You are on page 1of 19

General Objectives

The purpose of this is to present a general picture of Acute Gastroenteritis through


effective nurse-patient interaction and relevant researches with critical, competent, and
collaborative application of the nursing process.

Specific Objectives:

 To obtain pertinent information about the patient’s demographic and socio-


economic profile.
 To be well – informed on the patient’s history including the past and present
hospitalization.
 To be knowledgeable on the different diagnostic procedure to be ruled – out
acute gastroenteritis, focusing on the nursing responsibilities and patients
teaching.
 To be familiar with the structure of stomach and function of its parts.
 To educate our selves about the pathophysiology of acute gastroenteritis, its
pathogenesis, causes and its clinical manifestation.
 To identify the medical and surgical management indicated for the patient.
 To be acquainted with the medications prescribed for the patient noting there
therapeutic effects and adverse reactions.
 To established appropriate nursing care plan that includes the dependent,
independent and collaborative nursing; and lastly
 To formulate necessary discharge planning and health teachings essential for
the patients fast recovery and prevention of possible complication.
PATIENT PROFILE

Name: Mika Mamburan Age: 6 months


Address: Mangaldan, Pangasinan Nationality: Filipino
Civil Status: Single
Religion: Roman Catholic
Chief Complain: LBM
Date/Time of Admission: July 09, 2009
Attending Physician: Dr. Esperanza
GENERAL DATA:
A care of Mika Mamburan, 6mo. Old infant, female, Filipino, born on Dec. 16,
2008 residing of Mangaldan, Pangasinan and admitted for the 1st time at Region 1
Medical Center on July 09, 2009 around 10:30 am.
Informant: Mother
Reliability: 85%
Chief Complain: LBM

HPI:
Patient was apparently well until a day prior to admission, patient had LBM,
episodes, of watery consistency, yellowish in color. Her condition was accompanied by
fever, undocumented, remittent. No consultation was done but the mother gave
paracetamol offering no relief.
Few hours prior to admission, the informant noticed loss of appetite and the above
mentioned condition was persisted, thus prompted the mother o seek consult, hence the
admission.

Past Personal History:


*The Prenatal History
The mother was 28y/o, G2 p1 (1001), cognizant of pregnancy ay 2mons. AOG
due to amenorrhea confirmed by (+) pregnancy test. Prenatal checkups were done at
health center for 5 times with regular intake of multivitamins. Patient’s mother had LBM
of unknown mos. AOG during her pregnancy, the informant claimed that she took
cotrimoxale given by the midwife. No other complications noted like HPN, bleeding,
trauma.

Natal History:
Patient was born via NSO, cephalic, term, home delivered assisted by midwife
after 4hrs. of labor, cries immediately. Birth weight - undocumented.
Neonatal History:
There was no cyanosis at birth, no jaundice noticed on the first 24hrs. of life. No
convulsion. No umbilical stamp fell off after 2weeks.

Feeding History:
Patient was on a formula feeding, (2;1) on a per demand type. No allergic noted
on the type of milk given, Bonamil.

Immunizations:
The following vaccines were given of unrecalled month of administration. 1 dose
of BCG.

Past History:
No history of illness, hospitalization, trauma & major operation. No allergies to
foods and drugs.

Family History:
Mother: 28 y/o, vendor, healthy
Father: 34 y/o, vendor, healthy
Denies any heredofamilial diseases like DM, HPN, asthma, carcinoma. No exposure to
TB.

*Growth and Developmental Milestone*


(+) head control
(+) hands together
(+) rolls over
Social and Environmental History:
Patient lives in a cement type house, owned. Source of drinking water is from
mineral water their garbage are collected.

