CAGAYAN COLLEGES TUGUEGARAO

COLLEGE OF HEALTH

A CASE STUDY
ON

ACUTE GASTROENTERITIS
(AGE)
Submitted by: Dennis Gallardo

INTRODUCTION
Acute gastroenteritis (AGE) is an acute infectious process affecting
gastrointestinal tract caused by virus, bacteria and parasites. The disease is transmitted by
ingestion of contaminated food, water, or by contaminated hands, linens, equipments, and
supplies. Most serious complication is dehydration and electrolyte losses which may lead
to metabolic acidosis and death. The primary manifestation of gastroenteritis is diarrhea,
but it may be accompanied by nausea, vomiting, and abdominal pain. The vomiting
usually settles in a day or so. The diarrhea may last for up to 10 days, but usually lasts
only to 2 or 3 days. If there is fever, or blood and mucus in the stools it is more likely to
be contagious. Gastroenteritis is contagious as the organism lives in the gastrointestinal
tract, so it is important to wash hands thoroughly after going to the toilet and before
preparing food.
Acute gastroenteritis is associated with significant morbidity in developed
countries and each year is the cause of death of several million children in developing
countries. Estimates of the overall incidence of acute gastroenteritis range from 1.3 to 2.3
episodes of diarrhea per year in children under five years of age. Each year, more than
300 U.S. children die from this illness. In the United States alone, gastroenteritis accounts
for more than 220,000 hospital admissions per year in children less than five years of age,
or approximately 10 percent of hospitalizations in this age group.
Acute gastroenteritis is a common and costly clinical problem in children. It is a
largely self-limited disease with many etiologies. The evaluation of the child with acute
gastroenteritis requires a careful history and a complete physical examination to uncover
other illness with similar presentations. Minimal laboratory testing is generally required.
Treatment is primary supportive and is directed at preventing or treating dehydration.
When positive, an age-supportive diet and fluids should be continued. Oral rehydration
therapy using a commercial pediatric oral rehydration solution is preferred approach to
mild or moderate dehydration. The traditional approach using clear liquids is
inadequate. Severe dehydration requires the prompt restoration of intravascular volume
through the intravenous administration of fluids followed by oral rehydration therapy.
When rehydration is achieved, an aged-appropriate diet should be promptly resumed.
Anti-emetic and anti-diarrheal medications are generally not indicated and may
contribute to complications.
On its mortality and morbidity, AGE is a leading cause of infant mortality
throughout the world. By age 3 years, virtually all children become infected with the
most common agents. Severe cases are seen in the elderly, infant and immunosuppressed
population including transplant patients.
Last July 05, 2007, we encountered a patient with such kind of infection. This
patient has caught our attention and has given the opportunity to study his case. The
objective of this study is to help us understand the disease process of gastroenteritis and
to orient ourselves for appropriate nursing interventions that we could offer to the patient.

This approach enables us to exercise our duties as student nurses which is to render care.
I was given the chance to improve the quality of care I can offer and to pursue our chosen
profession as future nurses.

PATIENTS PROFILE
Patients Name: Budong
Age: 4 years & 7 months
Gender: Male
Address: Carig Sur, Tuguegarao City
Date of Birth: December 3, 2002
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Dialect: Ilocano

Date of Admission: July 5, 2007

Time Admitted: 9:50 AM
Attending Physician: Dra. M. Velarde
Chief Complaint: LBM & vomiting
Admitting Diagnosis: AGE with Dehydration
Final Diagnosis: AGE with Dehydration

NURSING HISTORY OF ILLNESS

PRESENT HEALTH HISTORY
Two days prior to admission (July 3, 2007 in the evening), the patient had
vomiting for 3 times associated with abdominal pain and passage of watery
stool due to his intake of ice-cold coke and water according to his mother. A
day prior to admission (July 4, 2007), the patient still attended his classes but
still with vomiting and passage of watery stool. And last July 5, 2007, he was
rushed to St. Paul Hospital due to weakness and severe abdominal pain.

