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INTRODUCTION

Diarrhea is one of the most common diagnoses in general practice. It is
estimated that each year US adults experience 99 million episodes of acute diarrhea or
gastroenteritis.2 In the United States, there are about 8 million physician visits and more
than 250,000 hospital admissions each year (1.5% of adult hospitalizations) due to
diarrhea or gastroenteritis.3 Most of the deaths associated with diarrhea illness occur in
the very young and the elderly populations, whose health may be put at risk from a
moderate amount of dehydration. The rate of diarrhea illnesses is 2 to 3 times greater in
developing countries.

The prevalence of diarrhea is not uniform in the general population. Food-and
water-borne outbreaks involving a relatively small subset of population and recurrent
bouts of illness in others make up the bulk of the cases. Diarrhea is more prevalent
among adults who are exposed to children and non-toilet-trained infants, particularly in
a daycare setting; travelers to tropical regions; homosexual males; persons with
underlying immunosuppressant; and those living in unhygienic environments and having
exposure to contaminated water or foods.

Every baby or child has different bowel habits. Your baby may have as many as
4 to 10 stools a day or as few as 1 every 3 days. Many breast-fed babies will have a
bowel movement with each feeding and sometimes between feedings. During infancy,
normal stool may be runny or pasty, especially if the baby is breast-fed. The presence
of mucus in the stool is not uncommon. Unless there is a change in your baby's normal
habits, loose and frequent stools are not considered to be diarrhea.

Children can have acute or chronic forms of diarrhea. Causes include bacteria,
viruses, parasites, medications, functional disorders, and food sensitivities. Infection
with the rotavirus is the most common cause of acute childhood diarrhea. Rotavirus
diarrhea usually resolves in 3 to 9 days.

Medications to treat diarrhea in adults can be dangerous to children and should
be given only under a doctor's guidance.
The definition of diarrhea depends on what is normal for you. For some, diarrhea
can be as little as one loose stool per day. Others may have three daily bowel
movements normally and not be having what they consider diarrhea as long as they are
not dehydrated. So the best description of diarrhea is "an abnormal increase in the
frequency and liquidity of your stools. But we have to know how serious it is and what to
do about it. We usually catch infectious types of diarrhea by actually eating microscopic
viruses, bacteria, or parasites. These microbes then flourish in our intestines, causing
damage and diarrhea. The offending microbes usually are passed from the diarrhea of
others. For example, if we don’t wash our hands after having bowel movements, we
can easily pass these infections through preparation of food, shaking hands or other
casual contact. And mind you this mode of transmission can be just as contagious as a
cold or respiratory flu.

Here are some helpful tips to prevent the transmission of the disease:

• Prevention is a matter of good hygiene. Always wash your hands before
preparing your own food or for others.

• Keep your hands away from your hands and mouth in general.

• Wash after shaking hands with a number of people.

• Of course, always wash your hands after using the bathroom, and be wary of
those who don’t!
B. Objective of the study

The aim of this study is to help and give much information for the patient’s

condition and providing also comfort while the patient is not well and not on right

condition and helps the patient while having some discomfort in his recovery. Having

this information and reference can help other students having the same case.

All the given care to the patient while he is admitted in the Male Medical ward is

reflected in this study in the one week rotation at J.R Borja General Hospital. This could

be a guide and helps to improve skills in handling patient having the same case of

diarrhea. It helps also to be a reference for more studies to come.

C. Scope and Limitation of the study

This study focuses on determining the main concern or problems of the

patient that impedes their progress towards the improvement of health condition. This

care study covers the assessment from June 29, 30 and July 1, 2008. During this short

span of our Hospital exposure at medical ward through duties at J.R Borja General

Hospital, Cagayan de Oro City, and data gathered through interview and observation

were recorded. It mainly covers about Vince Miguel Behiga, history of his present

illness, his lifestyle, and current condition. It is however limited only up to what it is

written on the chart of the patient and to the extent of the resources (verbal and non

verbal) provided to us by his mother.
A. PROFILE OF THE PATIENT

Name: ? Age: 12 years old

Address: ? Sex: Male

Birthday: ? Civil Status: Single

Placed of Birth: ?

