I.

READINGS

DEFINITION

Acute gastroenteritis is a general term referring to inflammation or infection of the

gastrointestinal tract, primarily the stomach and intestines.

Sometimes it is referred to simply as 'gastro'. It is often called the stomach flu or gastric
flu even though it is not related to influenza.

TYPES OF ACUTE GASTROENTERITIS ACCORDING TO CAUSATIVE

AGENT:
 Viral Gastroenteritis
- An infection caused by a variety of viruses that results in vomiting or diarrhea.
- Most common cause of gastroenteritis which cannot be cured by antibiotics.
- Occurs in people of all ages and backgrounds. Adenoviruses and astroviruses cause
diarrhea mostly in young children, but older children and adults can also be affected.

 Bacterial Gastroenteritis
- An inflammation of the stomach and intestines caused by bacteria or bacterial toxins.
- Can affect one person or a group of people who all ate the same contaminated food. It
more commonly occurs after eating at picnics, school cafeterias, large social
functions, or restaurants.

INCIDENCE

Worldwide, gastroenteritis kills 3 million to 5 million children every year, primarily in

developing nations where sanitation and health care are poor. Most of these children die from
extreme dehydration (abnormally low levels of body water) resulting from a combination of
severe diarrhea, vomiting and not drinking enough fluids. Even in the industrialized world,
millions of episodes of gastroenteritis occur each year, especially in young children.

This is more likely to happen in infants, children with chronic illnesses and children
taking immune-suppressing medications. By age 3 years, virtually all children become infected
with the most common agents.
 In the Philippines, acute gastroenteritis is one of the ten leading cause of morbidity and
mortality. Among Filipino children 1-4 years of age, it is the third most common cause of death
with 16.14 deaths per 100,000 population recorded.

According to the Provincial Health Office of Ilocos Norte, as of 2009, it was recorded
that gastroenteritis was in the top 10 leading causes of infant morbidity.

There are 3063 patients suffer from this illness in our province.

PHO also confirmed that acute gastroenteritis is a common cause of morbidity among
children less than five years of age, and that, it is estimated to 2000 infants, and the rest, is to be
credited to the adults.

RISK FACTORS/CAUSES

 Consumption of improperly prepared foods or contaminated water and travel or residence

in areas of poor sanitation.-AGE is basically attributed to food or water contaminated
with fecal material containing the virus. And to note, these viruses are potent and
aggressive. Evidence suggests that as few as ten viral particles are sufficient to cause
AGE.
 Overcrowding- overcrowding becomes an avenue to bacteria like the E.coli, because easy
transmission can occur
 Poverty- with less money, poor people are not able to buy proper sanitized food and
water, as well as, they are not able to buy medicines and drug supplements. People who
have less in life prioritize buying food than to avail medical assistance. It’s like “isang
kahig, isang tuka” system that hat they earn today, is only reserved from their day to day
survival for food.
 Poor sanitation- the presence of bacteria in the community cannot be lessened since these
filthy reservoirs are the best dwelling of disease-causing bacteria. With regards to AGE,
bacteria causing it survives for several days in a contaminated environments, thereby
making it also to easily spread virus.
 Pollution- leads to unhealthy environment which turns to be the reservoir of bacteria.
Thus, making the inhabitants of a certain polluted place to be susceptible of getting
infected, or say, their food to be contaminated, that leads to food poisoning.
 Age-By age 0-5 years, virtually all children become infected with the most common
agents since at this age bracket, they are very susceptible to viruses and bacteria causing
illnesses. Usually, they are very prone in touching things around them and accidentally
places their hands in their mouth, thereby, a point of entry for the pathogens to cause
illnesses. At this age, their immune system is still weak that they are easily suppressed by
these bacteria and viruses.
CLINICAL MANIFESTATIONS

 VIRAL GASTROENTERITIS

 Watery diarrhea

Diarrhea refers to the passage of loose or watery stools, and occurs at some point in the
life of nearly every child. Diarrhea is not a disease, but is a symptom of a number of
illnesses. Diarrhea caused by gastroenteritis is watery and may contain blood if the illness
is caused by a type of bacteria.

 Vomiting

Vomiting is a forceful action accomplished by a fierce, downward contraction of the

diaphragm. At the same time, the abdominal muscles tighten against a relaxed stomach
with an open sphincter. The contents of the stomach are propelled up and out.

 Headache

Headache or Cephalgia is pain anywhere in the region of the head or neck. It can be a
symptom of a number of different conditions of the head and neck

 Chills

Rigor or chills is a shaking occurring during a high fever. It occurs because cytokines and
prostaglandins are released as part of an immune response and increase the set point for
body temperature in the hypothalamus.

 Abdominal pain

Severe abdominal pain can be from mild conditions, such as gas or the cramping of viral
gastroenteritis

 Loss of appetite

The decreased sensation of appetite.