PAST HEALTH HISTORY

According to the patients mother, the patient has his complete immunizations.
He is taking his vitamin supplements but still he is very slim and never liked
vegetables. The patient was first hospitalized due to asthma. His second
hospitalization was due to bronchopneumonia and the latest was due to AGE.

FAMILY HEALTH HISTORY

According to the patients mother, their family have history of Hypertension,
Diabetes mellitus, Bronchial Asthma and Cancer. Hypertension is evident on
the patients grandfather and uncle, while Cancer is evident on the patients
aunt.

GORDONS 11 FUNCTIONAL PATTERN

Health Perception-Health Management Pattern
Before his hospitalization, the patient perceives health in a way that he is not
suffering from any disease. He takes vitamins for him to improve his health
and to protect him from acquiring any disease.
During his hospitalization, the patient feels so unhealthy according to his
mother because of his hospitalization. He is obedient in taking his medications
and is participative in all the nurses interventions.

Nutritional-Metabolic Pattern
Before his hospitalization, the patient takes his meal three times a day without
any restrictions. According to his mother, he has food preferences on fatty and
oily foods. Her mother even shared that when they eat adobo, he prefers to eat
the fat rather than the muscle because he gets irritated with foods between his
teeth. He has no difficulty in swallowing and he usually eat junk foods when
its snack time. He drinks 4-5 glasses of water a day and takes Clusivol to
improve his appetite.
During his hospitalization, his appetite decreased. He was restricted from
eating dairy products. His fluid intake increased for about 5-7 glasses of water
a day.

Elimination Pattern
Before his hospitalization, the patient used to eliminate once a day every
morning before going to school with a semi-solid consistency and is brownish
in color. He usually urinates 2 times a day with the normal light yellow color
and aromatic odor. He also perspires every time he plays.
During is hospitalization, the patients stool is watery with a yellowish color.
He urinates 2-3 times a day. He also perspires but its due to the hot
environment not from any activity since he just stays on bed.

Activity-Exercise Pattern
Before his hospitalization, especially during the weekend, he used to play
outside with his cousins. They usually play toy cars and the usual games of his
age. He stops playing when he feels tired.

 During his hospitalization, he used his time playing the cell phone of his
father. Most of his time was spent for resting and sleeping.

Sleep-Rest Pattern
Before his hospitalization, he usually sleeps 8-9 hours. He is fond of watching
the TV series Super Twins before going to bed when it was still showing.
During his hospitalization, the patient sleeps early but has sleep disturbances
when the nurses take his vital signs, administer medicines and also due to the
environment.

Cognitive-Perception Pattern
Before his hospitalization, the patient is normal in terms of his cognitive
abilities. He has no problems with his senses. His mother even shared to us
that he is already capable of writing his name and is capable of reading the
alphabet and numbers.
During his hospitalization, he relates to us actively. He responded to our
questions enthusiastically. He also related to us some of his school activities.

Self-Perception/ Self-Concept Pattern

According to the patients mother, hes a good son though sometimes he tends
to disobey his parents. She said this is normal for his age. He is the eldest but
according to her mother he acts as if he is the youngest.

Role-Relationship Pattern
The patient has a close relationship with his family, but he is closer to his
father. He has a 2 year old sister, but according to his mother, he does not play
the role of an elder brother. His mother even added that his sister ie more
obedient than he is. But during his confinement, he is more obedient because
he wanted to get well immediately.

Sexual-Reproductive Pattern
Prior to his age, the patient is not yet oriented with any sexual matters.
According to hid mother, he has not yet undergone circumcision.

Coping Stress- Tolerance Pattern

According to his mother, when he has problems he always approach his
parents. She even added that when he gets scolded, he just stays in his room.
When he is bullied or when his cousins get his toys, he does not quarrel with
them but instead he reports it to his parents. During his hospitalization, he
feels unsafe with people when his mother is not with him. He cries without the
sight of his mother.

