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Bulacan State University

City of Malolos, Bulacan

College of Nursing
Case Study of Patient with Acute
Submitted by:
Calma, Therese Josephine
Censon, Luwalhati
Submitted to:
Maribel Valencia, R.N.
"#ute $astroenteritis
Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in
acute diarrhea !he inflammation is caused most often by infection with certain viruses, less often by bacteria or their to"ins, #arasites, or
adverse reaction to something in the diet or medication At least $%& of cases of gastroenteritis as foodborne illness are due to norovirus
Another '%& of cases, and the ma(ority of severe cases in children, are due to rotavirus )ther significant viral agents include adenovirus

*ifferent s#ecies of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,
Clostridium, Escherichia coli, Yersinia, and others +ach organism causes slightly different sym#toms but all result in diarrhea Colitis,
inflammation of the large intestine, may also be #resent Some ty#es of acute gastroenteritis will not resolve without antibiotic treatment,
es#ecially when bacteria or e"#osure to #arasites are the cause Physicians may want to diagnose the cause by analy,ing a stool sam#le,
when stomach sym#toms remain #roblematic
-orldwide, inade.uate treatment of gastroenteritis /ills $ to 0 million #eo#le #er year and is a leading cause of death among infants
and children under $ !he most common sym#toms are diarrhea, vomiting and stomach #ain, because whatever causes the condition inflames
the gastrointestinal tract Another reason to see/ medical treatment is that some forms of acute gastroenteritis mimic a##endicitis, which may
re.uire emergency treatment As well, young children run an es#ecially high ris/ of becoming dehydrated during a long course of the stomach
flu )ne should receive directions regarding how to hel# affected /ids or adults get more fluids Sometimes children, those with com#romised
immune systems, and the elderly may re.uire hos#itali,ation and intravenous fluids *ehydration can actually cause greater nausea, and can
begin to cause organ shut down if not #ro#erly addressed
Acute gastroenteritis is .uite common among children, though it is certainly #ossible for adults to suffer from it as well -hile most
cases of gastroenteritis last a few days, acute gastroenteritis can last for wee/s and months
Acute gastroenteritis remains a serious health issue, and is res#onsible for over $%,%%% hos#itali,ations of children 1n develo#ing
countries, acute gastroenteritis is the leading cause of death for infants Acute gastroenteritis should thus be ta/en seriously, and #eo#le
should not hesitate to see/ medical treatment for es#ecially seniors and children who have been ill for more than a day
1n the Phili##ine 2ealth Statistic, gastroenteritis range as number 3% in the ten leading causes of infant mortality, with the rate of %$
and #ercentage of 43 cases in the Phili##ines by the year '%%4 this was u#dated last 5ebruary 3', '%%0
Signifi#an#e of the stu%&'
his study will enable the students to understand better about acute gastroenteritis and will e"#lain the different ris/ factors for
develo#ing the disease, including consum#tion of im#ro#erly #re#ared foods or contaminated water and travel or residence in areas of #oor
sanitation Since we are client6centered, we really should consider our #atient7s comfort and this study will give the students sufficient
/nowledge that will hel# them to #lan and im#lement nursing care #lans that will satisfy #atient7s needs
". $eneral *+e#ti,es
!his study aims to convey familiarity and to #rovide an effective nursing care to a #atient diagnosed with Acute Gastroenteritis through
understanding the #atient history, disease #rocess and management
B. Spe#ifi# *+e#ti,es
3 !o #resent a thorough assessment, through 8ursing 2ealth 2istory, Gordon7s !y#ology 33 5unctional Pattern, Physical Assessment, and
the inter#retation of the laboratory e"amination done on the #atient
' !o discuss the anatomy and #hysiology, #atho#hysiology of the #atient7s condition, usual clinical manifestations and #ossible com#lications
of this condition
9 !o have /nowledge to the client medication and be familiar to that medication
4 !o formulate a wor/able nursing care #lan on the sub(ective and ob(ective cues gathered through nurse6#atient interaction to be able to
hel# the #atient recover

