Northwestern UniversityCollege of Allied Health Sciences

Department of NursingLaoag City

A Case Study on

Acute Gastroenteritis

Submitted by:

Noe Cabantangan

Paz Margrette Cabuyadao

Ruzelle Ann Cahabagan

Jackielyn Calaramo

Shanette Ganotisi

Ralph Van Manuel

Louisse Jo Dominique A. Ros

Marie Antonette Sadornas

TABLE OF CONTENTS

I. Readings

Definition

Incidence

Predisposing Factors

Signs and Symptoms

Management and Treatment

II. Anatomy and Physiology

III. Pathophysiology

IV. Pertinent Data

V. Family Health History

Family Background

Lifestyle

Psychological Data

Past Health History

Present Health History

VI. Physical Assessment

VII. Nursing Care Plan

VIII. Diagnosing Procedures

IX. Drug Study

I. READINGS

Acute Gastroenteritis is a catchall term for infection or irritation of the digestive tract,

particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu,

although the influenza virus is not associated with this illness. Major symptoms include nausea

and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also

accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days.

Adults usually recover without problem, but children, the elderly, and anyone with an underlying

disease are more vulnerable to complications such as dehydration.

The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus,

adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all

over the world. Exposure typically occurs through the fecal-oral route, such as by consuming

foods contaminated by fecal material related to poor sanitation. However, the infective dose can

be very low (approximately 100 virus particles), so other routes of transmission are quite

probable. Typically, children are more vulnerable to rotaviruses, the most significant cause of

acute watery diarrhea.

Colloquially referred to as the "stomach flu," viral gastroenteritis can be passed from one

infected individual to another with relative ease. Sometimes, extremely spicy or unfamiliar food

can cause a short bout of acute gastroenteritis. This happens regularly in young children. Food

contaminated with bacteria can also cause inflammation. Drinking plenty of fluid and avoiding

food for a while can help ease the symptoms.

Children are also susceptible to adenoviruses and astroviruses, which are minor causes of

childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major

causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause

illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton,

and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major

symptom.

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking

water, or contaminated food-conditions common in developing nations. Natural or man-made

disasters can make underlying problems in sanitation and food safety worse. In developed

nations, the modern food production system potentially exposes millions of people to disease-

causing bacteria through its intensive production and distribution methods. Common types of

bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however,

Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed

nations.

INCIDENCE

Every year worldwide rotavirus in children under 5 causes 111 million cases of

gastroenteritis and nearly half a million deaths. 82% of these deaths occur in the world's poorest

nations.

In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of

these occurring in the third world. Lack of adequate safe water and sewage treatment has

contributed to the spread of infectious gastroenteritis. Current death rates have come down

significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the

global introduction of oral rehydration therapy.

The incidence in the developed world is as high as 1-2.5 cases per child per year and is a

major cause of hospitalization in this age group.

Age, living conditions, hygiene and cultural habits are important factors. Aetiological

agents vary depending on the climate. Furthermore, most cases of gastroenteritis are seen during

the winter in temperate climates and during summer in the tropics.

Risk factors/Predisposing factors

Gastroenteritis occurs all over the world, affecting people of every age, race and

background.

AGE: Children's immune systems aren't mature until about age 6, and adult

immune systems tend to become less efficient later in life.

Adults whose resistance is low — often because their immune systems are

compromised by HIV, AIDS or other medical conditions — are especially at risk.

Common signs and symptoms may include:

Low grade fever to 100°F (37.7°C)

Nausea with or without vomiting

Mild-to-moderate diarrhea:

Crampy painful abdominal bloating

More serious symptoms

Blood in vomit or stool

Vomiting more than 48 hours

Fever higher than 101°F (40°C)

Swollen abdomen or abdominal pain

Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and

lack of sweat and tears are characteristic findings.

Management and Treatment

Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort

and convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve

the symptoms. These medications work by altering the ability of the intestine to move or secrete

spontaneously, absorbing toxins and water, or altering intestinal microflora. Some over-the-

counter medicines use more than one element to treat symptoms.

If over-the-counter medications are ineffective and medical treatment is sought, a doctor

may prescribe a more powerful anti-diarrheal drug, such as motofen or lomotil. Should

pathogenic bacteria or parasites be identified in the patient's stool sample, medications such as

antibiotics will be prescribed.