Value-Belief Pattern
He is a Roman Catholic. They attend mass regularly. He afraid to do
something bad because he believes that God will punish him. According to his
mother, before they consult the doctors or the hospital, they first consult the
quack doctors.

PHYSICAL ASSESSMENT
Date assessed: July 06, 2007
General assessment: neat, conscious and coherent
Initial vital signs: T=37.9, RR=20, BP=80/60, PR=95
Area Assessed
Skin
Color

Lips, nail beds,

soles and palms
Moisture

Technique

Normal Findings

Actual Findings

Evaluation

Inspection

Light brown,
tanned skin (vary
according to race)
Lighter colored
palms, soles, lips
and nail beds
Skin normally dry

Tanned skin

Normal

Lighter colored
palms, soles, lips
and nail beds
Skin normally dry

Normally warm

37.9 o C

Smooth, soft and

flexible palms and
soles (thicker)

Smooth, soft and

flexible palms and
soles (thicker)

Inspection

Normal

Temperature

Inspection/
Palpation
Palpation

Texture

Palpation

Turgor

Palpation

Skin snaps back

immediately

Skin snaps back

immediately

Normal

Skin
appendages
a. Nails

Inspection
Inspection
Inspection

Capillary refill

Inspection/
Palpation

Transparent,
smooth and convex
Pinkish
Firm
White color of nail
bed under pressure
returned to pink
within 2-3 seconds

Normal

Nail beds
Nail base

Transparent,
smooth and convex
Pinkish
Firm
White color of nail
bed under pressure
should return to
pink within 2-3
seconds

Inspection
Inspection
Inspection/
Palpation

Evenly distributed
Black
Smooth

Evenly distributed
Black
Smooth

Normal
Normal
Normal

Eyes

Inspection

Visual Acuity

Inspection
(penlight)

Parallel to each
other
PERRLA- Pupils
equally round react

Parallel to each
other but sunken
PERRLA- Pupils
equally round react

d/t
dehydration
Normal

b. Hair
Distribution
Color
Texture

Normal
d/t
hyperthermia
Normal

Normal
Normal
Normal

Eyes

Eyebrows

Inspection

Eyelashes

Inspection

Eyelids

Inspection

to light and
accommodation
Symmetrical in
size, extension, hair
texture and
movement
Distributed evenly
and curved outward
Same color as the
skin

to light and
accommodation
Symmetrical in
size, extension, hair
texture and
movement
Distributed evenly
and curved outward
Same color as the
skin

Blinks involuntarily Blinks involuntarily

and bilaterally up to and bilaterally up to
20 times per minute 16 times per minute

Conjunctiva

Inspection

Sclera
Cornea
Pupils

Inspection
Inspection
Inspection

Iris

Inspection

Ears
Ear canal
opening

Hearing Acuity

Inspection

Inspection

Nose
Shape, size and
skin color

Inspection

Nasal septum

Inspection

Nares

Inspection

Normal

Normal
Normal

Normal

Do not cover the

pupil and the
sclera, lids
normally close
symmetrically
Transparent with
light pink color
Color is white
Transparent, shiny
Black, constrict
briskly
Clearly visible

Do not cover the

pupil and the sclera,
lids normally close
symmetrically
Transparent with
light pink color
Color is white
Transparent, shiny
Black, constrict
briskly
Clearly visible

Normal

Free of lesions,
discharge of
inflammation

Free of lesions,
discharge of
inflammation

Normal

Canal walls pink

Client normally
hears words when
whispered

Canal walls pink

Client normally
hears words when
whispered

Normal

Smooth, symmetric
with same color as
the face
Close to midline,
thicker anteriorly
than posteriorly

Smooth, symmetric
with same color as
the face
Close to midline,
thicker anteriorly
than posteriorly