". Biographi#al Data
*ate: :uly 3;, '%%< Clinical Area : Pedia ward room '%'
Name ' Ms BB
Address ' San 1sidro 11, Paombong, Bulacan
Date of Birth ' 8ovember $, '%%$
Age ' 9 = years old
Sex ' 5emale
Civil Status ' Single
Nationality ' 5ili#ino
eligious !references ' Born Again Christian
"ealth care financing ' Philhealth and 5inancial health assistance from baranggay health center
Date of Admission ' :uly 3$, '%%<
Diagnosis : Acute Gastroenteritis with signs of dehydration
B. Chief Complaint

According to the significant others, the client was vomiting and defecating that7s why they rushed her to the hos#ital
I). 0("LT0 0ISTR1
". 0istor& of -resent Illness

Prior to admission, the client was vomiting and defecating 2er stool was watery and its color is green At first, they to the baranggay
health center and the midwife gave them medication According to the midwife, the medication is for >BM, but after drin/ing the medication,
the client was still defecating and vomiting so the family decided to rush the client at +milio G Pere, Memorial *istrict 2os#ital the ne"t day
B. -ast 0istor&

!he client had fever, cough and colds She had com#leted all vaccinations including BCG, *P!, )ral Polio ?accine, MM@ and
2e#atitis B vaccine !he #atient had never been any of the childhood disease such as measles, mum#s and chic/en #o" !he #atient had
no history of accident or any in(ury She does not have allergy in any food or drug She was not hos#itali,ed before and she does not ta/e any
medication or su##lements to maintain her health
C. /amil& 0istor&
According to the significant others of BB they have a familial disease of asthma, both on her father and motherAs side And an incident
of hy#ertension on his fatherAs side
$$ yBo
$4 yBo
99 yBo
9' yBo
93 yBo
'< yBo
9$ yBo
93 yBo
'0 yBo
'9 yBo
$D yBo
-aternal 2aternal
1 y/o
3 y/o
'' yBo

/un#tional 0ealth -er#eption -rior to 0ospitali3ation During 0ospitali3ation

Nutritional 2eta*oli# -attern

E !he client eats four times a day
including brea/fast, lunch, merienda and
dinner According to the significant others,
she always eats rice and sou# She can
drin/ 4 glasses of water in a day She has
no eating discomforts She does not have
any dental #roblems because she has a
com#lete set of teeth
9 days food recall
:uly 33

9 cu#s rice
9 cu#s sou#
4 glasses of
:uly 3'

9 cu#s rice
3 #iece of egg
= #iece #a/siw
na bangus
9 glasses of

:uly 39

9 cu#s rice
9 cu#s sou#
' #ices of
4 glasses of

F !he client seldom eats at the hos#ital She does
not have a##etite for eating She seldom drin/s
water or other fluids

9 days food recall
:uly 34

' cu#s rice
3 bowl of
' glasses of
:uly 3$

3 glass of water
:uly 3;

' #ieces
= glass of

(limination -attern

"#ti,it&4e5er#ise -attern

Sleep4rest -attern

E !he client defecates everyday and her
stool is soft but formed and its color is
brown and has a foul odor She urinates
five times a day and is yellowish in color
She has no discomfort in defecating and
E !he client has sufficient energy for
com#leting her desired re.uired activities

%6 feeding
%6 clothing
116 bathing
116 grooming

E !he client slee#s about 3% hours a day
5rom 0#m to ;am She has no #roblem
falling aslee# and does not ta/e slee#
medications 2er slee# is always
continuous es#ecially when she is tired
She ta/es a na# during afternoon 5rom
3':9%#m to 9#m

E !he client defecates three times a day
2er stool is watery and its color is green
She urinates twice a day and it is yellowish
in color

E !he client does not have sufficient
energy for com#leting her desired re.uired

116 feeding
116 clothing

116 bathing
116 grooming

E !he client still slee#s 3% hours a day
She only wa/es u# when her medications
are due She has no #roblem falling aslee#
and does not ta/e any slee# medications
She does not ta/e na#s