It is important to stay hydrated and nourished during a bout of gastroenteritis. If

dehydration is absent, the drinking of generous amounts of nonalcoholic fluids, such as water or

juice, is adequate. Caffeine, since it increases urine output, should be avoided. The traditional

BRAT diet-bananas, rice, applesauce, and toast-is tolerated by the tender gastrointestinal system,

but it is not particularly nutritious. Many, but not all, medical researchers recommend a diet that

includes complex carbohydrates (e.g., rice, wheat, potatoes, bread, and cereal), lean meats,

yogurt, fruit, and vegetables. Milk and other dairy products shouldn't create problems if they are

part of the normal diet. Fatty foods or foods with a lot of sugar should be avoided. These

recommendations are based on clinical experience and controlled trials, but are not universally

accepted.

Minimal to moderate dehydration is treated with oral rehydrating solutions that contain

glucose and electrolytes. These solutions are commercially available under names such as

Naturalyte, Pedialyte, Infalyte, and Rehydralyte. Oral rehydrating solutions are formulated based

on physiological properties. Fluids that are not based on these properties-such as cola, apple

juice, broth, and sports beverages-are not recommended treating dehydration. If vomiting

interferes with oral rehydration, small frequent fluid intake may be better tolerated. Should oral

rehydration fail or severe dehydration occur, medical treatment in the form of intravenous (IV)

therapy is required? IV therapy can be followed with oral rehydration as the patient's condition

improves. Once normal hydration is achieved, the patient can return to a regular diet.

Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet,

herbal remedies, and homeopathy. An infusion of meadowsweet (Filipendula ulmaria) may be

effective in reducing nausea and stomach acidity. Once the worst symptoms are relieved,

slippery elm (Ulmus fulva) can help calm the digestive tract. Of the homeopathic remedies

available, Arsenicum album, ipecac, or Nux vomica are three said to relieve the symptoms of

gastroenteritis.

Probiotics, bacteria that are beneficial to a person's health, are recommended during the

recovery phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said

to be effective in soothing the digestive tract and returning the intestinal flora to normal. L.

acidophilus is found in live-culture yogurt, as well as in capsule or powder form at health food

stores. The use of probiotics is found in folk remedies and has some support in the medical

literature. Castor oil packs to the abdomen can reduce inflammation and also reduce spasms or

discomfort.

Gastroenteritis is usually resolved within two to three days and there are no long-term

effects. If dehydration occurs, recovery is extended by a few days.

II. ANATOMY AND PHYSIOLOGY

Anatomy of the Digestive System

If a human adult’s digestive tract were stretched out, it would be 6 to 9 m (20 to 30 ft)

long. In humans, digestion begins in the mouth, where both mechanical and chemical digestion

occurs. The mouth quickly converts food into a soft, moist mass. The muscular tongue pushes

the food against the teeth, which cut, chop, and grind the food. Glands in the cheek linings

secrete mucus, which lubricates the food, making it easier to chew and swallow. Three pairs of

glands empty saliva into the mouth through ducts to moisten the food. Saliva contains the

enzyme ptyalin, which begins to hydrolyze (break down) starch—a carbohydrate manufactured

by green plants.

Once food has been reduced to a soft mass, it is ready to be swallowed. The tongue

pushes this mass—called a bolus—to the back of the mouth and into the pharynx. This cavity

between the mouth and windpipe serves as a passageway both for food on its way down the

alimentary canal and for air passing into the windpipe. The epiglottis, a flap of cartilage, covers

the trachea (windpipe) when a person swallows. This action of the epiglottis prevents choking by

directing food from the windpipe and toward the stomach.

I. Stomach

A. Anatomy

The stomach is an enlarged segment of the digestive tract in the left superior portion of

the abdomen. It lies obliquely from left to right across the upper abdomen directly beneath the

diaphragm. When empty, the stomach resembles a J-shaped tube, a when full, a giant pear. The

normal capacity of the stomach is 1-2 liters. Anatomically, the stomach is divided into the

fundus, the body, and the pyloric antrum or pylorus. The concave lesser curvature forms the

upper right border of the stomach and the convex greater curvature forms the left and lower

borders. Sphincters at each end of the stomach regulate inflow and outflow. The cardiac

sphincter or lower esophageal sphincter (LES) allows foods to flow into the stomach and

prevents reflux of the gastric contents into the esophagus. The area of the stomach into which the

cardiac sphincter opens is known as the cardiac region. The terminal pyloric sphincter relaxes to

permit food to enter the duodenum, and when contracted prevents backflow of the intestinal

contents of the stomach.