Patient of Systems:
General: weak looking, poor appetite
HEENT: (-) head injury, redness, epistaxis, gum bleeding
(+) no tears
Chest and Lungs: (-) dyspnea
Hearth: (-) palpitations
GIT: see HPI
Cut: (-) hematuria
Neurologic: (-) seizures

Physical Examination:
Patient is conscious, febrile, weak looking, irritable, mild cardio pulmonary
distress
Vital Signs: CR: 109 WT:6KG AC:40
RR:102 HO:41
Temp.:40 CC;39
Skin: No rashes, po0r skin turgor, dry skin
HEENT: Pink palpebral conjuncture, anisteric sclerae, deep eyeball, no discharges.
Chest & lungs: Symmetrical chest expansion, (+) retraction, (+) crackles
Hearth: Dynamic precardium, no murmur
Abdomen: Glubural, soft, non-tender
Extremities: grossly normal

Assessment:
Age with Severe Dehydration
MEDICAL DIAGNOSIS
ACUTE GASTROENTERITIS WITH SEVERE
DEHYDRATION

WHAT IS AN ACUTE GASTROENTERITIS?

Gastroenteritis is the irritation and inflammation of the digestive tract. This


condition may cause abdominal pain, vomiting and diarrhea. Severe cases of
gastroenteritis can result in dehydration. In such cases, fluid replacement is the primary
factor in treatment. All ages and both sexes may be affected yet the most severe
symptoms are experienced by infants and those individuals over sixty years old. The use
of certain drugs such as aspirin, antibiotics or cortisone drugs may increase risk for this
condition.

Food poisoning, stress, excessive alcohol or tobacco use, viral infections, food allergies,
improper diet, certain drugs, food consumed in foreign countries and intestinal parasites
are all possible causes for this condition.

What causes it?

Gastroenteritis can be caused by viral, bacterial, or parasitic infections. Viral


gastroenteritis is highly contagious and is responsible for the majority of outbreaks in
developed countries.

Common routes of infection include:

• Food (especially seafood)


• Contaminated water
• Contact with an infected person
• Unwashed hands
• Dirty utensils
In less developed countries, gastroenteritis is more often spread through contaminated
food or water.

What are the symptoms of gastroenteritis?

The main symptom of gastroenteritis is diarrhea. When the colon (large intestine)
becomes infected during gastroenteritis, it loses its ability to retain fluids, which causes
the person’s feces to become watery. Other symptoms include:

• Abdominal pain or cramping


• Nausea
• Vomiting
• Fever
• Poor feeding (in infants)
• Unintentional weight loss (may be a sign of dehydration)
• Excessive sweating
• Clammy skin
• Muscle pain or joint stiffness
• Incontinence (loss of stool control)

Because of the symptoms of vomiting and diarrhea, people who have gastroenteritis can
become dehydrated very quickly. It is very important to watch for signs of dehydration,
which include:

• Extreme thirst
• Urine that is darker in color
• Dry skin
• Dry mouth
• Sunken cheeks or eyes
• In infants, dry diapers (for more than 4-6 hours)
How common is gastroenteritis?

Because gastroenteritis is so similar to diarrhea, and because so many cases do not


require hospitalization, it is difficult to determine how many cases of gastroenteritis occur
per year. Worldwide, it is estimated that three to five billion cases of acute diarrhea
(which can be caused by many other diseases besides gastroenteritis) occur per year, with
about 100 million cases in the United States (roughly one to 2.5 cases of diarrhea per
child). Gastroenteritis is estimated to cause about 5 to 10 million deaths per year
worldwide, and about 10,000 deaths per year in the United States.

Who is at risk for gastroenteritis?

Anyone can get the disease. People who are at a higher risk include:

• children in daycare
• students living in dormitories
• military personnel, and
• travelers

People with immune systems that are weakened by disease or medications or not fully
developed (i.e., infants) are usually affected most severely.

How is gastroenteritis diagnosed?

The doctor will take a medical history to make sure that nothing else is causing
the symptoms. Also, the doctor might perform a rectal or abdominal examination to
exclude the possibilities of inflammatory bowel disease (e.g., Crohn’s disease) and pelvic
abscesses (pockets of pus). A stool culture (a laboratory test to identify bacteria and other
organisms from a sample of feces) can be used to determine the specific virus or germ
that is causing gastroenteritis.