Cogniti,e4-er#eptual -attern

Role4relationship -attern

)alue4*elief -attern

E !he client does not have difficulty in
hearing and has no hearing aid According
to the significant others, whenever the
client feels #ain or any discomfort, they
always give her medications

E !he client lives with her mother, father
and grand#arents !he structure of her
family is e"tended And (ust li/e the ty#ical
family, their family has #roblems wherein
they have difficulty in handling, as stated by
the grandmother

E !he client is a born again Christian
According to the significant others, they
attend mass every Sunday

E !he client ta/es medications to relieve
any discomforts

E !he 5amily of the #atient es#ecially her
#arents are su##ortive and more caring

). D()(L-2(NT"L T"S6
(ri7 (ri7son4-s&#hoso#ial %e,elopment
!he #atient is currently in the early childhood stage G96; yBoH wherein the central tas/ is Initiati,e ,s. $uilt *uring this stage, initiative
adds to autonomy the .uality of underta/ing, #lanning, and attac/ing a tas/ for the sa/e of being active and on the move !he child is learning
to master the world around him or her, learning basic s/ills and #rinci#les of #hysicsI things fall to the ground, not u#I round things roll, how to
,i# and tie, count and s#ea/ with ease Guilt is a new emotion and is confusing to the childI he or she may feel guilty over things which are not
logically guilt #roducing, and he or she will feel guilt when his or her initiative does not #roduce the desired results At this stage the client
wants to begin and com#lete her own actions for a #ur#ose
1nter#retation: Positive @esolution
Jean -iaget8s Cogniti,e De,elopment
!he #atient is under the Pre6o#erational stage 1n this #eriod intelligence is demonstrated through the use of symbols, language use
matures, and memory and imagination are develo#ed, but thin/ing is done in a nonlogical, nonreversible manner +gocentric thin/ing
#redominates !he #atient was able to do ma/e believe #lay and able to imitate others, li/e her mother doing some household chores as
verbali,ed by the JS)J
1nter#retation: Positive @esolution
)I. -01SIC"L "SS(SS2(NT
*ate: :uly 3;, '%%< Clinical Area : Pedia ward room '%'
a Moisture Pal#ation Moisture in s/in folds and a"illae *ry s/in *eviated due to slight
b !e"ture Pal#ation Smooth @ough *eviated due to slight
c !urgor 1ns#ection and
S#rings bac/ immediately to
#revious state
Moves bac/ slowly *eviated due to slight
' Mouth
a >i#s
Pin/ in color, soft moist, smooth
te"ture, symmetrical no
tenderness, no lesions
*ry li#s
*eviated due to slight
bMucosa 1ns#ection and
Uniform #in/ color *ry and slightly #in/ in color *eviated from normal due
to slight dehydration
c Gums 1ns#ection and
Pin/ gums, moist, firm te"ture Pin/ gums, dry, firm te"ture *eviated from normal due
to slight dehydration
9 Abdomen
Bowel sounds Auscultation Audible bowel sounds 2y#eractive bowel sound *eviated due to diarrhea
)II. R()I(: I/ S1ST(2
Digesti,e S&stem
!he #rimary function of the digestive system is to brea/ down the food we eat into smaller #arts so the body can use them to build and
nourish cells and #rovide energy !here occurs #ro#ulsion which is the movement of food along the digestive tract !he ma(or means of
#ro#ulsion is #eristalsis, a series of alternating contractions and rela"ations of smooth muscle that lines the walls of the digestive organs and
that forces food to move forward 1t secretes digestive en,ymes and other substances li.uefies, ad(usts the #2 of, and chemically brea/s down
the food Mechanical digestion is the #rocess of #hysically brea/ing down food into smaller #ieces !his #rocess 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 !his #rocess, called segmentation, is similar to #eristalsis, e"ce#t that the rhythmic timing of the muscle constrictions
forces the food bac/ward and forward rather than forward only Chemical digestion which is the #rocess of chemically brea/ing down food into