The pyloric sphincter is of particular clinical interest because obstructive narrowing

(stenosis) may occur as a complication of peptic ulcer disease. Pyloric stenosis or pylorospasm

results when hypertrophied or spastic muscle fibers surrounding the opening fail to relax

sufficiently to permit food to pass easily from the stomach to the duodenum.

The stomach is composed of four layers. The serosa, or outer layer, is a part of the

visceral peritoneum. The two layers of the visceral peritoneum come together at the lesser

curvature of the stomach and the duodenum and extend upward to the liver, forming the lesser

omentum. Peritoneal folds reflected from one organ to another are distinguished as ligaments.

Thus, the lesser omentum (also known as the hepatogastric and hepatoduodenal ligaments)

suspense the stomach along its lesser curvature to the liver. At the greater curvature, the

peritoneum continuous downward as the greater omentum, dropping over the intestines like a

large apron.

The muscularis is composed of 3 layers of smooth muscles; an outer longitudinal, a

middle circular layer, and an inner oblique layer. This unique arrangement of fibers provides the

variety of contractions necessary to break food into the parietal cells, chum and mix it with

gastric juices, and propel it into the duodenum.

The submucosa is composed of loose areolar tissue that connects the muscularis and

mucosal layer. It permits the mucosa to move with peristaltic motion. This layer also contains the

nerve plexuses, blood vessels and lymph channels. Nerve plexuses; compose of parasympathetic

nerve fibers and cell bodies are found in the submucosa and muscularis layers. Together, the

nerve plexuses of both layers compose the intramural plexuses, which extremely important for

control of digestive tract functions.

The mucosa, the inner layer of the stomach, is arranged in longitudinal folds called rugae,

which allow for distention as the stomach becomes filled with food. Several types of glands are

located in this layer and are categorized according to anatomic portion of the stomach in which

they are located. Cardiac glands lie near the cardiac orifice and secrete mucus. The fundic or

gastric glands are located in the fundus and over the greater part of the stomach. Gastric glands

have three main types of cells. The Zymogenic or chief cells secrete pepsinogen. Pepsinogen is

converted into pepsin in acid environment. Parietal cells secrete hydrochloric acid and intrinsic

factor. Intrinsic factor is necessary for the absorption of vitamin B12 in the small intestine.

Mucous cells found in the neck of the fundic or gastric glands secrete mucous. The hormone

gastrin is produce by G cells located in the pyloric region of the stomach. Gastrin stimulates the

gastrin glands to produce hydrochloric acid and pepsinogen.

B. Digestive and Motor Functions of the Stomach

Digestive and Secretory Functions

Digestion of protein by pepsin and HCl is begun; digestion of starches and fats by gastric

amylase and lipase is of little importance in the stomach.

Gastrin synthesis and release are affected by ingestion of protein, distention of the

antrum, alkalinization of the antrum and vagal stimuli.

Intrinsic factor secretion enables the absorption of Vitamin B12 from the distal small

bowel to take place.

Mucus secretion forms a protective shell for the stomach as well contributing to

lubrication of food easier transport.

Motor Functions

Reservoir function: stores until it can be partially digested and moved on in GI tract;

adapts to increased volume without an increase in pressure by receptive relaxation of the smooth

muscle; this is mediated by the vagus nerve and induced by gastrin.

Mixing function: breaks food into small particles and mixes it with gastric juice through

contractions of muscular coat; peristaltic contractions controlled by a basic intrinsic electrical

rhythm.

Gastric emptying function: controlled by opening of pyloric sphincter, which is

influenced by viscosity, volume, acidity, osmotic activity and physical state, as well as by

emotions, drugs and exercise; gastric emptying is controlled by nervous and hormonal factors.

II. Small and Large Intestines

A. Anatomy

The small intestine is the longest segment of the GI tract, accounting for about to thirds

of the total length. IT folds back and forth on itself, providing approximately 7000 cm of surface

area for secretion and absorption. The small intestine is divided into three anatomic parts; the

upper part called the duodenum; the middle part called the jejunum; the lower part called the

ileum. The common bile duct, which allows for the passage of both bile and pancreatic juices

empties into the duodenum and the ampulla of Vater. The junction between the small and the

large intestine, the cecum is located in the right lower portion of the abdomen. HT eileocecal

valve controls the passage of contents into the large intestine and prevents reflux of bacteria.