 BACTERIAL GASTROENTERITIS

 Diarrhea

Diarrhea refers to the passage of loose or watery stools, and occurs at some point in the
life of nearly every child. Diarrhea is not a disease, but is a symptom of a number of
illnesses. Diarrhea caused by gastroenteritis is watery and may contain blood if the illness
is caused by a type of bacteria.

 Abdominal pain

Severe abdominal pain can be from mild conditions, such as gas or the cramping of viral
gastroenteritis

 Loss appetite

The decreased sensation of appetite

 Vomiting

Vomiting is a forceful action accomplished by a fierce, downward contraction of the

diaphragm. At the same time, the abdominal muscles tighten against a relaxed stomach
with an open sphincter. The contents of the stomach are propelled up and out.

 Fever

The presence of fever (with or without chills) generally suggests that an invasive
organism is the cause of diarrhea, although many extra intestinal illnesses can present
with both fever and diarrhea, especially in children.
TREATMENT & MANAGEMENT

 Give 2-4 ounces of extra fluid every time that he has a large watery diarrhea.
 BRAT diet
 Give sips of oral rehydration salt solution or pedialyte

 Don't eat solid foods until the diarrhea has passed, and avoid dairy products, which can
make diarrhea worse (due to a temporary state of lactose intolerance).
 Drink any fluid (except milk or caffeinated beverages) to replace fluids lost by diarrhea
and vomiting.
 Give children an electrolyte solution sold in drugstores.
 IV fluid

PREVENTION

To help prevent gastroenteritis in all members of your family, you can take the following steps:

 Wash your hands frequently, especially after using the toilet, after changing the diapers
and after carrying for a child with diarrhea.
 Wash your hands before and after preparing foods, especially after handling raw meat.
 Wash diarrhea-soiled clothing in detergent and chlorine bleach. If bathroom surfaces are
contaminated with stool, wipe them with a chlorine-based household cleaner
 Cook all meat thoroughly before you serve it to your family, and refrigerate leftovers
within 2 hours.
 Make sure you don’t transfer cooked foods on to unwashed plates that held raw meat.
 Wash kitchen countertops and utensils thoroughly after they have been used to prepare
meat.
 Never drink unpasteurized milk, unpasteurized apple cider or untreated water.
 If you travel to an area where sanitation is poor, make sure that your family drinks only
bottled water of soft drinks, and that they don’t eat ice, uncooked vegetables or fruit that
they haven’t peeled themselves.
PHARMACOLOGICAL MANAGEMENT

 Ondaserton-
CLASSIFICATION: Antiemetic
MECHANISM OF ACTION : Selective 5-HT3 receptor antagonist, blocking serotonin,
both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger
zone.

 Doxycycline
CLASSIFICATION: Antibiotic
MECHANISM OF ACTION: Inhibits protein synthesis of susceptible, bacteriostatic.

 Glucolyte
CLASSIFICATION: Fluid and electrolyte
MECHANISM OF ACTION: To increase fluid and electrolyte in the body

 Dicycloverine
CLASSIFICATION: Anticholinergic

MECHANISM OF ACTION: Thought to exert direct effect on GI smooth muscle by

inhibiting acetylcholine at receptor sites, thereby reducing GI tract motility and tone.

 Cotrimoxazole

CLASSIFICATION: Antibacterials (Sulfonamides)

MECHANISM OF ACTION: Sulfamethoxazole component inhibits the formation of

dihydrofolic acid from PABA; the trimethoprim component inhibits dehydrofolate
reduclase. Both decrease bacterial folic acid synthesis.

 Metronidazole

CLASSIFICATION: Gastrointestinal Stimulant (bactericidal)

MECHANISM OF ACTION: May caused bactericidal effect by interacting with bacterial

DNA. Active against many anaerobic gram-negative bacilli ,anaerobic gram-positive
cocci.
DIAGNOSTIC PROCEDURES

 Stool culture

Diseases can be detected with a stool culture. Toxins from bacteria such as
Clostridium difficile can also be identified. Viruses such as rotavirus can also be found
in stools.

 Hematology

Also known as full blood count (FBC) or full blood exam (FBE) or blood panel, is
a test requested by a doctor or other medical professional that gives information about the
cells in a patient's blood.

This procedure is done to the client to determine general health status and to
screen for a variety of disorders and in order to determine whether there are evaluations
in the blood components.

 Fecalysis

 To detect the presence of a specific disease agent

 To detect indirectly evidence or malfunction of some portions of the gastro-
intestinal tract.
II. Anatomy and Physiology

Digestive System
 The digestive system takes in food, breaks it down physically and chemically into
nutrient molecules, and absorbs the nutrients into the bloodstream. Then it rids the body of the
indigestible remains.
The alimentary canal performs the whole menu of digestive functions. The accessory
organs assist the process of digestive breakdown in various ways.

Mouth
The mouth is also called the oral cavity, a mucous membrane-lined cavity. The mouth is
the place where food is taken in and where digestion begins. The mouth is adapted to receive
food by ingestion, break it into small particles by mastication, and mix it with saliva.