sim#ler molecules !he #rocess is carried out by en,ymes in the stomach and small intestines !hen absor#tion or the movement of molecules
Gby #assive diffusion or active trans#ortH from the digestive tract to ad(acent blood and lym#hatic vessels Absor#tion is the entrance of the
digested food into the body And lastly, defecation which is the #rocess of eliminating undigested material through the anus
But because of acute gastroenteritis the normal functions were altered !he infectious agents that cause acute gastroenteritis causes
diarrhea by adherence, mucosal invasion, enteroto"in #roduction, andBor cytoto"in #roduction
!hese mechanisms result in increased fluid secretion andBor decreased absor#tion leading to diarrhea !his #roduces an increased luminal
fluid content that cannot be ade.uately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients
)III. "N"T21 "ND -01SIL$1
!he human digestive system is a com#le" series of organs and glands that #rocesses food 1n order to use the food we eat, our body
has to brea/ the food down into smaller molecules that it can #rocessI it also has to e"crete waste
Most of the digestive organs Gli/e the stomach and intestinesH are tube6li/e and contain the food as it ma/es its way through the body
!he digestive system is essentially a long, twisting tube that runs from the mouth to the anus, #lus a few other organs Gli/e the liver and
#ancreasH that #roduce or store digestive chemicals
The Digesti,e -ro#ess:
The start of the pro#ess 4 the mouth' !he digestive #rocess begins in the mouth 5ood is #artly bro/en down by the #rocess of chewing and
by the chemical action of salivary en,ymes Gthese en,ymes are #roduced by the salivary glands and brea/ down starches into smaller
n the wa& to the stoma#h' the esophagus 6 After being chewed and swallowed, the food enters the eso#hagus !he eso#hagus is a long
tube that runs from the mouth to the stomach 1t uses rhythmic, wave6li/e muscle movements Gcalled #eristalsisH to force food from the throat
into the stomach !his muscle movement gives us the ability to eat or drin/ even when weAre u#side6down
In the stoma#h 6 !he stomach is a large, sac/6li/e organ that churns the food and bathes it in a very strong acid Ggastric acidH 5ood in the
stomach that is #artly digested and mi"ed with stomach acids is called chyme
In the small intestine 6 After being in the stomach, food enters the duodenum, the first #art of the small intestine 1t then enters the (e(unum
and then the ileum Gthe final #art of the small intestineH 1n the small intestine, bile G#roduced in the liver and stored in the gall bladderH,
#ancreatic en,ymes, and other digestive en,ymes #roduced by the inner wall of the small intestine hel# in the brea/down of food
In the large intestine 6 After #assing through the small intestine, food #asses into the large intestine 1n the large intestine, some of the water
and electrolytes Gchemicals li/e sodiumH are removed from the food Many microbes Gbacteria li/e Bacteroides, #actobacillus acidophilus,
Escherichia coli, and $lebsiellaH in the large intestine hel# in the digestion #rocess !he first #art of the large intestine is called the cecum Gthe
a##endi" is connected to the cecumH 5ood then travels u#ward in the ascending colon !he food travels across the abdomen in the
transverse colon, goes bac/ down the other side of the body in the descending colon, and then through the sigmoid colon
The en% of the pro#ess 6 Solid waste is then stored in the rectum until it is e"creted via the anus
Digesti,e S&stem $lossar&:
anus 6 the o#ening at the end of the digestive system from which feces GwasteH e"its the body
appen%i5 6 a small sac located on the cecum
as#en%ing #olon 6 the #art of the large intestine that run u#wardsI it is located after the cecum
*ile 6 a digestive chemical that is #roduced in the liver, stored in the gall bladder, and secreted into the small intestine
#e#um 6 the first #art of the large intestineI the a##endi" is connected to the cecum
#h&me 6 food in the stomach that is #artly digested and mi"ed with stomach acids Chyme goes on to the small intestine for further digestion