The large intestine consists of an ascending segment on the right side of the abdomen, a

transverse segment and a descending segment on the left side of the abdomen. The terminal

portion of the large intestine composed of two parts; the sigmoid colon and the rectum. The

rectum is continuous with the anus. A network of striated muscle that forms both the internal and

the external anal sphincters regulates the anal outlet.

B. Functions of the Intestines

The digestive process continues in the duodenum. Secretions in the duodenum come from

the accessory digestive organs- pancreas, liver and gallbladder- and the glands in the wall of the

intestine itself. These secretions contain digestive enzymes and bile. Pancreatic secretions have

an alkaline pH because of high concentrations of bicarbonate. This neutralizes the acid coming

from the stomach to the small intestines. The pancreas also secretes digestive enzymes, including

trypsin, which aids in protein digestion; amylase for starch digestion; and lipase for fats. The

intestinal glands secrete mucus, hormones, electrolytes and enzymes. The mucus coats and

protects the mucosa from injury. Hormones, neuroregulators control the rate of intestinal

secretions and also influence GI motility. Small fingerlike projections called villi functions to

produce digestive enzymes as well as absorb nutrients. Absorption is the primary function of the

intestine. This begins in the jejunum and is accomplished by both active transport and diffusion

across the intestinal wall.

Within 4 hours after eating, residual waste materials pass into the terminal ileum and into

the proximal portion of the colon. Bacteria make up a major component of the contents of the

large intestine. They assist in completing the breakdown of waste material. Two types of colonic

secretions are added to the residual material. The electrolyte solution neutralizes the end products

formed by the colonic bacterial action. The mucus, on the other hand, protects the colonic

mucosa from the interluminal contents and provides adherence of fecal mass. Low, weak

peristaltic activity moves the colonic contents slowly along the tract. This allows sufficient

reabsorption of water and electrolytes, which is the primary function of the colon. The waste

materials reach and distend the rectum, in about 12 hours.

III. PATHOPHYSIOLOGY

Predisposing Factors: Precipitating Factor: Age ~ Poor hygiene

~ Unsanitary water supply

Ingestion of Food/H2O Contaminated with

Entameoba Hystolitica

Entry of pathogens in the G.I. Tract

Penetration and invasion of pathogens in the G.I.

Tract

Pathogens/Parasites produce or secrete toxins

Irritation of G.I. lining

Increase hypermotility of intestines

(s/s: 20 sounds/min)

Altered reabsorption of Na and H2O from

intestines

Increase excretion of Na and H2O from the body mass

(Increased fluid loss)

Activate inflammatory response

Vascular response Cellular response

Release of chemical mediators

Chemotaxis diapedesis of leukocytes to blood vessels

Initial vasoconstriction

Migration to site of infection/injury

Subsequent vasodilation (increase capillary permeability)

Hyperimin/ fluid shifting to site of infection

Neutrophils Monocytes Lymphocytes

Macrophages

PhagocytosisS/S: watery, large volume stools

DEHYDRATION

Edematous in GI Tract

Irritation to nerve endings

S/S: Pain

IV. PERTINENT DATA

PERSONAL DATA

Name : Baby LZ

Age : 1 year 6 months old

Sex : Male

Address : Dumalneg, Ilocos Norte

Date of Birth : September 8, 2008

Place of Birth : Dumalneg, Ilocos Norte

Civil Status : ----

Religion : Iglesia Filipina Independiente

Nationality : Filipino

Educational Attainment: ----

Occupation : ----

Diagnosis:

Admitting : Acute Gastroenteritis with some signs of Dehydration

Chief Complaint: Loose Bowel Movement with Vomiting

Hospital/Institution : Bangui District Hospital

Date and Time of Admission: February 20, 2010 @ 11:15PM

Admitting Physician : Dr. Diosdado Garvida

Ward & Room : Pedia Ward

Hospital Number : #079497

S/S: decrease skin turgor, dry skin

Admitting Vital Signs:

Body Temperature: 36.6 ° C

Respiratory Rate: 34 breaths/min

V. HEALTH HISTORY

a. Family Background

Members

Relation-ship with

the Patient

Age SexCivil

StatusResidence Occupation Religion

Educational Attainment

Cuinda Andres

Grand-father

54 M MDumalneg,

I.N.Farmer

IglesiaFilipina

IndependienteElementary

Lydia AndresGrand-mother

50 F MDumalneg,

I.N.Housewife

IglesiaFilipina

IndependienteElementary

Cleto Andres Uncle 25 M SDumalneg,

I.N.Student

IglesiaFilipina

IndependienteGraduating

Ideline Andres

Mother 19 F SDumalneg,

I.N.----

IglesiaFilipina

Independiente

HighschoolGraduate

Lord Zedrick Andres

(patient) 1 M SDumalneg,

I.N.----

IglesiaFilipina

Independiente-----

Baby LZ belongs to a extended type of family with five members. Their house is

located at Dumalneg, Ilocos Norte.

