CASE PRESENTATION
Acute Gastro Enteritis(A.G.E)
PREPARED BY: MARIAMMA JOHNSTAFF NURSE, PEDIA WARD
DEMOGRAPHIC DATA:
Name: Case no.2 MR No.: 195077 Diagnosis: Acute Gastroenteritis
Age: 1 year Gender: Female D.O. A: 23/01/2013 D.O.D: 25/01/2013
PHYSICAL ASSESSMENT: General Assessment:
Chief complaint: Febrile, Lethargic and decreased Activity
Skin: Dehydrated, Dry, Pale
and mottled, Cold extremities, capillary refill > 3 sec
Head and Neck: Neck Veins
Flattened, Sunken Eyes, Fontanel Sunken
Thorax: Normally symmetrical in size
Cardiovascular: Tachycardia present, no tachypnoea
Genitourinary: Redness of the perineal area, urine concentrated and dark color
Gastrointestinal: Abdomen is hyperactive and distended. Loose stools more than 7 times per day
Musculoskeletal: No deformities Noted. No joint or muscle pain noted during examination
Neurology: Growth and development is normal according to Erikson’s Psychosocial Stage
PATIENT HISTORY:
Past Medical History : There is no past medical history of any illness
Present Medical History: Now the baby is admitted with the complaints of loose stool, vomiting and fever
MILES STONE CHART: 0-1 YEARCHILD’S AGE and MASTERED SKILLS
1 MONTH Lifts head when lying on tummy.
Respond to sound. Stares at faces.
2 MONTHS Vocalizes: gurgles and coos. Follows
objects across field of vision. Notices his hands. Holds head up for short periods.
3 MONTHS Recognizes your face and scent.
Holds head steady. Visually tracks moving objects.
4 MONTHS Smiles, laughs. Can bear weight on
legs. Coos when you talk to him.
5 MONTHS Distinguishes between bold colors.
Plays with his hands and feet.
6 MONTHS Turns toward sounds and voices
Imitates soundsRolls over in both directions
7 MONTHS Sits without support. Drags objects
toward herself.
8 MONTHS Says ‘mama’ or ‘dada’ to parents.
Passes objects from hand to hand.
9 MONTHS Stands while holding onto
something. Jabbers or combines syllables. Understands object permanence.
10 MONTHS Waves good bye. Picks things up
with pincer grasp. Crawls well, with belly off the ground.
11 MONTHS Says ‘mama’ or ‘dada’ to the correct
parent. Plays patty- cake and peek-a-boo. Stands alone for a couple of seconds.
12 MONTHS Imitates others activities. Indicates
wants with gestures.
TOPIC PRESENTATION:
GASTROENTERITIS
Definition; Gastroenteritis is an
upset stomach. It causes nausea and vomiting. It is
sometimes called stomach flu, caused by viruses and bacteria.
ANATOMY AND PHYSIOLOGY:
The gastrointestinal tract is a muscular tube made by
epithelial cells. The individual components of
the gastrointestinal system are oral cavity, salivary
glands, esophagus, stomach, small intestine
and large intestine.
PHYSIOLOGY: ORAL CAVITY: Mechanical breakdown of food
occurring in mouth. Insalivations and absorption of small molecules such as glucose and water are the functions of oral cavity
SALIVARY GLANDS : 3 pairs of salivary glands present ,which produce saliva
ESOPHAGUS : It is a muscular tube which extend from pharynx to stomach .It acts as a transport medium between compartments.
