Age Case Presentation(Softcopy)

7/29/2019 Age Case Presentation(Softcopy)

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Acute Gastroenteritis

Introduction

Inflammation of the gastrointestinal tract, involving both the stomach and the

intestine and resulting in acute diarrhea. The inflammation is caused most often by

infection with certain viruses, less often by bacteria or theirtoxins, parasites,

oradverse 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 significantviral agents include adenovirus and astrovirus.

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 analysing a stool sample, when

stomach symptoms remain problematic. Inadequate treatment of gastroenteritis kills

5 to 8 million people per year and is a leading cause of death among infants andchildren under 5.

The most common symptoms are diarrhea, vomiting and stomach pain,

because whatever causes the condition inflames the gastrointestinal tract.

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

l t f k d th A t t t iti h ld th b t k i l d
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Parasiteshttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Foodborne_illnesshttp://en.wikipedia.org/wiki/Norovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Astrovirushttp://www.wisegeek.com/what-are-antibiotics.htmhttp://en.wikipedia.org/wiki/Infanthttp://en.wikipedia.org/wiki/Childhttp://en.wikipedia.org/wiki/Childhttp://en.wikipedia.org/wiki/Infanthttp://www.wisegeek.com/what-are-antibiotics.htmhttp://en.wikipedia.org/wiki/Astrovirushttp://en.wikipedia.org/wiki/Adenovirushttp://en.wikipedia.org/wiki/Rotavirushttp://en.wikipedia.org/wiki/Norovirushttp://en.wikipedia.org/wiki/Foodborne_illnesshttp://en.wikipedia.org/wiki/Adverse_reactionhttp://en.wikipedia.org/wiki/Parasiteshttp://en.wikipedia.org/wiki/Toxinhttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Acute_(medicine)http://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Inflammation


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last for weeks and months Acute gastroenteritis should thus be taken seriously and

Birthplace: Quezon City

Nationality: Filipino

Religion: Roman Catholic

Civil Status: Married

Date and Time of Admission: July 3, 2012 12:38AM

Medical History:

Past Medical History:

Client verbalized of having hepatitis A in the year 1989, this year being the

last time he had been hospitalized. He seldom had common illnesses like colds,

fever and cough.

History of Present Illness:

Patient AFL verbalized that 3 days before admission he experienced diarrhea

already, but he said that his condition was still tolerable and doesnt need for medical

help. He feels relieved of condition when he is able to eliminate. After 3 days of

diarrhea, patient AFL decided to consult for medical help to identify what is the

reason for his condition. He was admitted in the UPHSD Medical Center on July 3,

2012.

Nursing History (Gordons Functional Pattern of Assessment)


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formed and brownish in color. During ill, he experienced to eliminate 8 times a day,

watery and greenish stool. Patient experienced pain when he is not able to eliminateas soon as peristalsis is felt.

ACTIVITY-EXERCISE PATTERN

Patient AFL said that his only exercise is his daily activities in his work. He

does all of his daily activities independently.

SLEEP-REST PATTERN

Patient AFL usually sleeps 6-7 hours per night. He feel rested whenever he

wakes up. He watches television as his ritual to feel sleepy.

SELF-PERCEPTION AND SELF-CONCEPT PATTERN

Patient AFL, describes his self as a very calm person. He answers questions

readily. He views his self as a neutral type of person. He said that he controls the

situation as calm as possible that he doesnt want to stress his self too much. He

also said that in everything and decision he makes he is assertive of it.

ROLE-RELATIONSHIP PATTERN


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PHYSICAL ASSESSMENT

General Appearance

Area

Assessed

Actual Findings Normal Findings Analysis

Body Built Proportionate Proportionate Normal

Body Odor No odor no odor Normal

Posture and

Gait

Coordinated and

erect

Coordinate and

erect

Normal

Affect or mood Calm Cooperative Calm and cooperative

Speech Understandable Understandable Normal

Vital Signs

Area

Assessed


Temperature 36 degreesCelsius

36.5-37.5degreeCelsius

Normal

Pulse Rate 79 bpm 60-100 bpm Normal


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areas areas

Skin turgor Skin snaps backimmediately

Skin snaps backimmediately

Good skin turgor

Mouth

Area

Assessed


Lips Moistened Pinkish, moist, intact Normal

Teeth Yellowish in color

with some dentalcaries

Pearly white normal teeth Normal

Gums Pinkish Pinkish Normal

Tongue Midline, movable Midline, movable Normal

Abdomen

Area Assessed Actual Findings Normal Findings Analysis


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RBC 0-1/hpf

DVS CEUS 4-6/HPF

Epithelial Cells RareBacteria Few

Fecalysis:

Result

Color Greenish brownConsistency Mucoid

Pus Negative

Mucus Positive

Parasite None

BUN & Creatinine Test:

Normal Result

BUN 3.2 7.1 mmo/L 5.4

Creatinine 58 110 cmoL/L 85

Potassium 3.5 5.1 mmo/L 3.5

Sodium 137 145 mmo/L 141

Complete Blood Count:

Normal Results

RBC 4 0 6 0 10^12/L 6 87


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Signs and Symptoms:

Increased White Blood Cells Increased Platelet Count

Acute Diarrhea

Increased hemoglobin

Abdominal Cramps

Greenish stool

Sympthomatology:

Clinical Manifestation Absent/ Present Rationale

Increased White BloodCells

Present Acute infection occured,the white blood cellsproduce colony-stimulatingfactor (CSF), which further

stimulates the bonemarrow to increase theproduction of the whiteblood cell. This productioncan be doubled within afew hours.

Increased Platelet Count Present A high platelet count canbe caused by cancer,infections, anemia, andinflammatory diseasesincluding inflammatory


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Greenish stool Present Stool can also appeargreen for physical

reasons, and not just fromwhat you've been eating.Bile that is secreted in thefirst part of the smallintestine is actually green.As stool is digested andpassed through the large

intestine it is turned into adarker brown color.Because of the fastperistalsis the largeintestine is unable tochange the color of thestool.

ANATOMY AND PHYSIOLOGY

Gastro-Intestinal Tract
http://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htmhttp://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/cs/otherdiseases/g/deflargeintest.htmhttp://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htmhttp://ibdcrohns.about.com/library/glossary/bldef-smallintestine.htm


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Esophagus:

Once food has been chewed and mixed with saliva in the mouth, it is

swallowed and passes down the oesophagus. The oesophagus has a stratified

squamous epithelial lining (SE) which protects the oesophagus from trauma; the

submucosa (SM) secretes mucus from mucous glands (MG) which aid the

passage of food down the oesophagus. The lumen of the oesophagus is

surrounded by layers of muscle (M)- voluntary in the top third, progressing toinvoluntary in the bottom third- and food is propelled into the stomach by waves of

peristalisis.

Stomach:

The stomach is a 'j'-shaped organ, with two openings- the oesophageal and

the duodenal- and four regions- the cardia, fundus, body and pylorus. Eachregion performs different functions; the fundus collects digestive gases, the body

secretes pepsinogen and hydrochloric acid, and the pylorus is responsible for

mucus, gastrin and pepsinogen secretion.

The stomach has five major functions:

Temporary food storage

Control the rate at which food enters the duodenum

Acid secretion and antibacterial action

Fluidization of stomach contents


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Small Intestine

The small intestine is the site where most of the chemical and mechanicaldigestion is carried out, and where virtually all of the absorption of useful materials is

carried out. The whole of the small intestine is lined with an absorptive mucosal type,

with certain modifications for each section. The intestine also has a smooth muscle

wall with two layers of muscle; rhythmical contractions force products of digestion

through the intestine (peristalisis). There are three main sections to the small

intestine.

The duodenum forms a 'C' shape around the head of the pancreas. Its main

function is to neutralise the acidic gastric contents (called 'chyme') and to initiate

further digestion; Brunner's glands in the submucosa secrete an alkaline mucus

which neutralises the chyme and protects the surface of the duodenum.

The jejunum

The ileum. The jejunum and the ileum are the greatly coiled parts of the small

intestine, and together are about 4-6 metres long; the junction between the two

sections is not well-defined. The mucosa of these sections is highly folded (the folds

are calledplicae), increasing the surface area available for absorption dramatically.

The pancreas consists mainly of exocrine glands that secrete enzymes to aid

in the digestion of food in the small intestine. The main enzymes produced arelipases, peptidases and amylases for fats, proteins and carbohydrates respectively.