Pharynx

A fibromuscular passageway, commonly called the throat, that extends from the base of
the skull to the level of the sixth cervical vertebra. It serves both the respiratory system and the
digestive system by receiving air from the nasal cavity and air, food, and water from the oral
cavity.

Esophagus
 The esophagus, or gullet, runs from the pharynx through the diaphragm to the stomach.
About 25 cm long, it is essentially a passageway that conducts food to the stomach.

Stomach
The stomach is the sac-like portion of the gastrointestinal system that follows, and
receives food from the esophagus. The stomach is located in the upper left quadrant of the
abdomen is divided into different regions. The cardiac region surrounds the cardioesophageal
sphincter,
through
which food
enters the
stomach
from the
esophagus.
The fundus
is the
expanded
part of the
stomach
lateral to the
cardiac
region. The
body is the
midportion,
and the
funnel-
shaped
pylorus is the terminal part of the stomach. The stomach is continuous with the small intestine
through the pyloric sphincter, or valve. The stomach is approximately 25cm long, but its
diameter depends on how much food it contains. When it is full, it can hold about 4 liters of
food. When it is empty, it collapses inward on itself, and its mucosa is thrown into large folds
called rugae.
Small intestine
The small intestine is the body’s major digestive organ. The small intestine is a muscular
tube extending from the pyloric sphincter to the ileocecal valve. It is the longest section of the
alimentary tube, with an average length of 2 to 4 m hangs in sausagelike coils in the abdominal
cavity, suspended from the posterior abdominal wall by the fan-shaped mesentery. The large
intestine encircles and frames it in the abdominal cavity.
The small intestine is divided into the duodenum, jejunum, and ileum. The duodenum,
which curves around the head of the pancreas, is about 25cm long. The jejunum is about 2.5m
long and extends from the duodenum to the ileum. The ileum, about 3.6m long, is the terminal
part of the small intestine. It joins the large intestine at the ileocecal valve.
Large
intestine

The large intestine is much larger in diameter than the small intestine, but shorter in
length. About 1.5m long, it extends from the ileocecal valve to the anus. Its primary role
is the excretion of non-absorbed material passed from the small intestine and water
absorption.
Rectum
The part of the gastrointestinal tract that continues from the sigmoid colon of the large
intestine to the anal canal and has a thick muscular layer. It follows the curvature of the sacrum
and is firmly attached to it by connective tissue.

Anus
The terminal opening of the gastrointestinal tract. The last 2 to 3 cm of the GI tract is the
anal canal, which continues from the rectum and opens to the outside at the anus. The mucosa of
the rectum is folded to form longitudinal anal columns. The smooth muscle layer is thick and
forms the internal anal sphincter at the superior end of the anal canal. This sphincter is under
involuntary control. There is an external anal sphincter at the inferior end of the anal canal. This
sphincter is composed of skeletal muscle and is under voluntary control.

PERTINENT DATA

NAME: Baby Agee

AGE: 2 years old

GENDER: male

ADDRESS: Brgy. Sumader Batac City

BIRTHDAY: January 28, 2008

BIRTHPLACE: Batac City

RELIGION: Aglipayan

NATIONALITY: Filipino

WEIGHT: 5kgs.

HEIGHT: 2’’7’

HOSPITAL NUMBER: IPS062

ADMITTING DATE AND TIME: July 22,2010 9:15 AM

ADMITTING DIAGNOSIS: Acute Gastroenteritis

ADMITTING PHYSICIAN: Dr. Ramon Gaoat

ADMITTING HOSPITAL: Gaoat General Hospital

DISCHARGE DATE AND TIME: July 25, 2010 3:45PM

 III. HEALTH HISTORY

FAMILY BACKGROUND

NAME AGE RELATIONSHIP EDUCATIONAL OCCUPATION DISEASE

ATTAINMENT
Carmelo 60 Grandfather Elementary N/A Hypertension
Foronda (mother side) graduate arthritis
Agapita 60 Grandmother Elementary Utility worker Hypertension
Foronda (mother side) graduate arthritis
Teodoro 56 Grandfather Elementary Farmer Hypertension
Fontanill (father side) graduate
a
Carmelita 54 Grandmother Elementary N/A Hypertension
Fontanill (father side) graduate
a
Billy 27 Father High school Tricycle driver Cataract
Fontanill graduate
a
Loida 38 Mother College graduate Avon franchise Asthma
Fontanill dealer
a
Abelord 2 Child N/A N/A AGE
Fontanill
a

A. FAMILY HEALTH HISTORY

Baby Agee belongs to a nuclear family. He is the only son of Mr. & Mrs. Agee.

His mother lamented that Hypertension has been the prevailing disease of the family
especially the old ones. They were diagnosed before and were prescribed a drug maintenance but
they did not take it either. Also, arthritis as prominent to the old people, they also suffered from
it but are able to manage it by applying Efficacent oil. Baby Agee’s father has been diagnosed to
have a cataract and was recommended to be operated. However, due to financial constraint, he
was not able to avail for one. On the other hand, Baby Agee’s mother suffers from Asthma and
she is able to manage it through herbal medicines like oregano.