STOMACH : Stomach is a “j” shaped bag located just left of the midline between the esophagus and small intestine. Its functions are
• The short term storage of ingested food• Mechanical breakdown of food• Chemical digestion of proteins by acids,
enzymes
ETIOLOGY: VIRAL: E.g.; Rotavirus , Adenoviruses, Norovirus , Parvovirus and Astroviruses
BACTERIAL; E.g.; Salmonella, Shigella, E- coli, Clostridium deficit
PARASITES AND PROTZOANS: E.g.; Giardia, Cryptosporidium
PATHOPHYSIOLOGY ACUTE GASTROENTERITIS
Predisposing Factors- Age
- Malnutrition
Precipitating Factors- Contaminated
Food and Water
Direct Invasion of the bowel wall
Ingestion of fecally contaminated food
and water
Endotoxins are released
Stimulation and Destruction of
mucosal lining of the bowel wall
Attempted Defecation
Excessive gas formation
GI Distention
Digestive and Absorptive Malfunction
Secretion of food and electrolytes in the intestinal lumen
Increase Peristaltic Movement
Mild Diarrhea
Fluid and Electrolytes Imbalance
Increased Protein in the Lumen
LI is overwhelmed and unables to reabsorb
the lost food
Intense diarrhea >10times watery
stool
Serious Fluid Volume Deficit
Hypovolemic Shock Death
SIGNS AND SYMPTOMS:
Book Based
Diarrhea Nausea Crampy
abdominal pain Vomiting
Patient Manifested
Nausea Diarrhea Vomiting Fever Dehydration Tachycardia
INTERVENTION:
Maintain hydration Promoting intake of nutrients Reduce hyperthermia Monitoring and preventing potential
complications
Promoting family knowledge
TREATMENT:BOOK BASE A.G.E is usually an acute
and self limiting disease that does not require medication
The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy, metaclopromide or ondansteron if needed
If it is viral : soft anti diarrheal diet Oral rehydration IV Fluids
Bacterial: Antibiotics
PATIENT TREATMENT Treated with IV Fluids, ORS solution, Inj. Perfalgan 200mg
iv prn, Voltaren suppository
12.5mg prn
COMPLICATIONS:
Pseudomembraneous enterocolitis ( usually only seen in those who are taking antibiotics)
Gastro intestinal bleeding Dehydration Electrolyte Imbalance (Hypokalemia,
Hypernatremia) Shock Sepsis ( secondary bacterial
infection )
PRIORITIZATION OF NURSING PROBLEMS:
Altered fluid volume deficit due to diarrhea and vomiting
Altered electrolyte imbalance due to diarrhea and vomiting
Imbalanced nutrition less than body requirement due to less food intake
Hyperthermia related to infection
Lack of skin integrity due to severe loose stool
NURSING CARE PLAN:
ASSESSMENT NURSING DIAGNOSIS
PLANNING IMPLEMENTATION
RATIONALE EVALUATION
SUBJECTIVEPatient’s Mother Complaints Of Increase No Of Loose Stools And VomitingOBJECTIVELoose Stool More Than 7 Times Per Day1. Dry Skin2. Cracked Lips
Altered fluid volume deficit related to active fluid loss
Within 12hrs of nursing intervention patient will Hydrated Normal lipsNo vomiting
1. Encouraged oral intake of fluids
2. Given nutritionally enrich drinks with more taste enrich with electrolyte (e.g. Pedialyte)
3. Administered IV Fluids 5% dex in ½ NS + 5 ml kcl at 60ml / hour
4. Provided rest with calm and quiet environment
5. Monitored intake and output chart
6. Provided soft Anti-Diarrheal diet
1. Helps to promote hydration
2. To avoid dehydration
3. Helps to provide fluids , calories and electrolytes
4. To maintain electrolyte imbalance
5. Will determine if output exceeds input
6. Fiber and solid food may cause gastric irritation
After 12 hours of nursing intervention the goals was partially met as evidenced by : Frequency
of diarrhea decreased
Still dehydration
No fatigue No vomiting
NURSING CARE PLANS
ASSESSMENT NURSING DIAGNOSIS
PLANNING IMPLEMENTATION
RATIONALE EVALUATION
SUBJECTIVEPatient mother complaints baby feel hot while touchingOBJECTIVEFever ( 39 – 40 c)DrowsyTachycardiaWeakness
Hyperthermia related to infection
Within 24 hours patient will completely relieved from fever
1. Removed excessive clothing
2. Provided tepid sponge bath
3. Encouraged fluid intake
4. Administer IV Fluids 5% dex in ½ NS + 5 ml kcl at 60ml / hour
5. Administered Antipyretics (e.g. Inj.perfalgan 200mg IV PRN, Rofenac suppository 12.5mg PRN )
1. Excessive clothing may elevate temperature
2. High temperature causes coagulation of cell protein and cell die. High temperature leads to brain damage
3. To prevent dehydration
4. To prevent electrolyte imbalance
5. To reduce body temperature
After 2 days of nursing intervention the goals are fully met. No fever No
weakness Fully
nourished
NURSING HEALTH TEACHING: Encourage the mother to feed the
baby with a nutritious diet which is not harmful to the stomach
Advise to increase the activities gradually
Advise the mother to prepare the food in a hygienic manner
Advise the mother to maintain the personal hygiene of the baby
Encourage rest to the baby
CONCLUSION:
Patient relieved from signs and symptoms.
Discharge medications: Pedialyte and voltarin suppository 12.5mg prn. Review after 1
week
BIBLIOGRAPHY
Brunner & Suddarth’s. Test book of Medical Surgical Nursing. 12thEdition.
Lippincott Manual of Nursing Practice. 9th Edition.
KHALASShukran for listening…