According to the mother with regards to their familial history of disease, her

father side has a history of hypertension and his Aunt died because of cancer. LZ’s

mother was unable to recall the date of the death of her Aunt. On her mother side, the

known hereditary disease is asthma.

The patient’s family had already experienced headache, dizziness, fever, cough

and colds, toothache, diarrhea, body ache and flu. They usually manages these illnesses

by taking OTC drugs such as Paracetamol for fever and headache, Alaxan for body ache,

Mefenamic acid for toothache, Neozep for colds, Carbocisteine and Amoxicillin for

cough, Kremil S for stomachache and Imodium for diarrhea. They had already

experienced infectious and communicable diseases such as chicken pox, mumps and

measles.

b. Lifestyle

Baby LZ has a normal sleeping pattern according to his mother. He often sleep

early at night because he is tired playing all day long without any waking disturbances.

He wakes up early and will spend the most of the day playing. He sometimes plays

outside their house without any slippers or shoes said his mother. He sometimes sleeps

early in the afternoon if he is tired. Her mother is giving him formula milk, breast milk

and solid foods like rice and banana. However, if not attended, he would tend pick

scattered foods and swallow it.

c. Psychological Data

Socially, toddlers are little people attempting to become independent at this stage,

which they are commonly called the “terrible twos". They walk, talk, use the toilet, and

get food for themselves. Self-control begins to develop. If taking the initiative to explore,

experiment, risk mistakes in trying new things, and test their limits is encouraged by the

caretaker of the child will become autonomous, self-reliant, and confident. If the

caretaker is overprotective or disapproving of independent actions, the toddler may begin

to doubt their abilities and feel ashamed for the desire for independence. The child's

autonomic development will be inhibited, and be less prepared to successfully deal with

the world in the future.

d. Past Health History

Baby LZ is the only son of Ideline. He was born in their house September 8, 2008

through NSVD with a traditional birth attendant who performed it.

The mother claimed that her child’s past illnesses were a typical cough, colds, and

mild fever that usually last for three days. The remedy of her mother is through over-the-

counter drugs such as paracetamol which is used to treat fever and neozep drops for

colds. For his immunizations, his mother claimed that he already completed it and were

all done at their Rural Health Center. There were no particular allergies of Baby LZ being

identified. Baby LZ doesn’t have hereditary diseases or not manifesting any of the

hereditary diseases that runs in their family.

e. Present Health History

Three days prior to admission, Baby LZ did not manifest any symptoms until one

time he suffered from vomiting and diarrhea for more than three times. His mother was

not alarmed about it because Baby LZ used to adapt normally to his environment and he

would keep on playing and running inside the house. However, they would go to the

Health Center in their barangay for check-up whenever Baby LZ experiences the same

thing and Cotrimoxazole was prescribed by their barangay health physician.

Every check-up, the mother was convinced that the cause of her child’s disease is

because of ingestion of non-potable water because their neighbors also suffered from it.

The mother claimed that she never boils the water for her baby’s drinking purpose.

This prompted the mother to bring Baby LZ to Bangui District Hospital last

February 20, 2010 @ 11:15 in the evening with a chief complaint of LBM and vomiting

and was diagnosed by Dr. Diosdado Garvida to have Acute Gastroenteritis with some

signs of dehydration based on the fecal analysis done.

VI. PHYSICAL ASSESSMENT

Date of Assessment: February 23, 2010

A. General Appearance:

Baby LZ is seen sleeping on bed in lateral position. He wears a red shorts and a white

sando, all neat in appearance. He is still on IV therapy with D5W inserted at his left hand. He

looks happy and is fair in appearance but began to cry when he saw us approaching him. He has

endomorph body built.

Height: 2’9”

Weight: 9.5 kg

BMI: *applicable only to >18 years old

B. Head-to-Toe Assessment

Skin (overall):

Complexion: Fair

Condition: With poor skin turgor.