%es#en%ing #olon 6 the #art of the large intestine that run downwards after the transverse colon and before the sigmoid colon
%uo%enum 6 the first #art of the small intestineI it is C6sha#ed and runs from the stomach to the (e(unum
epiglottis 6 the fla# at the bac/ of the tongue that /ee#s chewed food from going down the wind#i#e to the lungs -hen you swallow, the
e#iglottis automatically closes -hen you breathe, the e#iglottis o#ens so that air can go in and out of the wind#i#e
esophagus 6 the long tube between the mouth and the stomach 1t uses rhythmic muscle movements Gcalled #eristalsisH to force food from the
throat into the stomach
gall *la%%er 6 a small, sac6li/e organ located by the duodenum 1t stores and releases bile Ga digestive chemical which is #roduced in the liverH
into the small intestine
ileum 6 the last #art of the small intestine before the large intestine begins
+e+unum 6 the long, coiled mid6section of the small intestineI it is between the duodenum and the ileum
li,er 6 a large organ located above and in front of the stomach 1t filters to"ins from the blood, and ma/es bile Gwhich brea/s down fatsH and
some blood #roteins
mouth 6 the first #art of the digestive system, where food enters the body Chewing and salivary en,ymes in the mouth are the beginning of
the digestive #rocess Gbrea/ing down the foodH
pan#reas 6 an en,yme6#roducing gland located below the stomach and above the intestines +n,ymes from the #ancreas hel# in the
digestion of carbohydrates, fats and #roteins in the small intestine
peristalsis 6 rhythmic muscle movements that force food in the eso#hagus from the throat into the stomach Peristalsis is involuntary 6 you
cannot control it 1t is also what allows you to eat and drin/ while u#side6down
re#tum 6 the lower #art of the large intestine, where feces are stored before they are e"creted
sali,ar& glan%s 6 glands located in the mouth that #roduce saliva Saliva contains en,ymes that brea/ down carbohydrates GstarchH into
smaller molecules
sigmoi% #olon 6 the #art of the large intestine between the descending colon and the rectum
stoma#h 6 a sac/6li/e, muscular organ that is attached to the eso#hagus Both chemical and mechanical digestion ta/es #lace in the stomach
-hen food enters the stomach, it is churned in a bath of acids and en,ymes
trans,erse #olon 6 the #art of the large intestine that runs hori,ontally across the abdomen
I;. -"T0-01SIL$1
Person to #erson GhandsH Contaminated food andBor water
1ngestion of Pathogens
Stimulation and destruction of mucosal lining of the
bowel wall
8on6modifiable 5actor: Age
Modifiable 5actors: >ifestyleI *ietI 2ygiene
*irect invasion of the bowel wall +ndoto"ins are released
*igestive and absor#tive malfunction +"cessive gas formation G1 *istention
Secretion of fluid K
electrolytes in the
intestinal lumen
1ncreased #eristaltic
1ncreased secretion of Cl
K 2C)9 ions in the
1nhibition of 8a
Complete Bloo% Count'
+tiology: Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,
Clostridium, Escherichia coli, Yersinia,8orovirus, adenovirus
8ausea K vomiting
5luid and electrolytes imbalance
*ry li#s, dry mouth,
flushed s/in, fatigue,
Bloo% Test Stan%ar% Range "#tual /in%ings Interpretation
:BC $3% " 3%
B> ''9 " 3%
B> !he body is fighting against an infection
RBC 90%6$0% 3%
B> $$9 5 3%
B> 8ormal
0$B 33%63;$ gB> 39; gB> 8ormal
0CT 9$%6$%% 3Bl %443 3Bl 8ormal
-LT 3$%69<%" 3%
Bliter 3$; " 3%
Bliter 8ormal
3%%6$%% 3%
399 3%
Bl 8ormal
0% L <D f>
0% f> 8ormal
';$ 6 99$ >
'4; > An indication of microcytic, hy#ochromic anemia
93$69$% >gBl
9%0 >gBl An indication of iron deficiency anemia
3%%63$% &
3$3& An indication of iron deficiency anemia
;$633% f>
0$ f> 8ormal
< L12
3D640 > &
3$D >& 8ormal
463% >&
09 > & 8ormal
< $R"
496D; 2&
03% 2& 1ndicates #resence of infection
= L12
3'69' 3%<B>
9$ 3%<B> 1ndicates #resence of infection
%96%0 3%<B>
%D 3%<B> 8ormal
3'6;0 3%<B>
303 3%<B> 1ndicates #resence of infection
Blood ty#e: )
@2 : M