Mrs. Agee also informed us that their family also experiences fever, cough, common
colds and stomachache. They often manage it through herbal plants such as oregano and
“dangla” for cough, eucalyptus for common colds, extracts of “tawwa-tawwa” for
stomachache.For the fever, they often manage it through self-prescription or medication with
over-the-counter drugs such as Paracetamol/Biogesic. She also added that sudden change in
weather such as a decrease in temperature is a contributory factor for the family members to
acquire common colds and cough. Other management for their common illnesses would include
increase fluid intake or water therapy for fever, cough and common colds; taking in vitamin C-
rich foods and dringking calamansi juice for cough and common colds; TSB for fever; mumps is
also experienced by the family members and they usually treat it by applying “akot-akot” and
vinegar topically. Childhood illnesses experienced by the family members would also include
chicken pox and measles. They usually manage chicken pox through bed rest and by exposing to
the burnt onions when lesions are healing. As for measles, they usually treat it by wearing black
long-sleeved shirts.

At times of illnesses like cough or fever, the family tries to manage this on their own by
taking some OTC drugs or by herbal plants but when they experience serious illnesses, they
usually seek consultation in the RHU. And for other severe cases, the family would go to
hospital for further consultation and management.

According to Mrs. Agee, Baby Agee’s relatives were drinking coffee and tea. They do
not smoke nor intoxicate themselves with liquor. Their family does not have any kind of allergy
to foods, medicines and environment. The client as well as his family likes any type of cooked
foods.

B. PAST HEALTH HISTORY

The interview became an avenue to trace several diseases in the family. Mrs. Agee told
us that Baby Agee had experienced cough, colds, fever, stomachache and measles. Independent
management such as rest and giving in medications are found to be helpful. Medications such as
Paracetamol (biogesic). She also added that they are bringing Baby Agee to “ilots”. She also
revealed to us that they are using some herbal plants when it comes to cough and common colds
and stomachache such as oregano, “dangla” and “tawwa-tawwa” and they found it to be very
effective. However, she admits that there were also instances that such kinds if illnesses are not
manageable especially when things get worst and could no longer tolerate. As such, that will be
the time for them to seek medical advised.

With regards with Baby Agee’s immunization, he had been vaccinated of BCG, OPV and
anti measles. Some other immunizations cannot be remembered by the mother. He availed this
doses of immunization at the RHU which is located at Brgy. Nalupta, Batac City. He also had
his vaccination for AH1N1 correspondingly.
 Last November 2008, Baby Agee was hospitalized with a chief complaint of cough and
common colds. He was admitted at Gaoat General Hospital with Dr. Ramon Gaoat as the
admitting physician.
 C. PRESENT HEALTH HISTORY

Three days before his hospitalization, Baby Agee attended a birthday party at their
neighborhood. According to Mrs. Agee, Baby Agee ate pancit and shanghai together with a soda.

The next day, Baby Agee began to move his bowel frequently. He defecated six times
and began to have fever. Mere touch of the mother shows that Baby Agee is being ill with fever.
Mrs. Agee all knew that it was just a fever and LBM that he ate something which is not good for
his stomach.

On the second day, the patient experienced body weakness and abdominal pain.

They submitted Baby Agee to Gaoat General Hospital last July 22, 2010 at 9:15 AM and
accompanied by his mother and father. He was admitted by Dr. Ramon Gaoat with the admitting
diagnosis of acute gastroenteritis.

D. LIFESTYLE AND RECREATION

Baby Agee is a 2 year old boy. He usually eats his breakfast with coffee and pandesal. After
having his breakfast he usually plays with his mother because he doesn’t have any playmate in
the neighborhood.

Baby Agee usually sleeps at 7 or 8:30 in the evening and wakes up at about 4 or 6 in the
morning.

He is having his bowel movement once every morning.

They make use of the well as the source of their water supply.

In instances when the family is invited to attend a party, they usually bring their son with
them and part ate also what eve food is being served.
 E. PSYCHOLOGICAL DATA

Psychosocial Theory of Erik Erickson

According to Erik Erikson’s Theory of Psychosocial Development, our patient belong to

the Early Childhood age bracket (18 months-3 years old), with a central task of Autonomy vs.
Shame & Doubt.

Erickson’s envisions life as a sequence of levels of achievement. Each stage signals a

task that must be achieved which viewed a series of crises. A successful resolution would
indicate a support to the person’s ego while the failure to resolve the crises is damaging to the
ego. Erikson believes that the greater the task achievement, the healthier the personality of the
person while failure to achieve the task influences the person’s ability to achieve the next tasks.

According to Erikson’s Developmental Theory, the primary developmental task of the

stage early childhood is, autonomy, which is the capacity of a rational individual to make an
informed, un-coerced decision.