Uniformity:

Texture

Generally uniform: face and extremities slightly

darker

Smooth

Moisture: With minimal moisture on skin folds and at the

axillae

Temperature: temperature in normal range (36.6 OC/axilla)

Head:

Size: Normocephalic

Configuration: Proportional to body size

Range of Motion: Able to move to desired direction ŝ difficulty (1800)

Face Shape: Round

Hair:

Color: Black

Texture: Smooth

Scalp Moisture: Slightly oily

Distribution: Equal

Scalp: Clean

Eyes:

Shape: Symmetrical

Movement: Coordinated

Color of Sclera: White

Color of Iris: Black

Conjunctiva: Pinkish and moist; shiny, smooth conjunctiva

Reaction to Light: Pupils Equally Rounded and Reactive to Light and

Accommodation (PERRLA)

Visual Acuity: Symmetrical visual acuity

Eyelids: intact skin

Eyelashes and

Eyebrows: Equally distributed, black in color

Ears:

Appearance: With free earlobes and small auricles which are

symmetrical

Alignment: Upper corner of auricles aligned to the outer canthus

of the eyes

Condition: Oily and waxy with small amount of cerumen at the

inner ears

Hearing Capacity: Able to hear what the student says at a distance of

4.5 ft.

Nose:

Appearance: Semi-flat, semi-pointed

Condition: Clean

Patency: No obstruction noted

Nares: Symmetrical

Lips:

Appearance: Thin

Condition: With minimal cracks and dryness both on upper and

lower lips

Color: Varies from pinkish to light brown

Tongue:

Motion: Can move freely to any desired direction

Color: Pink

Condition: With minimal moist

Gums: Pink and moist; firm and textured

Teeth: 5 intact white teeth on both upper and lower

Neck: Proportional to body built

Chest:

Appearance: Proportional to body built

Breath: No abnormal breath sound noted

Respi. Rate: 34 breaths per minute

Cardiac Rate: 103 beats per minute

Abdomen:

Appearance: Round abdomen but not flabby

Umbilicus: Deeply sunken and clean

Peristalsis: With bowel sounds of 20 per minute

Condition: No tenderness noted upon palpation

Upper Extremities:

Appearance: Symmetrical and proportional to body built

Range of Motion: Able to abduct, adduct, and rotate freely

Nail: Clean and well-cut, with pink nail beds and with

capillary refill of 1 second

Pulse: 100 beats per minute

Lower Extremities:

Appearance: Symmetrical and proportional to body built

Range of Motion: Able to abduct, adduct and rotate without difficulty

Nails: Slightly dirty but well-cut

VII. NURSING CARE PLAN

A. Nursing Diagnosis: Fluid volume deficit related to excessive loose of fluid

secondary to GI irritation as manifested by poor skin turgor.

Nursing Inference: excessive loss of fluid is caused by vomiting, diarrhea, water

deprivation.

Nursing Goal: After 8 hours of nursing interventions, the patient will maintain fluid and

electrolyte balance as evidenced by good skin turgor, smooth skin texture and

decrease frequency in vomiting and defecating of watery stools.

Nursing Interventions:

1.) Observe for excessively dry skin and mucous membranes, decreased skin

turgor, slowed capillary refill.

Rationale: Indicates excessive fluid loss/resultant dehydration.

2.) Weigh daily.

Rationale: Indicator of overall fluid and nutritional status.

3.) Maintain oral restrictions, bed rest and avoidance of exertion.

Rationale: Colon is placed at rest for healing and to decreased intestinal fluid

losses.

4.) Administer parenteral fluids as ordered.

Rationale: Maintenance of bowel rest requires alternative fluid replacement to

correct losses/anemia. Note: fluids containing sodium may be restricted in

presence of regional enteritis.

5.) Administer medications as indicated: Antidiarrheal and antibiotics.

Rationale: Reduces fluid losses from intestines.

Nursing Evaluation: After 8 hours of nursing interventions, the patient was able to

maintain fluid and electrolyte balance as evidenced by good skin turgor, smooth skin

texture and decrease frequency in vomiting and defecating of watery stools.

B. Nursing Diagnosis: Diarrhea related to GIT irritation by microorganisms and

bacterial toxins as manifested by watery stools.

Nursing Inference: GIT irritation caused by microorganisms and bacterial toxins

causes increase in GIT peristalsis. This then caused increase in the passage of

stools, decreasing water absorption, thus diarrhea occurs.