Oval, symmetric
and without

Oval, symmetric
and without

Normal

Normal
Normal
Normal
Normal

Normal

Normal
Normal

Normal

discharge

discharge

Inspection

Pink, moist
symmetric

Pink, moist
symmetric

Normal

Buccal mucosa

Inspection
Inspection

Hard palate- domeshaped

Soft Palate- light
pink

Glistening pink soft

moist
Slightly pink color,
moist and tightly fit
against each tooth
Moist, slightly
rough on dorsal
surface medium or
dull red
Firmly set, shiny
No tooth decay
Hard palate- domeshaped
Soft Palate- light
pink

Normal

Gums

Glistening pink soft

moist
Slightly pink color,
moist and tightly fit
against each tooth
Moist, slightly
rough on dorsal
surface medium or
dull red
Firmly set, shiny

Neck is slightly
hyper extended,
without masses or
asymmetry
Neck moves freely,
without discomfort
Rises freely with
swallowing
Midline
Clear breath sounds

Neck is slightly
hyper extended,
without masses or
asymmetry
Neck moves freely,
without discomfort
Rises freely with
swallowing
Midline
Clear breath sounds

Skin same color

with the rest of the
body

Skin same color

with the rest of the
body

Mouth and
Pharynx
Lips

Tongue

Inspection

Teeth

Inspection

Hard and soft

palate

Inspection

Neck
Symmetry of
neck muscles,
alignment of
trachea
Neck Rom

Inspection
Inspection

Thyroid gland

Palpation

Trachea
Thorax and
Lungs
Abdomen

Inspection
Auscultation

Bowel sounds

Auscultation

Neurology
system

Inspection

Clicks or gurling
Clicks or gurling
sounds occur
sounds occur
irregularly and
irregularly and
range from 5-35 per range from 5-35 per
minute
minute

Normal
Normal
Normal
Normal

Normal
Normal
Normal
Normal
Normal
Normal

Normal

Level of
consciousness

Inspection

Behavior and
appearance

Inspection

Fully conscious,
respond to
questions quickly,
perceptive of
events

Fully conscious,
respond to
questions quickly
perceptive of events

Makes eye contact

Makes eye contact
with examiner,
with examiner,
hyperactive
hyperactive
expresses feelings
expresses feelings
with response to the with response to the
situation
situation

Normal

Normal

LABORATORY RESULTS
HEMATOLOGY RESULTS
WBC
Hgb
Hct
Differential Count
Lymphocytes
Segmenters

Normal Value
5-10 x 10 g/L
M 13-16 g/dl
F 12-16 g/dl
M 39%-54%
F 37%-48%

Results
7.8
11

Analysis
Normal
Decreased

33%

Decreased

20%-40%
60%-70%

31%
69%

Normal
Normal

FECALYSIS
Method used: Direct Smear
Physical properties:
Color
Consistency

Results

Analysis

Light brown
Watery

Normal
d/t profuse secretion of
water and electrolytes

Remarks:
No oral intestinal parasite seen

URINALYSIS
Color
Transparency

Results
Yellow
Slightly turbid

Reaction
Specific gravity

6.0
-1.020

Sugar
Protein

Negative
Trace

Analysis
Normal
d/t increased urine
concentration
Normal
Decreased: d/t
dehydration
Normal
Normal

MICROSCOPIC EXAM
Round epithelial cells
Mucus thread
RBC
Pus cells
Amorp urates/phosphates