These are released into the duodenum via the duodenal ampulla.


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What Are the Functions of the Gastrointestinal Tract?

esophagus acts like a conduit, a tube that moves ingested materialfrom the mouth to the stomach. Wavelike contractions (called peristalsis) move foodfrom the mouth down the neck, through the chest and into the stomach. Theesophagus has a tight sphincter muscle where it meets the stomach. This loweresophageal sphincter is a ring of thick muscle that acts as a door, and it preventsacid reflux or movement of acid from the stomach back up into the esophagus.

sist in the early stages of

digestion and prepare the food for further processing in the small intestine. First, itserves as a short-term storage area, allowing the animal to consume a large mealquickly and processing it over a longer period of time. Second, substantial chemicaland enzymatic digestion begins in the stomach, particularly of proteins. Third, thestomach's contractions mix and grind food with secretions, liquefying or blending thefood, a necessary step before the food is delivered to the small intestine.

blood occurs. When in the small intestine, food particles are exposed to enzymesand bile, which convert the food to even smaller particles capable of being absorbedinto the blood. In addition to absorbing food particles, the small intestines also theabsorb other materials such as water, electrolytes and other molecules. The smallintestines provide nutrients to the body and play an important role in water and acid-base balance.

very important functions. It recovers the last available water and electrolytes from thefood, forms and stores feces, and works with bacteria to produce enzymes capableof breaking down difficult-to-digest material


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Pathophysiology

Predisposing Factors:

Age

Precipitating Factors:

Ingestion of contaminated food

Ingestion of

contaminated food

Direct Invasion of

the bowel wall.

Stimulation and

destruction of mucosal

lining of the bowel wall

Stimulates

defacation

Digestive and

absorptive malfunction


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Nursing Diagnoses:

Actual Nursing Problem

1. Diarrhea related to inflammation of the GI tract.

2. Acute Pain related to injuring agents (physical-inflammation of the GI tract).

3. Contamination related to ingestion of contaminated food.

Potential Nursing Problem

1. Risk for Deficient Fluid Volume related to excessive loss through feces.

2. Risk for Imbalance Nutrition: less than body requirement related to altered

taste sensation as evidenced by aversion to eating.

Prioritization List:

ACTUAL PROBLEMS

PROBLEM RANK CUES JUSTIFICATION

Diarrhea related to

inflammation of the

GI tract.

1 BM 3x

Stool: watery andgreenish in color

This is our 1st

priority because it isthe chief complaintof the client that

ti


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POTENTIAL PROBLEMS

PROBLEM RANK CUES JUSTIFICATIONRisk for DeficientFluid Volumerelated toexcessive lossthrough feces.

1 Hyperactive bowelmovements, BM 3x

This became our 1stpriority because itcauses loss of fluidand electrolytesassociated withdiarrhea and/orvomiting. Fluids andelectrolytesimbalances canalso alter vital bodyfunctions.

Risk for Imbalance

Nutrition: less than

body requirement

related to altered

taste sensation as

evidenced by

aversion to eating.

2 Sudden weight lossof 2%.

This became our2nd priority becauseit can be managed

by proper diet. Andpatient can complyto the regimenindependently.


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NURSING CARE PLAN

ACTUAL

Assessment NursingDiagnosis Planning Intervention Rationale Evaluation

O:

(+) BM 3x

Stool : wateryand greenish incolor

Hyperactivebowel sound

(+) mucus in

stool (+) abdominal

pain

(-) blood instool

Diarrhea relatedto inflammation of

the GI tract.

After 6 hoursof nursingintervention,the patient willverbalizeunderstandingof causativefactors and

rationale fortreatmentregimen.

Obtain baselinevital signs andmonitor every 24hours.

Observe stools foramount, color,

consistency, odor,and frequency.

Determined recentexposure todifferent or foreignenvironments,change in drinkingwater or foodintake.

Teach interventions

to prevent futureepisodes ofdehydration/inadequate intake.

Encourage increaseoral intake of fluids.

Fluid andelectrolyteimbalancescan alter vitalbody functions.

Aids in thediagnosis andin monitoring

the childsstatus.

It may help toidentify thecausativeenvironmentalfactors.

To understand

the importanceof drinkingextra fluidduring bouts ofdiarrhea.

To replacefluid and lossand to preventdehydration.