Nursing Goal: After 1 to 2 days of rendering nursing interventions, the client will

achieve normal bowel pattern as will be manifested by well-formed stools.

Nursing Interventions:

1. Encourage client to decrease bulk in the diet.

Rationale: Increased roughage in the diet increases GIT motility, thus if

decreased, peristalsis will be slowed down.

2. Encourage client to increase oral fluid intake.

Rationale: To replace fluid loss.

3. Be careful of the food taken in by the client.

Rationale: To prevent the introduction of microorganisms in the GI tracts, thus,

preventing the occurrence of re-infection and complications.

4. Administer IV fluids as prescribed

Rationale: To replace fluid loss.

5. Administer antibiotics such as Ampicillin.

Rationale: to treat underlying cause, decreasing GI irritation, thus, normalizing

bowel pattern.

Nursing Evaluation: After 2 days of rendering nursing interventions, the client achieved

normal bowel pattern as manifested by well-formed stools.

VIII. DIAGNOSING PROCEDURES

LABORATORY PROCEDURESDate ordered: 02-20-10

CBC Examination Found Value Normal Value SignificanceHgb 93 M: 140 – 160

F: 130 - 150Decreased

Hct 0.31 M: 0.36 -0.42F: 0.36 – 0.37

Decreased

WBC 9.20 x 10 5.0-10 x 10 9/L NormalDifferential Count

Neutrophils 0.27 0.50-0.70 DecreasedLymphocytes 0.71 0.20-0.40 There is an increase

due to the presence of infection

Monocytes 0.01 0.02-0.08 DecreasedEosinophils 0.01 0.01-0.04 NormalBasophils ----- 0.00-0.01 Normal

Hematology

Definition: The complete blood count (CBC), a screening test, is one of the most frequently

ordered laboratory procedures. It is a group of test that usually includes the

hemoglobin, hematocrit, red blood cell count, white blood cell count, differential

white cell count, red cell indeces and stained red cell examination.

Purpose: The procedure was done to the client to check for infection and other health problem.

Specimen sent: Blood

HEMOGLOBIN: It is the main component of RBC’s. Its main function is to carry oxygen from

the lungs to the body tissues and to transport carbon dioxide the product of cellular

metabolism back to the lungs.

HEMATOCRIT: The hematocrit is a measurement of the percentage of the red cells in the total

volume of blood.

RED BLOOD CELL: The erthrocytes are a determination of the number of red blood cells

found in each cubic millimeter of whole blood.

WHITE BLOOD CELLS: The total WBC is the absolute number of WBC circulating in a

cubic millimeter of blood; white cells are produced in the red bone marrow and

lymphatic tissues. After they are formed they enter the blood which transports them

to parts of the body where they are needed to defend against invading

microorganisms through phagocytosis and produce/ transport and distribute

antibodies to help maintain immunity.

NEUTROPHILS: Sometimes referred as polymorphonuclear leukocytes. They play a vital role

in the body inflammatory reaction because they are both the first and most numerous

type of cell to arrive at any area of the disease.

Analysis: Since they are the first to migrate towards the site of infection in large number, this

then result to a decrease remaining number of circulating neutrophils in the blood

stream.

LYMPHOCYTES: Their protective function is antibody production and humoral immunity

such as bacterial infection.

MONOCYTES: Since monocytes act as a scavenger cells to dispose off non-infectious foreign

substances. They are not as diagnostically significant as other white cells

BASOPHILS: Their protective function is not fully understood. They contain histamine and

heparin and appear to be involved in immediate hypersensitivity reactions.

PLATELET COUNT: The adhesive/ sticky quality of platelet allows them to clump together/

aggregate and adhere to injured surfaces. They release a substance that begins the

coagulation process. Along with fibrin they form the network for a clot to form.

URINALYSIS Found Value Normal Value SignificanceColor Yellow Amber Normal

Clarity clear Clear Normal

Specific Gravity 1.010 1.010-1.025 Normal

Clinical MicroscopyWBC 4-6/hpf IncreasedRBC 1-2/hpf Normal

Mucus threads some Normal

URINALYSIS

COLOR: The color of the urine normally ranges from pale yellow to deep amber. It is an

indication on how concentrated the urine is, though certain drugs and certain foods

change urine color.

CLARITY: Fresh voided urine is normally transparent. It becomes cloudy on standing but

adding a few drops of acid can reverse this. Increase’s in opacity, indicates

pathologic condition as a result of presence of bacteria, crystals, and other foreign

material in the urine.