Result
Occasional
Many
0-1
1-2
Few

Analysis
Normal
Normal
Normal
Normal
Normal

ANATOMY AND PHYSIOLOGY

THE DIGESTIVE SYSTEM

Every morsel of food we eat has to be broken down into nutrients that can be
absorbed by the body, which is why it takes hours to fully digest food. In humans, protein
must be broken down into amino acids, starches into simple sugars, and fats into fatty
acids and glycerol. The water in our food and drink is also absorbed into the bloodstream
to provide the body with the fluid it needs.
The digestive system is made up of the alimentary canal and the other abdominal
organs that play a part in digestion, such as the liver and pancreas. The alimentary canal
(also called the digestive tract) is the long tube of organs including the esophagus, the
stomach, and the intestines that runs from the mouth to the anus. An adult's digestive
tract is about 30 feet long.
Digestion begins in the mouth, well before food reaches the stomach. When we
see, smell, taste, or even imagine a tasty snack, our salivary glands, which are located
under the tongue and near the lower jaw, begin producing saliva. This flow of saliva is set
in motion by a brain reflex that's triggered when we sense food or even think about
eating. In response to this sensory stimulation, the brain sends impulses through the
nerves that control the salivary glands, telling them to prepare for a meal.
As the teeth tear and chop the food, saliva moistens it for easy swallowing. A
digestive enzyme called amylase, which is found in saliva, starts to break down some of
the carbohydrates (starches and sugars) in the food even before it leaves the mouth.
Swallowing, which is accomplished by muscle movements in the tongue and
mouth, moves the food into the throat, or pharynx. The pharynx (pronounced: fair-inks),
a passageway for food and air, is about 5 inches long. A flexible flap of tissue called the
epiglottis reflexively closes over the windpipe when we swallow to prevent choking.
From the throat, food travels down a muscular tube in the chest called the
esophagus. Waves of muscle contractions called peristalsis force food down through the
esophagus to the stomach. A person normally isn't aware of the movements of the
esophagus, stomach, and intestine that take place as food passes through the digestive
tract.
At the end of the esophagus, a muscular ring called a sphincter allows food to
enter the stomach and then squeezes shut to keep food or fluid from flowing back up into
the esophagus. The stomach muscles churn and mix the food with acids and enzymes,
breaking it into much smaller, more digestible pieces. An acidic environment is needed
for the digestion that takes place in the stomach. Glands in the stomach lining produce
about 3 quarts of these digestive juices each day.
Most substances in the food we eat need further digestion and must travel into the
intestine before being absorbed. When it's empty, an adult's stomach has a volume of one
fifth of a cup, but it can expand to hold more than 8 cups of food after a large meal.

By the time food is ready to leave the stomach, it has been processed into a thick
liquid called chyme. A walnut-sized muscular tube at the outlet of the stomach called the
pylorus keeps chyme in the stomach until it reaches the right consistency to pass into the
small intestine. Chyme is then squirted down into the small intestine, where digestion of
food continues so the body can absorb the nutrients into the bloodstream.
The small intestine is made up of three parts:
1. the duodenum, the C-shaped first part
2. the jejunum, the coiled midsection
3. the ileum, the final section that leads into the large intestine
The inner wall of the small intestine is covered with millions of microscopic, fingerlike projections called villi. The villi are the vehicles through which nutrients can be
absorbed into the body.
The liver (located under the ribcage in the right upper part of the abdomen), the
gallbladder (hidden just below the liver), and the pancreas (beneath the stomach) are
not part of the alimentary canal, but these organs are still important for healthy digestion.
The pancreas produces enzymes that help digest proteins, fats, and carbohydrates. It
also makes a substance that neutralizes stomach acid. The liver produces bile, which
helps the body absorb fat. Bile is stored in the gallbladder until it is needed. These
enzymes and bile travel through special channels (called ducts) directly into the small
intestine, where they help to break down food.
The liver also plays a major role in the handling and processing of nutrients. These
nutrients are carried to the liver in the blood from the small intestine.
From the small intestine, food that has not been digested (and some water) travels to
the large intestine through a valve that prevents food from returning to the small intestine.
By the time food reaches the large intestine, the work of absorbing nutrients is nearly
finished. The large intestine's main function is to remove water from the undigested
matter and form solid waste that can be excreted. The large intestine is made up of three
parts:
1. The cecum is a pouch at the beginning of the large intestine that joins the small
intestine to the large intestine. This transition area allows food to travel from the
small intestine to the large intestine. The appendix, a small, hollow, finger-like
pouch, hangs off the cecum. Doctors believe the appendix is left over from a
previous time in human evolution. It no longer appears to be useful to the
digestive process.
2. The colon extends from the cecum up the right side of the abdomen, across the
upper abdomen, and then down the left side of the abdomen, finally connecting to
the rectum. The colon has three parts: the ascending colon and transverse colon,