 Infancy Birth – 18 months Trust vs. Mistrust

 Early Childhood 18 months – 3 years Autonomy vs. Shame & Doubt

 Late Childhood 3 – 5 years Initiative vs. Guilt

 School Age 6 – 12 years Industry vs. Inferiority

 Adolescence 12 – 20 years Identity vs. Role Confusion

 Young Adulthood 18 – 25 years Intimacy vs. Isolation

 Adulthood 25 – 65 years Generativity vs. Stagnation

 Maturity 65 years to death Integrity vs. Despair

 TASK PROOF ANALYSIS
Toilet training We can say that our patient MET
met this task because he is
able to go to the toilet alone
and urinate. He neither wears
diapers at daytime nor at
nighttime.
Motor skills We can say that our patient MET
had exemplified to develop his
motor skill like walking and
climbing during his play time.
He is able to show his motor
skills like playing even he
feels such illness.

ANALYSIS:

Our patient builds rapport with his family. He gets along with us and he seems to be
friendly, thereby, he displays autonomy within him.
PHYSICAL ASSESSMENT:

The physical assessment was done last July 23, 2010 at 6:30 AM at Gaoat General
Hospital, pediatric ward.

GENERAL APPEARNCE:

Baby Agee was seen lying on bed with white sando and blue printed short. He has an IV
fluid of D5 W 500 cc @ 200 cc level regulated to 63 gtts/min infusing well at his right arm, weak
in appearance. He has trimmed hair and short, clean fingernails. His skin is light brown. He has
white sclera.

VITAL SIGNS:

Vital Signs July 23, 2010

Body temp. 37.80C
Cardiac rate 126bpm
Respiratory 20bpm
rate

HEAD TO TOE ASSESSMENT

1. Hair

COLOR Black

TEXTURE AND MOISTURE Soft

DISTRIBUTION Equally distributed

THICKNESS AND THINNESS Fine

CONDITION OF THE SCALP No lice and dandruff noted

2. Head

CONDITION No mass palpated

CONFIGURATION Normocephalic

3. Eyes

CONDITION OF THE EYES With coordinated eye movement

COLOR OF THE SCLERA White in color

 CONDITON OF THE CONJUNCTIVA Pale palpebral conjunctiva

REACTION TO LIGHT PERRLA (Pupil are Equally Round and

Reactive to Light Accomodation)

VISUAL ABILITY With good visual ability can follow hand

direction.

4. Ears

APPEARANCE Symmetrical in size and shape

ALLIGNMENT Both eyes are aligned to the outer canthus of

the eyes

CONDITION OF THE EAR No cerumen impacted and no lesions noted

5. Nose

PATENCY OF THE NOSE No secretions

SYMMETRY With intact nasal septum and in midline

position

CONDITION No flaring of the nose

6. Mouth

LIPS

MOISTURE Upper and lower lips are dry

COLOR Pinkish in color

CONDITION No lesions noted

TONGUE

MOISTURE Moist

COLOR Pinkish in color

TEETH

NUMBER OF TEETH with complete set of milk teeth(20)

CONDITION no dental carries noted

 GUMS

COLOR Pinkish in color

CONDITION No swollen gums or bleeding

MUCOUS MEMBRANE

COLOR Pinkish in color

CONDITION Moist, intact mucous membrane

7. Neck

RANGE OF MOTION Able to move without difficulty

CONDITION No mass palpated

8. Chest

CONDITION No rales, wheezing sounds upon

auscultation

9. Abdomen
SHAPE globular

BOWEL SOUND Hyperactive bowel sound (35)

CONDITION soft upon palpation and dull upon percussion

Upper Extremities

RANGE OF MOTION Both arms has a good ROM (360º) able to

extend and flex on normal ROM

CONDITION OF THE SKIN good skin turgor

APPEARANCE with scar on the right deltoid

CONDITION OF THE FINGERNAILS Short and clean

COLOR OF NAILBED Pinkish

CAPILLIARY REFILL With normal capillary refill, at 2 seconds

Lower Extremities
 RANGE OF MOTION Both leg has a good ROM able to extend
and flex on normal ROM

CONDITION OF THE TOENAILS Slightly long and slightly dirty

COLOR OF THE NAILBED Pinkish

CAPILLIARY REFILL With normal capillary refill, at 2 seconds

10. Skin

COLOR Light brown

TEMPERATURE Warm to touch

TEXTURE smooth

APPEARANCE flushed skin

ON-GOING APPRAISAL

JULY 23, 2010

On the first day of our appraisal, we has seen Baby Agee on bed lying with an IV fluid of
D5 W 500 cc @ 200 cc level regulated to 63 mgtts/min, infusing well. He is weak in appearance,
with a complaint of stomach pain and febrile. He was in soft diet.

Vital Signs:

Body temp.-37.8 degrees Celsius

CR-126bpm

RR-20bpm

JULY 24, 2010

We had seen our patient sitting on bed with an IV fluid of D5 IMB 500 cc @ 100 cc level
regulated at 63 gtts/min, infusing well. He still weak in appearance with stomach pain and
afebrile. He was still in soft diet.

Vital Signs:

Body temp.-36 degrees Celsius

CR-138bpm

RR-22bpm

JULY 25,2010

We had seen our patient on bed awake and he is fair in appearance. The doctor’s order is
MGH.