Other diseases that could cause diarrhea and vomiting are pneumonia, septicemia (a
disease caused by toxic bacteria in the bloodstream), urinary tract infection, and
meningitis (an infection that causes inflammation of the membranes of the spinal cord or
brain). Also, conditions that require surgery, such as appendicitis (an inflammation of the
appendix), intussusception (a condition in which the intestine folds into itself, causing
blockage) and Hirschsprung’s disease (a condition where nerve cells in the intestinal
walls do not develop properly) can cause symptoms similar to gastroenteritis.

How is gastroenteritis treated?

The body can usually fight off the disease on its own. The most important factor
when treating gastroenteritis is the replacement of fluids and electrolytes that are lost
because of the diarrhea and vomiting. Foods that contain electrolytes and complex
carbohydrates, such as potatoes, lean meats (e.g., chicken), and whole grains can help
replace nutrients. You can also buy electrolyte and fluid replacement solutions at food
and drug stores. Or, if hospitalization is required, the nutrients can be replaced
intravenously (injected directly into the veins).

How can gastroenteritis be prevented?

There are several steps that you can take to reduce your risk of getting gastroenteritis,
including:

• Washing your hands frequently, especially after going to the bathroom and when
you are working with food;
• Cleaning and disinfecting kitchen surfaces, especially when working with raw
meat or eggs;
• Keeping raw meat, eggs, and poultry away from foods that are eaten raw
• Drinking bottled water and avoiding ice cubes when traveling
Stomach
Anatomy
The stomach is a “J” shaped hollow, muscular organ suspended under the diaphragm. The
upper larger portion of the stomach or Fundus is situated in the upper left quadrant of the
abdomen and entrance to the stomach is gained through the esophagus through the
Gastroesophageal Juncture (GE juncture or sometimes called the cardiac sphincter).
Anatomically its structure narrows as it gradually slopes downward towards the mid-
epigastric right hand quadrant, where it eventually passes into the pyloric sphincter and
empties into the 1st phase of the small intestine- the duodenum.

The major portions of the stomach include the fundus (upper), body (middle), and
antrum (lower). Sometimes a fourth area is identified immediately upon entry into the
stomach as the cardiac region . As the stomach descends to the right quadrant the upper
smaller angulation is termed the lesser curvature whereas the lower much longer
angulation is termed the greater curvature .

On average the adult stomach can hold about 5 to 8 pints, and weighs about 4.5 ounces.
Ventral aspect of the exterior of the stomach;
Ventral aspect of the posterior mucosa of the
stomach. 1 Esophagus 2 Cardiac Notch 3
Cardiac part of the stomach 4 Lesser
Curvature 5 Pyloric Sphincter 6 Angular
Notch 7-8 Antrum 9 Fundus 10 Greater
Curvature 11 Body 12 Gastric Folds

Tissue

There are three layers of muscle utilized in the functioning of the stomach: an outer
longitudinal muscle layer, a middle circular muscle layer, and an inner oblique muscle
layer. These muscles are used in peristalsis and digestion of chyme (food and gastric
enzymes). The oblique layer muscle is covered with a mucous membrane. This
membrane contains many gastric glands designed with different regulatory functions. The
shape of this membrane is distinguished by its convolutions called rugae , which in
appearance are similar to the convolutions of the brain and seem to wane as the wall of
the stomach expand.
Vessels and Nerves
Blood is supplied to the stomach via the gastric, pyloric and branches of the splenic
arteries. The left side of the stomach is drained via the gastric vein and the right side is
drained via the splenic vein and superior mesenteric vein.

The stomach is innervated by both sympathetic fibers of the celiac plexus and
parasympathetic fibers of the gastric branch of the vagus nerve.

Function
The function of the stomach is to receive food from the esophagus and churn it with
digestive juices into a pasty substance called chyme. The convolutions noted in the
stomach are from gastric glands in the mucosal lining of the stomach. These glands also
known as “pits” contain several secretory cells :
Gland Product Function
Mucous Cell Alkalytic mucous Protective Barrier on stomach
Hydrochloric Acid Acidic area for action of pepsin
Parietal Cells
Intrinsic factor Intestinal absorption of B 12
Precursor to Pepsin (converted In the presence of pH < 5.0;
Chief Cell Pepsinogen
HCL)

There are 3 phases of gastric juice secretion:


Cephalic phase

The sensory phase where stimuli are received thru the senses (tasting, chewing and
swallowing)

This phase is under the direction of the vagus nerve and its release of Ach for activation
of the parietal and chief cells, which in turn secrete Acid and Pepsinogen. This phase may
also fall under the response of insulin secretion from hyperglycemia

Gastric Phase

Is initiated when food actually enters the stomach which distends the stomach or when
digested proteins are detected. These proteins are broken down from the enzyme Pepsin.
Gastrin is released which causes enhanced secretory effects.