which absorb water and salts, and the descending colon, which holds the resulting
waste. Bacteria in the colon help to digest the remaining food products.
3. The rectum is where feces are stored until they leave the digestive system
through the anus as a bowel movement.

PATHOPHYSIOLOGY
(GASTROENTERITIS)

Precipitating Factors

Predisposing Factors
Age

Lifestyle

Environment

Poor Hygiene
Diet

Etiology: infants/young children: Haemophilus influenzae

Person to person (hands)

Contaminated food/water

Ingestion of Pathogens

Invasion of the GIT

Animal pets

Enterotoxin production

Affects the vomit

receptors

Interacts with mucosal lining

Alters permeability

Destruction of epithelial
cells

Vomiting center
in the brain is
stimulated

Superficial ulceration of
mucosa

Abdominal
cramps

Cellular metabolism
d/t underlying injury
to GI

Blood, mucus
in stool

Abdominal
abdominalpain
pain

Systemic Invasion

Inflammation of
layer of tissue
beneath epithelium
of mucosa

abdominal spasm to limit

mucosal injury

Vomiting
Vomiting

Profusesecretion
secretionof
offluids
water
Profuse
and electrolytes

reduced absorption
of fluid &
electrolytes

Hyperthermia and edema

Abdominal cramps
Diarrhea
General weakness

Excretion of
Interstitial fluids

Access to
Systemic circulation

Fluid and electrolytes loss

Infection in other
part of the body

Dehydration
Deterioration and collapse

DEATH

Septicemia Meningitis

NURSING CARE PLANS

ASSESSMENT
Subjective data:
Mainit po ang
pakiramdam ko as
verbalize by the
patient
Objective data:
T= 37.9 o C
Skin is
warm to
touch
RR= 20

NURSING
DIAGNOSIS
Hyperthermia
r/t exposure to
hot environment

PLANNING
At the end of
thirty minutes, the
patient will
maintain a core
temperature
within normal.

NURSING
INTERVENTIONS
Provide proper
ventilation.

RATIONALE
Proper ventilation
may reduce the
temperature of the
patient.

Monitor heart rate

and rhythm.

Dysrhythmias are
common due to
electrolyte
imbalance,
dehydration, and
direct effects of
hyperthermia on
blood and cardiac
tissue.

Promote surface
cooling by means
of cool
environment
and/or fans.

Heat loss by
convention.

EVALUATION

 Promote client
safety.
Encourage
patients
participation in
ways to protect
oneself from
excessive
exposure to hot
environment.

Objective data:
Decreased
immunity

Risk for
infection r/t IV
therapy

At the end of 30
minutes, the
client will
verbalize
understanding of
individual
causative and risk

Ensuring patients
safety prevents
other problems.
Self-care awareness
help in the
prevention and
control of
hyperthermia.

Instruct client/SO
to increase fluid
intake.

Adequate fluid
intake prevents
dehydration.

Review sings and

symptoms of
hyperthermia.

These may indicate

prompt
interventions.

Note risk factors

for the occurrence
of infection.

Identifying the
possible causative
factors helps
prevent/control the
occurrence of
infection.

factors.
Observe for
localized sings for
infection at
insertion sites.
Assess skin
conditions around
insertion sites of
pins, wires, and
tongs, noting
inflammation and
drainage.

Visible sings of
infection enable the
management of
more severe
infections.
The skin is our
primary defense
against infectious
diseases.