Vital Signs:

Body temp.- 36.6 degrees Celsius

CR-139bpm

RR-23bpm
JULY 26, 2010 (home visit)

We visited our patient and he is playing in front of their house. Still continuing all the
medication.

Vital Signs:

Body temp.- 36 degrees Celsius

CR- 136bpm

RR-21

JULY 27,2010 (home visit)

We had seen our patient playing with his toy inside their house together with his mother,
no complaints of stomach pain.

Vital Signs:

Body temp.- 36.4 degrees Celsius

CR-136bpm

RR- 23bpm

DATE July 23 July 24 July 25 July 26 July 27

IVF D5 W D5 IMB   
DIET Soft Soft DAT DAT DAT
WEAK IN   X X X
APPEARANCE
STOMACH    X 
PAIN

BODY TEMP. 37.80C 360C 36.60C 360C 36.40C

CARDIAC 126bpm 138bpm 139bpm 136bpm 136bpm
RATE
RESPIRAORY 20bpm 22bpm 23bpm 21bpm 23bpm
RATE
NURSING CARE PLAN

1)

Nursing Diagnosis

Acute pain related to irritation of mucosal lining secondary to release of enterotoxin of

microorganism as evidenced by facial grimacing, guarding behavior, expressive behavior
(crying) and verbalization “mama nagsakit buksit ko”.

Nursing Inference

One of the manifestations of gastroenteritis is abdominal pain. During the course of

inflammation, the body’s immune response, causing the release of cytokine and prostaglandin
causing an increase in vascular permeability and causes pain, which felt by the patient in the
abdomen.

Nursing Goal

After 1-2 hours of rendering effective and appropriate nursing intervention the pain felt
by the patient will be minimize or reduce. As will be manifested by absence of guarding
behavior, absence of facial grimacing, absence of expressive behavior (crying) and verbalization
“haan unay nasakiten”.

Nursing Intervention

1. Reassess for PQRST ( provokes, quality, radiates, severity, time) of pain

Rationale: To validate data.

2. Provide comfort measures such as changing position and backrub.

Rationale: to provide relaxation (non-pharmacological pain management)

3. Provide quiet environment

Rationale: to relax the client and away from pain and lessen the perception.

4. Suggest significant others (parents) should always be present.

Rationale: to comfort child

5. Give pain medication as prescribed.

Rationale: to decrease or eliminate pain.

Nursing Evaluation:

After 1-2 hours of rendering effective and appropriate nursing intervention the pain felt
by the patient was minimized or reduced. As manifested by absence of guarding behavior,
absence of facial grimacing, and absence of expressive behavior (crying) and verbalization “haan
unay nasakiten”.

2)

Nursing Diagnosis:

Hyperthermia related to release of pathogens as manifested by elevated body

temperature above normal range (body temp. of 37.8 0C) skin warm to touch, flush and
WBC increase skin and verbalization of “napudot nak.”

Nursing Inference:
The entry of foreign substance detected by the body. The immune system sense
signals to the hypothalamus which regulates the body temperature. The hypothalamus
increases the body temperature to compensate with the foreign substance that attack the
body.

Nursing goal:

After 30mins-1 hour of rendering effective nursing interventions, the patient will
be able to maintain normal range of body temperature 37.5 0C as will be manifested by
decrease body temperature in normal range (36.50C-37.50C ) absence of warm skin,
flushed skin and verbalization of “haan nak napuduten.”
Nursing Interventions:

1. Monitor body temperature

Rationale: To obtain data base

2. Render Tepid Sponge Bathing

Rationale: To decrease heat loss through conduction

3. Provide adequate fluid intake

Rationale: To replace fluid loss and to flush microorganisms

4. Administer anti-pyretic drugs as ordered like paracetamol

Rationale: To help reduce body temperature and maintain normal range of temperature.

Nursing Evaluation:

After 1 hour of rendering effective nursing interventions, the patient was able to
maintain normal range of body temperature 360C as manifested absence of warm skin,
flushed skin and verbalization of “haan nasakit ulo kun”

3)

Nursing Diagnosis:

Nutritional imbalance less than body requirements related to intestinal pain after
eating, decreased transit through bowel as manifested by bowel sounds and manifested by
abdominal pain and cramping.

Nursing Inference:

Insufficient intake of nutrients causes the body to body to fail to meet its
metabolic needs.
Nursing Goal:
 After 30 minutes-1 hour of rendering therapeutic interventions, the patient will be
able to have a normal bowel sound and relieve pain.

Nursing Interventions:

1. Ascertain understanding of individual nutritional needs.

Rationale: To determine what information will going to provide with the patient.

2. Discuss eating habits, including food preferences and intolerance.

Rationale: to appeal to the patient his/her likes/dislikes.

3. Instruct the mother to restrict solid food intake in the diet of the patient

Rationale: To allow for bowel rest/decrease intestinal workload

4. Assess weight, age, body built, strength, activities/rest level and so forth.

Rationale: To have comparative baseline.

