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Case Study of Patient with

Acute Gastroenteritis

Submitted by:
Mason William de la Cerna
BSN – III-B, Group B3

Submitted to:
Ms. Marissa Guadalupe, R.N.
I. INTRODUCTION

Acute Gastroenteritis

Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving


both the stomach and the small intestine and resulting in acute diarrhea. The
inflammation is caused most often by infection with certain viruses, less often by
bacteria or their toxins, parasites, or adverse reaction to something in the diet or
medication. At least 50% of cases of gastroenteritis as foodborne illness are due
to norovirus. Another 20% of cases, and the majority of severe cases in children,
are due to rotavirus. Other significant viral agents include adenovirus and
astrovirus.

Different species of bacteria can cause gastroenteritis, including


Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium,
Escherichia coli, Yersinia, and others. Each organism causes slightly different
symptoms but all result in diarrhea. Colitis, inflammation of the large intestine,
may also be present. Some types of acute gastroenteritis will not resolve without
antibiotic treatment, especially when bacteria or exposure to parasites are the
cause. Physicians may want to diagnose the cause by analyzing a stool sample,
when stomach symptoms remain problematic.

Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year


and is a leading cause of death among infants and children under 5. The most common
symptoms are diarrhea, vomiting and stomach pain, because whatever causes the
condition inflames the gastrointestinal tract.

II. OBJECTIVES:

A. General Objectives

This study aims to convey familiarity and to provide an effective nursing


care to a patient diagnosed with Acute Gastroenteritis through understanding the patient
history, disease process and management.

B. Specific Objectives
1. To present a thorough assessment, through Nursing Health History, Gordon’s
Typology 11 Functional Pattern, Physical Assessment, and the interpretation
of the laboratory examination done on the patient.
2. To discuss the anatomy and physiology, pathophysiology of the patient’s
condition, usual clinical manifestations and possible complications of this
condition.
3. To have knowledge to the client medication and be familiar to that medication.
4. To formulate a workable nursing care plan on the subjective and objective
cues gathered through nurse-patient interaction to be able to help the patient
recover.
III. PATIENT'S PROFILE

A. Biographical Data

Date: August 22, 2009 Clinical Area : Gastro ward, bed

Name : Mr. MZ.


Address : B9, Samagta st., San Juan, Taytay
Rizal
Date of Birth : ---------
Age : 4 months old
Sex : Male
Civil Status : Single
Nationality : Filipino
Religious Preferences : Roman Catholic
Date of Admission : August 18, 2009
Diagnosis : Acute Gastroenteritis with
dehydration T/C lactose intolerance

B. Chief Complaint

According to the significant others, the client was defecating more often
than the usual that’s why they rushed him to the hospital.

IV. HEALTH HISTORY

A. History of Present Illness


Prior to admission, the client was defecating several times than the usual.
His stool was watery and its color is green. The client was still defecating so, the
family decided to rush the client to Angono Genereal Hospital.

B. Past History

The client had fever, cough and colds. He had completed all vaccinations
including BCG, DPT, Hepatitis B vaccine. The patient had never been any of the
childhood disease such as measles, mumps and chicken pox. The patient had no
history of accident or any injury. He does not have allergy in any food or drug. He
was hospitalized before because of the same complaint.

PHYSICAL ASSESSMENT
Date: August 22,2009 Clinical Area: Gastro ward, Bed 11

BODY
NORMAL ACTUAL
PARTS TECHNIQUES INTERPRETATION
FINDINGS FINDINGS
ASSESSED

1.Skin

a. Moisture Palpation Moisture in skin Dry skin Deviated due to slight


folds and axilla dehydration

b Texture Palpation Smooth Rough Deviated due to slight


dehydration

c. Turgor Inspection and Springs back Moves back Deviated due to slight
Palpation immediately to slowly dehydration
previous state

2. Mouth Inspection Dry lips Deviated due to slight


dehydration
a. Lips Pink in color, soft
moist, smooth
texture,
symmetrical no
tenderness, no
lesions

b.Mucosa Inspection and Uniform pink color Dry and slightly Deviated from normal
Palpation pink in color due to slight
dehydration

c. Gums Inspection and Pink gums, moist, Pink gums, dry, Deviated from normal
Palpation firm texture firm texture due to slight
dehydration