2i#ros#opi# /in%ings Normal )alues "#tual /in%ings "nal&sis>Interpretation
,a> parasite 8)PS +ntamoeba 1nvasion of microorganism
RBC %6$Bh#f 96$Bh#f 8ormal
2u#us %6 M 1nvasion microorganisms
Ba#teria 8egativeG6H MMMM 1nvasion microorganisms
-us Cells % 063'Bh#f 1nvasion of microorganisms
;I. DR!$ ST!D1
DR!$ N"2(
DS"$(, R!T(,
3 Cefuro"ime '$% mg
G. 0 hrsH

6 1t interferes with the
final ste# in the formation
of the bacterial cell wall
6 >ower res#iratory tract
6 2y#ersensitivity to

8 and ?, anore"ia,
abdominal cram#s or
#ain and headache
6 Protect drug
from sunlight
6 1nstruct the
client to ta/e with
food to enhance

' @anitidine 3'mg
G. ; hrsH
6 1nhibits gastric acid
secretion by bloc/ing the
effect of histamine on
histamine 2' rece#tors
6 G+@*
6 Cirrhosis of the
6 1m#aired renal or
he#atic function
Abdominal #ain,
headache, di,,iness,
malaise, 8 and ?

6 !a/e as directed
with immediately
following meals
6 Store at room
3'$mgB 9$ ml
G. 0 hrsH
6 1nhibits growth of
amoebae by binding to
*8A, resulting in loss of
6 Active organic
disease of the C8S
6 Blood dyscrasias
6 nausea, dry mouth,
vomiting, diarrhea

6 !a/e with food
or mil/ to reduce G1
helical structure, strand
brea/age, inhibition of
nucleic acid synthesis and
cell death
6 Amoebiasis
6 *rug may turn
urine brown, don7t be

;II. N!RSIN$ C"R( -L"N
bowel sounds
watery and
greenish in

related to
1ntroduction of
bacteria into the G1
@elease of
bacterial to"ins
*isru#ts the
mucus lining of the
@elease of 2Cl
cause gastric
1ncrease gastric

1ncrease gastric
After 0 hours of
8ursing 1ntervention,
client will be able to
reestablish and
maintain normal
#attern of bowel
FMonitor 1B)
F@estrict solid food
F 1ncrease oral
fluid inta/e and
return to normal
diet as tolerated
F Administer
medications as
%&hese assessments
are used to monitor
volume status'
%&o allo( for bo(el
rest) reduced
intestinal (or*load
% &o ensure
ade+uate amt' of
fluid is ta*en by the
% &o decrease
motility and minimi,e
fluid loses
Goal met
After 0 hours of
8ursing 1ntervention,
client will be able to
reestablish and
maintain normal
#attern of bowel
Fwatery stool
@is/ for
deficient fluid
volume rBt
loss of fluids
*igestive and
1ncreased secretion
of fluid and
electrolytes in the
1ncreased water
content of the stools
acom#anied by
1mbalanced fluid and
@is/ for deficient fluid
MS8, >eMone and
Bur/e, ## D$4, D$D
After ' hrs of nursing
intervention the ct with
the hel# of the JS)J
will be able to
demonstrate behaviors
to #revent
develo#ment of fluid
volume deficit
FMonitor 1B)
balance, being
aware of altered
inta/e or out#ut
F)ffer fluids
between meals K
throughout the day
F Promote inta/e of
high6water content
foods andBor
re#lacement drin/s
su##lemental fluids
as indicated
%&o ensure accurate
picture of fluid status'
%&o prevent
occurrence of deficit
%&o facilitate
% -luids may be
given if the ct' is
unable to ta*e oral
fluid. or (hen rapid
fluid resuscitation is
% &o decrease
motility and minimi,e
fluid loses
Goal Meet
After ' hrs of nursing
intervention the ct
with the hel# of the
JS)J was able to
behaviors to #revent
develo#ment of fluid
volume deficit