Nursing Evaluation:

After 30 minutes-1 hour of rendering therapeutic interventions, the patient was

able to have normal bowel sound and relieved pain.
LABORATORIES AND DIAGNOSTIC PROCEDURE

Hematology and CBC (Complete Blood Count)

Date Ordered: July 22, 2010

A complete blood count (CBC), also known as full blood count (FBC) or full blood exam
(FBE) or blood panel, is a test requested by a doctor or other medical professional that gives
information about the cells in a patient's blood. A scientist or lab technician performs the
requested testing and provides the requesting medical professional with the results of the CBC.

The cells that circulate in the bloodstream are generally divided into three types: white
blood cells (leukocytes), red blood cells (erythrocytes), and platelets (thrombocytes).
Abnormally high or low counts may indicate the presence of many forms of disease, and hence
blood counts are amongst the most commonly performed blood tests in medicine, as they can
provide an overview of a patient's general health status. A CBC is routinely performed during
annual physical examinations in some jurisdictions.

PURPOSE:

This Procedure was done to the client to determine general health status and to screen for
a variety of disorders and in order to determine whether there are evaluations in the blood
components. And this will use for physical examination and evaluation of acute disease or
symptoms of anemia or infection. CBC is also done asses blood loss, renal function, muscle
breakdown and risk for excessive bleeding or clotting and reveal of blood cell destruction. This
test is used to evaluate plate production.

Nursing Responsibilities:

Check doctor’s order.

Inform the patient about the procedure to gain cooperation.

Explain that a tingling sensation maybe felt when collecting the specimen.

Follow-up result and refer it to the physician once available.

RESULT

Results Normal values Interpretation

RBC count 4.83 g/L 4.5-5.1 g/l Normal
WBC count 18.1 g/L 5.00-10.00 Increased
Hematocrit 0.35 g/L 0.35-0.44 Normal
Platelet 300 150-450 Normal
Differential count Results Normal Values Interpretation
Neutrophils 0.75 0.50-0.70 Increased
Lymphocytes 0.15 0.20-0.10 Normal
Monocytes 0.10 0.00-0.07 Normal
Eosinophils 0.02 0.00-0.07 Normal

ANALYSIS:

A serious bacterial infection causes the body to produce an increased number of

neutrophils, resulting in a higher than normal white blood cell count (WBC).
FECALYSIS

Date ordered: July 23, 2010

Fecalysis is also known as stool analysis. It refers to a series of laboratory tests done on
fecal samples to analyze the condition of a person's digestive tract in general. Among other
things, a fecalysis is performed to check for the presence of any reducing substances such as
white blood cells (WBCs), sugars, or bile and signs of poor absorption as well as screen for
colon cancer.

To properly check for inadequate absorption, a fecal fat test may be required. This is a
diagnostic procedure used to recognize problems with fat absorption. A quantitative fecal fat test
is usually completed in three days and able to verify the amount of fat within a person's body.

PURPOSES:

 To detect the presence of a specific disease agent

 To detect indirectly evidence or malfunction of some portions of the gastro-
intestinal tract.
 Used as a clue in several medical and surgical diagnosis.
Diagnostic Normal Value Result Significance
Color Yellow Yellow Normal
Consistency Soft Watery Presence of infection
Cellular Findings
RBC None Not seen Normal
Pus Cells 0-2 0-1/Hpf Normal
Bacteria None Many Infection is present
Yeast None None Normal

ANALYSIS:

The color of the stool is not normal, because normally the color is yellow. The presence of pathologic
bacteria signifies the presence of infection. The consistency of the stool shows that there is presence of
infecton. The consistency of the stool shows that the body attempts to overcome the disease by flushing
the microorganism out of the gastrointestinal tract.

DRUG STUDY
Date ordered: July 22, 2010

Generic name: Dicycloverine

Brand name: Dicyloveine Hcl

Dosage, Route, Frequency: 1 tsp Oral TID

Classification: Anti- cholinergic

Mechanism of action:

Thought to exert direct effect on GI smooth muscle by inhibiting acetylcholine at

receptor sites, thereby reducing GI tract motility and tone.

Desired effect:

Treatment of functional disturbances of GI motility.

Nursing Responsibilities:

1. Check for the Doctor’s order.

2. Check for allergies and contraindication.

Rationale: to prevent further complication
3. Take prescribed dose 1 hour before meal.
Rationale: for optimal absorption
4. Discuss the side effects of the drugs to the watcher such as:
Constipation
-ensure adequate fluid intake ,proper diet.
Difficulty in urination
-empty bladder immediately before taking drug
5. Emphasize to the watcher to report rash and flushing skin.
Rationale :to prevent further complication
Date Ordered: July 22, 2010

Generic name: Cotrimoxazole

Brand name: Kathrex

Dosage, Route, Frequency: 1 tsp Oral TID

Classification: Antibacterials (Sulfonamides)

Mechanism of action:

Sulfamethoxazole component inhibits the formation of dihydrofolic acid from PABA; the
trimethoprim component inhibits dehydrofolate reduclase. Both decrease bacterial folic acid
synthesis.
Desired effect:

It is to treat infection.

