Signs:

Temperature ()Pulse Rate (bpm)Respiratory Rate (cpm)Diagnostic/Laboratory

Examinations

1. Complete Blood Count 2. Fecalysis

Medical Management:IVF Drugs:

Paracetamol drops Cephradine Diet:

DAT Activity:

Ambulatory

2. Discharge planninga. METHOD

M > Cotrimoxazole (Zerrprim) tsp BID

E >

T >

H > reminded SO for frequent handwashing

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> instructed SO to continue meds as ordered

> encourage SO to increase OFI

> encourage SO to increase Vitamin C, CHO and

CHON intake

> instructed SO to always keep the pt.s back dry

> discussed the importance of fluid replacement to SO

O > instructed SO to come back one week after the

discharge at Out Patient Department for follow-up

check up

D > DAT

> increase fluid intake with SAP

VII. CONCLUSIONS AND RECOMMENDATIONS

Wherever hospital you may go Acute Gastroenteritis is already a common

problem. It is not that chronic sickness however it can be fatal due to severe

dehydration in both adults and children, especially in the very young and the old or in

those who have poor immunity. This acute gastro enteritis can be prevented by proper

hygiene, such as good hand washing, a good balanced diet and clean food preparation.

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As the group further reviewed and researched for the etiology and things that are

related to their case, the group have learned and appreciated the disease condition

acute gastroenteritis. They were able to help their patient by performing proper

interventions to the patient. Knowing the disease itself during lecture is not enough for

them to have a deeper understanding of the disease. Handling the patient manifesting

the signs and symptoms made them appreciate more and comprehend better. The

group was able to learn appropriate interventions they could give to the patient. And it is

quite an overwhelming feeling knowing that somehow, they made the patients condition

better.

Their case, Acute Gastroenteritis had made a big challenge to the group. Though

they pour all their efforts in making these case a successful one, there are still somerecommendations that can be made in order to make this case study stronger one. In

making a perfect a case study, the data that have been collected must be true and

reliable. They must come from a good source such as the chart and the SO of the

patient. But sometimes, these data arent enough so its better to analyze deeply the

acquired data. Ask some professional advice, such as from the physician, if there are

data that seems to be confusing. It is also helpful if the acquired data are studied very

carefully such as drugs that are given to a patient.

VIII. BIBLIOGRAPHY

BOOKS

Smeltzer, Suzanne C., et.al. Brunner and Suddarths Textbook of Medical-

Surgical Nursing Eleventh Edition. Copyright 2008 by Lippincott Williams and

Wilkins, a. Wolters Kluwer Business

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Deglin, Judith Hopfer, et.al. Daviss Drug Guide for Nurses Tenth Edition.

Copyright 2007 by F.A.Davis Company

WEBSITES

http://www.medicalnewstoday.com

http://www.sciencedaily.com

http://www.wikipedia.com

Angeles University Foundation

College of Nursing

In Partial Fulfillment of the

Requirements for the degree of
http://www.medicalnewstoday.com/http://www.sciencedaily.com/http://www.wikipedia.com/http://www.medicalnewstoday.com/http://www.sciencedaily.com/http://www.wikipedia.com/

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Bachelor of Science in Nursing

Acute Gastroenteritis

Presented by:

Dizon, Jessel Carmen F.

Licudan, Aldrich Edison M.

Macapagal, Jamie R.

Ponio, Rose Juliene S.

BSN III-7

Group 27

Presented to:

Annalyn Gonzales, RN

Documents

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