Stress proper
hand washing
techniques by all
caregivers and
SOs of the
patient.

Hand washing
technique is a firstline defense against
nosocomial
infections.

Instruct client/SO
in techniques to
protect the
integrity of the
skin.

Care for the skin

integrity prevents
the occurrence of
infection.

Subjective data:
Nagsuka siya at
nagtae, as
verbalized by her
mother
Objective data:
Dry
mucous
membranes
and lips
Sunken
eyeballs

Fluid volume
deficit
related to
increase
metabolic
demand and
insensible
fluid loss
through
vomiting and
increased
body
temperature

At the end of
the shift, the
patient will be
able to:
- Achieve
adequate
hydration as
evidenced by
good skin
turgor, moist
mucous
membranes and
lips, no
alteration in
mentation

Assessed vital
signs and
degree of
hydration and
level of
consciousness

Provides baseline
data and
information; this is
also important in
the evaluating
clients condition an
success of
intervention

Encouraged
adequate fluid
intake as
tolerated by the
patient.
Instructed SO
to provide
fluids in the
bedside

Adequate fluids
will replace fluid
lost through
insensible water
loss due to hyper
metabolic state and
vomiting

Regulated IVF
according to
specified flow
rates basing on
the physicians
order

Regulation of fluid
is critical in
maintaining
adequate circulating
fluids to recover for
the amount of water
loss through fever
and vomiting

 Monitored
frequency of
urination and
amount of
excreted urine

Urine output serves

as an important
parameter in
assessing clients
ability to conserve
fluids

DRUG STUDY
METRONIDAZOLE
Generic name: Metronidazole
Brand name: Flagyl
Classification: Trichomonacide, amebicide
Action:
Effective against anaerobic bacteria and protozoa. Specifically inhibits
growth by binding to DNA, resulting in loss of helical structure, strand breakage,
inhibition of nucleic acid synthesis and cell death.
Side Effects:
GI: nausea, dry mouth, metallic taste, vomiting,
abdominal discomfort, andominal pain
CNS: headache, dizziness
Nursing Responsibilities:
Monitor stool number and character.
With IV therapy, assess for sodium retention.

METOCLOPRAMIDE
Generic name: Metoclopramide
Brand name: Reglan
Classification: gastrointestinal stimulant
Action:
Dopamine antagonist that acts by increasing sensitivity to acetylcholine;
results in increased motility of the upper GI tract and relaxation of the pyloric sphincter
and duodenal bulb.
Side Effects:
GI: nausea, bowel disturbances
CNS: restlessness, drowsiness, fatigue, headache, dizziness
Nursing Responsibilities:
Inject slowly IV to prevent transient feelings of anxiety and restlessness.
Assess abdomen for bowel sounds and distention.

AMPICILLIN
Generic name: Ampicillin
Brand name: Unasyn
Classification: Antiboitic, penicillin
Action:
Synthetic, broad-spectrum antibiotic suitable for gram-negative bacteria.
Side Effects:
GI: diarrhea, abdominal distention
CNS: fatigue, headache
GU: dysuria, urinary retention
At the site of infection: pain and thrombo-phlebities
Nursing Responsibilities:
Note history of sensitivity/reactions to these or related drugs.
Monitor CBC, liver, and renal function
Monitor urinary output and serum potassium levels
RANITIDINE
Generic name: Ranitidine
Brand name: Zantac
Classification: histamine H2 receptor blocking drug
Action:
Competitively inhibits gastric acid secretion by blocking the effect of histamine
on histamine H2 receptors.
Side Effects:
GI: constipation, diarrhea, abdominal pain
CNS: dizziness, headache, insomnia, anxiety
Nursing Responsibilities:
Assess patient GI condition before starting therapy and regularly thereafter to
monitor the doing effectiveness.
Be alert for adverse reaction and drug interaction.
Assess patients and family knowledge of the drug therapy.