3.
Abdomen
Auscultation Audible bowel Hyperactive Deviated due to
Bowel sounds bowel sound diarrhea
sounds

V. REVIEW IF SYSTEM

Digestive System

The primary function of the digestive system is to break down the food we
eat into smaller parts so the body can use them to build and nourish cells and provide
energy. There occurs propulsion which is the movement of food along the digestive
tract. The major means of propulsion is peristalsis, a series of alternating contractions
and relaxations of smooth muscle that lines the walls of the digestive organs and that
forces food to move forward. It secretes digestive enzymes and other substances
liquefies, adjusts the pH of, and chemically breaks down the food. Mechanical
digestion is the process of physically breaking down food into smaller pieces. This
process begins with the chewing of food and continues with the muscular churning
of the stomach. Additional churning occurs in the small intestine through muscular
constriction of the intestinal wall. This process, called segmentation, is similar to
peristalsis, except that the rhythmic timing of the muscle constrictions forces the
food backward and forward rather than forward only. Chemical digestion which is the
process of chemically breaking down food into simple molecules. The process is
carried out by enzymes in the stomach and small intestines. Then absorption or the
movement of molecules (by passive diffusion or active transport) from the digestive tract
to adjacent blood and lymphatic vessels. Absorption is the entrance of the digested
food into the body. And lastly, defecation which is the process of eliminating undigested
material through the anus.

But because of acute gastroenteritis the normal functions were altered.


The infectious agents that cause acute gastroenteritis causes diarrhea by
adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production.
These mechanisms result in increased fluid secretion and/or decreased
absorption leading to diarrhea. This produces an increased luminal fluid content that
cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes
and nutrients.

VI. ANATOMY AND PHYSIOLOGY

The human digestive system is a complex series of organs and glands that processes
food. In order to use the food we eat, our body has to break the food down into smaller
molecules that it can process; it also has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-like
and contain the food as it makes its way through the body. The digestive system is
essentially a long, twisting tube that runs from the mouth to the anus, plus a few other
organs (like the liver and pancreas) that produce or store digestive chemicals.
The Digestive Process:
The start of the process - the mouth: The digestive process begins in the
mouth. Food is partly broken down by the process of chewing and by the chemical
action of salivary enzymes (these enzymes are produced by the salivary glands and
break down starches into smaller molecules).

On the way to the stomach: the esophagus - After being chewed and
swallowed, the food enters the esophagus. The esophagus is a long tube that
runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements
(called peristalsis) to force food from the throat into the stomach. This muscle
movement gives us the ability to eat or drink even when we're upside-down.

In the stomach - The stomach is a large, sack-like organ that churns the food
and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly
digested and mixed with stomach acids is called chyme.

In the small intestine - After being in the stomach, food enters the duodenum,
the first part of the small intestine. It then enters the jejunum and then the ileum (the
final part of the small intestine). In the small intestine, bile (produced in the liver and
stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced
by the inner wall of the small intestine help in the breakdown of food.

In the large intestine - After passing through the small intestine, food passes
into the large intestine. In the large intestine, some of the water and electrolytes
(chemicals like sodium) are removed from the food. Many microbes (bacteria like
Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large
intestine help in the digestion process. The first part of the large intestine is called the
cecum (the appendix is connected to the cecum). Food then travels upward in the
ascending colon. The food travels across the abdomen in the transverse colon,
goes back down the other side of the body in the descending colon, and then through
the sigmoid colon.

The end of the process - Solid waste is then stored in the rectum until it is
excreted via the anus.