Goal met.

Patientverbalizedunderstandingof causativefactors andrationale fortreatment

regimen.


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Promote adequaterest period.

Monitor intake and

output.

To reduceperistalsismovement.

Provide

information todetermine thestatus of fluidbalance fluidneedsreplacement.

Assessment Diagnosis Planning Intervention Rationale

S: Hindi ko kasi alamna panis na pala yungkinain ko.O:

Abdominal pain

(+) nausea andvomiting

Contamination relatedto ingestion of

contaminated food.

After 6 hours of nursinginterventions, thepatient will verbalizeunderstanding ofindividual factors thatcontributed to injury andplans for correctingsituation(s) wherepossible.

Implemented acoordinateddecontaminationplan (e.g., removalof clothing,showering with soapand water).

Recommendedperiodic inspectionof well water, tapwater and food.

To prevent furtherharm to client and toprotect healthcareproviders.

To identify possiblecontaminants.


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Assessment Diagnosis Planning Intervention Rationale Evaluation

S: Sumasakit kasiyung tiyan ko lalona kapagnararamdaman kong padumi na ko.O:

Mild Pain on theabdomen.

Pain scale: 6/10

Facial grimace

Pain related toinjuring agents(physicalinflammation of GItract).

After 6 hours ofnursing

interventions, thepatient will report

reduce of pain from6/10 to 2/10.

Observednonverbal cuesand painbehaviors.Assessed forthe level of pain.

Providedcomfortmeasures suchas properpositioning,quietenvironmentand calmactivities.

Instructed andencouraged useof relaxationtechniques suchas deepbreathingexercise.

Encourageddiversionalactivities(watching TV,listening toradio,socializationwith others.)

It can helpdetermine thedegree of pain.

To promotenonpharmacological painmanagement

To promoterelaxation.

To distractattention andreduce tension.

Goal met.

Patient reportedreduce of painfrom 6/10 to3/10.


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POTENTIAL


O:

3 BM

Good skinturgor

Slightly moisttongue

Weakness

Slightlyelevated RBC

Risk for DeficientFluid Volume

related toexcessive lossthrough feces.

After 6 hours ofnursingintervention, thepatient willdemonstratebehaviors orlifestyle changes to

preventdevelopment offluid volume deficit.

Discussedindividual riskfactors,potentialproblems andspecificinterventions.

Monitoredintake andoutput.Encouragedclient tomaintain diaryof food/fluidintake; numberand amount ofvoiding and

stool. Encouraged

increase oralintake of fluids.

Assess level ofconsciousness,skin turgor,mucous

To prevent orlimit occurrenceof fluid deficit.

To ensure

accurate pictureof fluid status.

To replace fluid

loss.

Will determinedegree ofhydration andadequacy ofinterventions.

Goal met.

Patientdemonstratedbehaviors orlifestylechanges toprevent

developmentof fluid volumedeficit.


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membranes,skin color andtemperature,capillary refill,eyes, andfontanels every4 hours.


S: Wala kasiakong ganangkumain eh. Dahilnga wala akongpanlasa.O:

Altered tastesensation

Hyperactive

Risk forImbalancedNutrition: less thanbody requirementrelated to alteredtaste sensation asevidenced byaversion to eating.

After 6 hours ofnursinginterventions, thepatient willdemonstratebehaviors, lifestylechanges to regaintoward goal.

Determinedclients ability tochew, swallowand taste food.

Discussedeating habits,including foodpreferences,intolerances, or

To recognize allthe factors thatcan affectingestion.

To appeal toclients tastes

Goal met. Patient

demonstratedbehaviors,lifestylechanges toregain towardgoal.


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20

bowel sound

Poor appetite

Aversion toeating

aversions.

Assessedweight

Promotedpleasant,relaxingenvironment,includingsocialization.

Minimizedunpleasantodors or sights.

Encouragedclient to choosefoods or havefamily memberto bring foodsthat seemappealing.

To establishbaselineparameters.

To enhanceintake.

May have anegative effecton appetite andeating.

To stimulateappetite.