Nursing Responsibilities:

1. Chek for the Doctor’s order

2. Check for allergies and contraindication.

Rationale: to prevent further complication
3. Advise the mother to give the patient on regular schedule as prescribed.
Rationale: adherence to antibiotic treatment should be strictly followed to avoid
resistance.
4. Teach significant others to recognize and immediately report signs and symptoms of
hypersensitivity, especially rash.
Rationale: to prevent further complication
5. Discuss the side effect of the drug to the watcher such as:
 headache
- emphasize bed rest to prevent from falling, injury or accident.

 Nausea and vomiting

- frequent, small meals.
Date ordered: July 24, 2010

Generic name: Metronidazole

Brand name: Flagex

Dosage, Route, Frequency: 1 tsp Oral TID

Classification: Gastrointestinal Stimulant (bactericidal)

Mechanism of action:

May caused bactericidal effect by interacting with bacterial DNA. Active against many
anaerobic gram-negative bacilli ,anaerobic gram-positive cocci.

Desired effect:

To treat infection.

Nursing Responsibilities:

1. Check for the Doctor’s order

2. Check for allergies and contraindication.

Rationale: to prevent further complication
3. Take with food or milk

Rationale: to reduce GI upset that may cause metallic taste

4. discuss the side effect of the drug to the watcher such as:
 dry mouth with strange metallic taste
- frequency mouth care, sucking sugarless candies.
 nausea, vomiting
- frequent, small meals.
 diarrhea
-add bulk to diet
 darker the color of urine
-discuss to significant other so that they will not be alarm.
5. Encourage the patient to take full course of drug therapy.

Rationale: adherence to antibiotic treatment should be strictly followed to avoid

resistance
Date ordered: July 24, 2010

Generic name: Paracetamol

Brand name: Myrenol

Dosage, Route Frequency: 1 tsp Oral QID

Classification: Antipyretic

Mechanism of action:

It is thought to relieve fever by central action in the hypothalamic heat-regulating center.

Desired effect:

It is given to our patient to lower down fever.

Nursing Responsibilities:

1. Check for the Doctor’s order

2. Check for allergies and contraindication.

Rationale: to prevent further complication
3. Take extended relief product with water

Rationale: to mask the unpleasant taste of the drug

4. Review with parents the difference between the concentrated dropper dose formulation
and teaspoon dose formulation

Rationale: to prevent overdose/toxicity

5. discuss the side effect of the drug to the watcher such as:
 headache
- emphasize bed rest to prevent from falling, injury or accident.
 Drowsiness
- emphasize bed rest to prevent from falling, injury or accident.
GENERAL EVALUATION

Two days prior to admission our patient experienced abdominal pain and diarrhea.On the
first day of onset, he move his bowel 6 times with watery , yellowish and foul odor stool. They
went to a ‘manghihilot’ and his mother applies acete de manzanilla to relieve the pain but then
the said pain was not minimized. On the second day managed it by giving glucolyte but the
diarrhea worsen. So they rushed at Gaoat General Hospital with a chief complaint of fever and
lbm. He was diagnosed by Dr. Ramon Gaoat and the final diagnosis was AGE.

When he was confined at Gaoat General Hospital, he underwent diagnostic procedure

such as Hematology ( complete blood count) to confirm any abnormal findings inside the body ;
(fecalysis) to determine the cause of infection. The patient was put under soft diet to allow for
bowel rest. He was hooked with D5 W 500cc regulated to 63 microgtts/min.

Medication were given Paracetamol, Antipyretic, 1tsp PO QID; Co- trimoxazole, Anti
infective, 1 tsp PO TID; Dicycloveine Hcl, 1 tsp PO TID; Metronidazole, Gastrointestinal
stimulant ( Bactericidal), 1 tsp PO TID.

As shown in the fecalysis result, there is the presence of pathologic bacteria in our
patien’s stomach.

Our client was discharged July 25, 2010 with Co- trimoxazole 1 tsp PO TID,
Dicycloveine Hcl, 1tsp PO TID, Metronidazole, 1tsp PO TID as take home medications.

As we student nurses, who monitored Baby Agee’s case, he has regained strength since
he went home July 25, 2010.
 NORTHWESTERN UNIVERSITY
COLLEGE OF ALLIED HEALTH AND SCIENCES
DEPARTMENT OF NURSING
LAOAG CITY

ACUTE GASTROENTERITIS

SUBMITTED BY:

AQUINO, PRINCESS
ARQUILLO, CHEERS
COLOBONG, THEA
CORPUZ, CHERRY
GANOTISI, SNANETTE
NICOLAS, ZEILSTRA HANNA
PADILLA, CHERRY
RUBIO, RALPH
RABAGO, IRINEO
TAGATAC, MA. BENELYN SUERTE
BSN III-F GROUP IV

August 3, 2010