Specific gravity: It is a measurement of the kidneys ability to concentrate urine. This test can be

used to estimate the person’s general fluid status. Since one of the major function of

the kidney is to maintain fluid balance typically, the more concentrated the urine, the

more fluid depleted the person is. In terms of renal function, this measurement

primarily indicates the person’s concentrating and diluting ability, when the kidneys

lose these abilities, the urine no, longer reflects physiologic stimuli and the specific

gravity become fixed at a level equal to that of the plasma.

Analysis: The patient’s level is still within normal range however it is already on its

lower limit due to the presence of bacteria, epithelial cells, mucus threads, leukocyte

esterase and amorphous phosphates.

WHITE BLOOD CELLS: It constitutes only one of the total blood volumes. They originate in

the bone marrow and circulate through the lymphoid tissues of the body. There they

function against inflammation.

Analysis: Since there is the presence of bacteria and inflammation there would be

increased on the number of white blood cells as an immune response to fight off the

bacteria invasion. However in process, some WBC’s are flushed out in the urine.

RED BLOOD CELL: There is a normal microscopic finding in routine urinalysis.

EPITHELIAL CELL: Normally this is found in the urine.

BACTERIA: Normally there are no bacteria in the urine.

MUCUS THREADS: Normally it is present in the urine.

Feces Exam Found Value Normal Value SignificancePhysical Character soft Soft Normal Color Yellow Yellow-brown NormalParasites/ova: Presence of

Entameoba hystolitica, oil granules - many

none This protozoan is the causative agent of this disease

Analysis: The presence of ova in the stool confirms that specific etiologic factor of the patient’s

diagnosis (acute gastroenteritis).

IX. DRUG STUDY

A. Date ordered: February 21, 2010

Generic name: Metoclopramide

Brand name: Reglan

Classification: Antiemetic

DRF: 3ml, per Orem, every 8 hours

Mechanism of action:

Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic

secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter

which when combined with effects on motility accelerate gastric emptying and intestinal

transit; little effects and gallbladder or colon motility; increase lower esophageal sphincter

pressure; has sedative properties; induces release of prolactin.

Desired effect:

This drug was given to our patient to prevent nausea and vomiting.

Nursing Responsibilities Rationale1.) To check Doctor’s order. For clarification.2.) Follow 10 R’s To potentiate the effects of the drug.

3.) Administer and monitor response to medications that prevent or relieve nausea

Provides sedative effect and prevents or relieve nausea

4.) Note systemic condition that may result nausea

Helpful on determining appropriate interventions or needs for treatment of underlying condition

5.) Instruct the mother to have the baby drink liquids before or after meals instead of with meals.

6.) Instruct the mother to let the baby eat small frequent meals throughout the day instead of large meals

So stomach does not feel excessively full

7.) Auscultate abdomen For presence, location and characteristics of bowel sounds

8.) Review medications Which often causes changes on bowel habits, especially on children

9.) Restrict solid food intake as indicated To allow for bowel rest/reduce intestinal workload

B. Date ordered: February 21, 2010

Generic name: Ampicillin

Brand name: Ampicillin sodium

Classification: Antibiotic

DRF: 150mg, IV, every 6 hours

Mechanism of action:

Belonging to the penicillin group of beta-lactam antibiotics, ampicillin is able to

penetrate Gram-positive and some Gram-negative bacteria. It differs from penicillin only by

the presence of an amino group. That amino group helps the drug penetrate the outer

membrane of gram-negative bacteria.

Ampicillin acts as a competitive inhibitor of the enzyme transpeptidase, which is

needed by bacteria to make their cell walls. It inhibits the third and final stage of bacterial cell

wall synthesis in binary fission, which ultimately leads to cell lysis.

Desired effect: This drug was given to treat the infection caused by the bacteria as well as

serve as a prophylaxis to the occurrence of opportunistic infection.

Nursing Responsibilities Rationale

1.) Check Doctor’s orders. For clarification.

2.) Test for sensitivity of the patient to

the drug by skin testing.

To avoid adverse reactions related to

hypersensitivity.

3.) To observe the 10 R’s in drug

administration.

To potentiate the effects of the drug.

4.) Check for the patency of the IV line

before the administration of the drug.

To be sure the drug really gets into the

vein.

5.) Administer the drug slowly. Antibiotics are known to be painful

during IV administration.