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DRUG STUDY

Name of

Drug:

Classification: Mechanism of

Action:

Indication: Contraindication: Adverse

Reaction:

Nursing

responsibilities:

Brand name:

>Ciprofloxacin

Generic

name:

>Cipro, Cipro

XR, Proquin

XR

Dosage:

>500mg

Frequency:

>BID

Route:

>Oral

>Antibiotic

>Antibacterial

>Inhibition oftopoisomerase(DNAgyrase),enzymeswhich inhibitsrelaxation ofsupercoiled DNA

and promotesbreakage ofdouble strandedDNA.

>Ciprofloxacin

Is used to treat

infection of the

lungs, airways,

bones and joints

caused by

susceptible

bacteria.

> Ciprofloxacin is

also frequently

used to treaturinary infections

caused by

bacteria such as

E.coli.

> Ciprofloxacin is

> Ciprofloxacin is

contraindicated in

person with a

history of

hypersensitivity to

ciprofloxacin, any

member of the

quinolone class of

micro bacterial

agents, or any of

the product

components.>co administration

of Ciprofloxacin

with other drugs

primarily

metabolized by

>Nausea

>Vomiting

>Stomach

pain

>Diarrhea

>Fever

>Headache

>Difficulty of

breathing

and

swallowing.

>Feeling anurgent need

to urinate.

>Rapid

irregular or

pounding

>Monitor Blood

pressure

>Prevention and

treatment of

infection like

fever and pain

are reduced.

>Tell patient that

ciprofloxacin can

cause side effect

that may impair

his and reaction.>Tell patient that

be careful if he

plans to drive or

do anything that

requires him


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effective in

threatening

infectious

diarrheas caused

by E.coli,

Campylobacter

jejuni, Shigella

bacteria.

CYPIA2 result in

increased plasma

concentration of

these drug and

could lead to

clinically significant

adverse event of

the co-administered

drug.

heartbeat. awake and alert.

>Instruct patient

to take

Ciprofloxacin

with a full of

glass of water.

Name of

Drug:

Classification: Mechanismof Action:


Reaction:

Nursing

Responsibilities:

Brand name:

>Omeprazole

Generic

name:

>Mepraz

>Proton Pump

inhibitor

> Pump

inhibitors act

by irreversibly

blocking the

hydrogen/pota

ssium

adenosine

>Short-term

treatment of

active

duodenal

ulcer.

>First line

therapy of

>Omeprazole

delayed-release

capsule are

contraindicated in

patient with

hypersensitivity to

any component of

CNS:

>Headache

>Dizziness

>Vertigo

>Dream

abnormalities

>Anxiety

History :

Hypersensitivity to

Omeprazole or any

of components;

Pregnancy and

Lactation.


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Dosage:

>20mg

>40mg

Frequency:

>OD

Route:

>Oral

triphosphate

enzymes

system (the

H+/K+

ATPase,or

more

commonly

gastric proton

pump)of the

gastric parietal

cells. The

proton pump

is the terminal

stage in

gastric acid

secretion,

being directly

responsible for

secreting H+

ions into the

gastric

heartburn or

symptom of

(GERD)

>Short-term

treatment of

active benign

gastric ulcer.

>Long-term

therapy:

Treatment of

pathologic

hyper

secretory

condition

(Zollinger-

Ellison

syndrome,

multiple

adenomas,

systemic

Mastocytosis)

the formulation. Dermatologic:

>Rash

>Urticaria

>Inflammation

>Pruritus

>Alopecia

>Dry skin

GI:

>Diarrhea

>Abdominal

pain

>Nausea and

Vomiting

>Constipation

>Dry mouth,

and tongue

>Atrophy

Respiratory:

>URI

symptoms

>Cough

Physical:

>Skin lesions,

reflexes, affect

urinary output,

abdominal exam;

respiratory

auscultation.

>Report any adverse

reaction.

>administer before

meals caution patient

to swallow capsule

whole or not to open,

chew or crush

Them.

>Arrange for further

evaluation of patient

after 8weeks of

therapy for gastro

reflux disorders not

intended for


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24

lumen, making

it an ideal

target for

inhibiting acid

secretion.

. >Epistaxis

Other:

>Cancer in

preclinical

studies

>Back pain

>Fever

maintenance

therapy.