Digestive System Glossary:


anus - the opening at the end of the digestive system from which feces (waste)
exits the body.
appendix - a small sac located on the cecum.
ascending colon - the part of the large intestine that run upwards; it is located
after the cecum.
bile - a digestive chemical that is produced in the liver, stored in the gall bladder,
and secreted into the small intestine.
cecum - the first part of the large intestine; the appendix is connected to the
cecum.
chyme - food in the stomach that is partly digested and mixed with stomach
acids. Chyme goes on to the small intestine for further digestion.
descending colon - the part of the large intestine that run downwards after the
transverse colon and before the sigmoid colon.
duodenum - the first part of the small intestine; it is C-shaped and runs from the
stomach to the jejunum.
epiglottis - the flap at the back of the tongue that keeps chewed food from going
down the windpipe to the lungs. When you swallow, the epiglottis automatically
closes. When you breathe, the epiglottis opens so that air can go in and out of the
windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic
muscle movements (called peristalsis) to force food from the throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and
releases bile (a digestive chemical which is produced in the liver) into the small
intestine.
ileum - the last part of the small intestine before the large intestine begins.
jejunum - the long, coiled mid-section of the small intestine; it is between the
duodenum and the ileum.
liver - a large organ located above and in front of the stomach. It filters toxins
from the blood, and makes bile (which breaks down fats) and some blood
proteins.
mouth - the first part of the digestive system, where food enters the body.
Chewing and salivary enzymes in the mouth are the beginning of the digestive
process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above
the intestines. Enzymes from the pancreas help in the digestion of
carbohydrates, fats and proteins in the small intestine.
peristalsis - rhythmic muscle movements that force food in the esophagus from
the throat into the stomach. Peristalsis is involuntary - you cannot control it. It is also
what allows you to eat and drink while upside-down.
rectum - the lower part of the large intestine, where feces are stored before they
are excreted.
salivary glands - glands located in the mouth that produce saliva. Saliva
contains enzymes that break down carbohydrates (starch) into smaller molecules.
sigmoid colon - the part of the large intestine between the descending colon
and the rectum.
stomach - a sack-like, muscular organ that is attached to the esophagus. Both
chemical and mechanical digestion takes place in the stomach. When food enters
the stomach, it is churned in a bath of acids and enzymes.
transverse colon - the part of the large intestine that runs horizontally across the
abdomen.
VII. DRUG STUDY

DOSAGE, ROUTE, NURSING


DRUG NAME INDICATION / ACTION CONTRAINDICATIONS ADVERSE EFFECTS
FREQUENCY RESPONSIBILITIES
1. Cefuroxime 250 mg - It interferes with the - Hypersensitivity to N and V, anorexia, - Protect drug from
TIV final step in the formation cephalosphorins abdominal cramps or sunlight
(q 8 hrs.) of the bacterial cell wall. pain and headache. - Instruct the client
- Lower respiratory to take with food to
tract infection enhance absorption

2. Ranitidine 12mg - Inhibits gastric acid - Cirrhosis of the liver Abdominal pain, - Take as directed
TIV secretion by blocking the - Impaired renal or headache, dizziness, with immediately
(q 6 hrs.) effect of histamine on hepatic function malaise, N and V following meals
histamine H2 receptors. - Store at room
- GERD temperature

XII. NURSING CARE PLAN


ASSESSMENT DIAGNOSIS ANALYSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Acute Introduction of After 8 hours of Nursing Independent: Goal met


bacteria into the GI
Gastroenteriti Intervention, client will
tract >Monitor I/O. >These assessments After 8 hours of
s with be able to reestablish
are used to monitor Nursing Intervention,
Objective: dehydration and maintain normal
volume status. client will be able to
Release of bacterial pattern of bowel
>Hyperactive toxins reestablish and
functioning.
bowel sounds maintain normal
>Restrict solid food
>To allow for bowel pattern of bowel
>vomiting intake.
Disrupts the mucus rest/ reduced intestinal functioning.
lining of the stomach
>BM (4x), workload
watery and
> Increase oral fluid > To ensure adequate
greenish in color
Release of HCl cause intake and return to amt. of fluid is taken
gastric irritation
normal diet as by the pt.
tolerated.

Increase gastric
Dependent:
motility/peristalsis > To decrease
> Administer gastrointestinal
antidiarrheal motility and minimize
Increase gastric
motility medications as fluid loses
indicated.
Frequent
defecation