Intestinal Phase

The movement of chyme into the duodenum. The acidity from the chyme causes a release
of a hormone cholecystokinin pancreozymin, which inhibits Gastrin stimulated acid
production and inactivates pepsin thus ending the cycle. At rest, gastric secretion in the
stomach averages about 50 milliliters of fluid
Urinary Result:
Mika mamburan Lab. Test No.
Pedia Age: 6 mos. Sex: F

Color: yellow Epithelial cell: same


Transparency: Sligthly turbid Pus cell: 1-3/hpf
pH: no rgt RBC: 2-3/hpf
Specific gravity: no rgt Amorphous (urates): few
Protein: no rgt
Sugar: no rgt

Fecalysis Result:

Color: yellow RBC: 0-1/hpf


Consistency: mucoid Pus cells: 0-1/hpf
Others: fat globules #

Hematology Result:
Exam Name: Result Unit Normal Values
WBC count 16.9 10^9/L 6.0-14.0
Neutrophilis 0.59 0.36-0.66
Hemoglobin 110 g/dl 105-140
Hematocrit 0.34 0.32-0.42
Platelet 496 10^9/L 140-440 10^9/L
Blood Chemistry Report:

Normal Values
Sodium 151mmol/L 135.0-148.0mol/L
Potassium 4.79mmol/L 3.5-5.3mmol/L
Chloride 131.6mmol/L 95-103mmol/L

Medication
Ampicillin 150mg IVF q6 hours
Paracetamol 150mg/ml 0.4ml q6 hours
Probiotics 1 sachet OD
Zinc 10mg/ml 1ml OD
Ceftriaxone 300mg IVF q 12 hours
Doctor’s Order
(7/9/09)
9:15am
>please admit patient to PICU, green service
>secure consent for admission and management
>TPR q shift and recorded
CR-102
RR- >NPO
T-40 # LBM
Wt.=6kg >Diagnostics:
-CBG, PLT
-U/A
-SE
-Serum Na, K+
150cc/hr >hook to D5LRS 500ml TRA 150ugtts/min x 6hr. from Dra. c/o PNOD
>IV hook 60cc PNSS now
>Ampicillin 150g IVF q 6hrs. if temp>38c
>Probiotics 1 sachet OD
>Zinc 10mg/ml 0.14ml q 6hrs. ANST (-)
>TSB if persistently febrile
>Watch out for persistent LBM an Tx
>Volume for for volume replacement with PNSS
>Monitor V/S q 1hr. and record
> I and O q shift and recorded, shift
>Refer accordingly
>O2 inhalation at 1-2 LPM via nasal cannula

Dr. Estrada/Esperanza
07/09/09 >Discontinue Ampicillin
2:10 >Start Ceftriaxone 300g IVF q 12hr. ANST (-)
(+)LBM=ix >Decrease IVF to 100 ugtts/min. x 6hrs. refer to PNOD and NA
(+)sunken >Continue volume per volume replacement with PNSS
(+)dry lips >Ff. u[ CBC, pH, serum Na, K+ results
>Refer accordingly

Dr. Estrada

5:45pm >Decrease IVF to 50 ugtts/min. x 6hr. from Dr. Estrada c/o PNOD

Dr. Estrada

7/10/09 >Same IVF @ SR


>May start fluids with SAP
>D/c o2 inhalation
>May transfer patient to regular ward
>Con’t. meds. IVF accordingly
>Refer accordingly

Dr. Estrada

7/11/09 >IVF to follow D5IMB 500cc TRA 25 ugtts/min.


8:20am >Con’t. BF with SAP
>Con’t. Medications and monitoring
>Refer accordingly

Dr. Estrada