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Name of

drug:

Classification: Mechanism of

Action:


Reaction:

Nursingresponsibilities:

Brand name:

>Hidrasec

Generic name:

>Racecadotril

Dosage:

>100mg

Frequency:

>TID

Route:

>Oral

>Anti-

diarrheals

>Hidrasec is an

inhibitor of

enkephalinase,

the enzymes

responsible for

breaking down

enkephalins. It is

a selective but

reversible

inhibitor and

protects

endogenous

enkephalins

which are

physiologically

active in the

digestive.

>Treatment

of acute

diarrhea.

>Adjunct to

oral or

parenteral

rehydration

in the

treatment

of acute

watery

diarrhea in

infant and

in adult.

>Renal or Hepatic

impairment

fructose

intolerance,

glucose and

galactose

malabsorption

syndrome or

sucrose

isomaltase

deficiency.

>Dizziness

>Nausea and

Vomiting

>Constipation

>Drowsiness

>Headache

>Monitor Blood

Pressure

>Hidrasec

30mg.If

rehydration by

rehydration

solution is

prescribe, the

conditions of use

and the method of

reconstitution

should be

explained clearly

and precisely.

>Maintain feeding

during period of

diarrhea:

Excluding certain


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product especially

fruits, green

vegetables, spicy

food and also

iced foods or

drinks; giving

prefer to grilled

meat and rice ;

withdrawal of milk

and dairy product

should be

considered in

each individual

case.


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Discharge Planning

Medication: upon discharge client was advised to continue intake of:

Omeprazol tablet 20 mg once a day.

Hidrasec capsule 100 mg three times a day Ciprofloxacil tablet 500 mg every 12 hours

Exercise:

Carry out daily activities as tolerated.

Do activities of daily living as tolerated.

Treatment:

A.L was advised for increase fluid intake and take medication as schedule and as prescribed for fast recovery.

Health teaching:

Proper hygiene to avoid complication.

Frequent hand washing is advised.

Proper food preparation and handling to avoid infection.

Diet:

Follow religiously the prescribed diet to regain strength and improve health status; these include BRAT (banana,rice, apple, tea) diet.


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Spiritual:

Advise family to ask assistance and guidance from the divine providence for speedy recovery.

Reference:

Nandas Pocket Guide Diagnoses, Prioritized Interventions and rationales, Marilynn E. Doengnes,Mary Frances

Moorhouse, Alice C. Murr, Daviss Nursing Resource Center.

Mims Drug Guide

http://www.steadyhealth.com/articles/What_does_high_white_blood_cells_count_indicate__a723.html

http://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.html

http://www.petplace.com/dogs/structure-and-function-of-the-gastrointestinal-tract-in-dogs/page1.aspx

http://www.uptodate.com/contents/acute-diarrhea-in-adults-beyond-the-basics

http://www.mayoclinic.com/health/high-hemoglobin-count/MY00112/DSECTION=causes

http://www.wisegeek.com/what-causes-abdominal-cramping.htm
http://www.steadyhealth.com/articles/What_does_high_white_blood_cells_count_indicate__a723.htmlhttp://www.steadyhealth.com/articles/What_does_high_white_blood_cells_count_indicate__a723.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.htmlhttp://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.htmlhttp://www.petplace.com/dogs/structure-and-function-of-the-gastrointestinal-tract-in-dogs/page1.aspxhttp://www.uptodate.com/contents/acute-diarrhea-in-adults-beyond-the-basicshttp://www.uptodate.com/contents/acute-diarrhea-in-adults-beyond-the-basicshttp://www.mayoclinic.com/health/high-hemoglobin-count/MY00112/DSECTION=causeshttp://www.mayoclinic.com/health/high-hemoglobin-count/MY00112/DSECTION=causeshttp://www.wisegeek.com/what-causes-abdominal-cramping.htmhttp://www.wisegeek.com/what-causes-abdominal-cramping.htmhttp://www.wisegeek.com/what-causes-abdominal-cramping.htmhttp://www.mayoclinic.com/health/high-hemoglobin-count/MY00112/DSECTION=causeshttp://www.uptodate.com/contents/acute-diarrhea-in-adults-beyond-the-basicshttp://www.petplace.com/dogs/structure-and-function-of-the-gastrointestinal-tract-in-dogs/page1.aspxhttp://www.le.ac.uk/pa/teach/va/anatomy/case6/frmst6.htmlhttp://www.steadyhealth.com/articles/What_does_high_white_blood_cells_count_indicate__a723.html

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Age Case Presentation(Softcopy)