Religion: R. Catholic

Occupation:Student Nationality: Filipino

Date Admission: June 27, 2008 Time: 6:30 PM

Attending Physician: ?

Admitting Clerk:

Father’s name: ?

Mother’s name: ?

Height: 5’

Weight: 46 kgs

Blood pressure: 110/80 mmHg

Pulse rate: 90bpm

Respiratory Rate: 20bpm

Temperature: 37.2º C.
HEALTH HISTORY:

Vince was born on x. He was delivered NSVD in the hospital. Two weeks past
after birth, he was experiencing fever due to the stump umbilical cord that was
infected. The mother observed that there was a present of pus on the said area. So
she really suspected that the fever was due to infection. She decided to go to her
pediatric physician in there place where she was given Cephalexine 2.5ml TID for
antibacterial and Tempra .6ml every 4 hours. Following fever was cough and cold.
And successfully the illness gone.
The mother denied no any heterofamilial disease. And patient has no
allergy to any. So far, this are the illnesses encountered by Vince as ended by the
mother.

HISTORY OF PRESENT ILLNESS:

A case of ?, 12 Years old, male, Roman Catholic lived in ? came in at x due to
Loss bowel movement (LBM) and vomiting. Patient was admitted last June x at 6:30
p.m.
Condition started on that day, x had LBM three consecutive defecation within an
interval of 30minutes with watery, nonblood seen associated with vomiting at least
two times after such intake of foods/fluids as stated by the mother where prompt to
admission. There was no associated symptom like fever during that day.
Vince was diagnosed to have an Acute gastroenteritis with mild dehydration
(AGE).
D. CHIEF COMPLAINT

The patient was admitted due to LBM three consecutive defecation within an interval

of 30minutes with watery, no blood seen associated with vomiting at least two times

after such intake of foods/fluids

DEVELOPMENTAL HISTORY:

Sigmund Freud’s Psychosocial Development:

According to Freud, the source of bodily pleasure is concentrated in zones
around the musculocutaneous junctions. These erotogenic zones displace one another
in sequence as the child matures. Initially, the infants erotogenic zone is the mouth, thus
gratification of the id is derived through oral satisfaction. During the first 6 months of life,
the infant is in the oral dependent or oral passive stage, as evidenced by sucking. After
the first teeth erupt at about 5 to 7 months of age, the infant enters the oral aggressive
stage with biting and sucking as the means of gratification.

Infants enjoy sucking and later biting anything that touches the erogenous zone
of the lips and mouth. Some infants enjoy this oral activity more than the others. While
some may be satisfied by sucking at the breast or bottle, others require pacifiers, toys or
other objects that can be orally manipulated.

The young infant operates on the basis of primary narssism or self-love, wanting
what is wanted immediately and unable to tolerate a delay in gratification. This process,
the pleasure principle, later becomes a part of the ego structure that operates on the
reality principle, giving up what is wanted now for something better in the future. If the
mother or her substitute always sees to it that the infant’s need before there is evidence
of these needs, the infant will feel no control over the environment. On the other hand, if
required to wait too long after expressing a need, the infant will feel unable to control the
environment and thus learns to mistrust the caregiver.

MEDICAL ORDERS/RATIONALE/MEDICINE/LABORATORY:

MEDICINE ORDERED DATE ORDERED RATIONALE
o Cotrimoxazole 125mg/5ml June 27, 2008 Antibacterial – for
suspension 4.0ml BID (8-6) Shigellosis or UTIs
caused by
susceptible strains of
Escherichia coli,
Proteus (in dole
positive or
negative),Klebsiella,
or Enterobacter
species.
o Metronidazole 125mg/5ml June 27, 2008 Amoebicides &
suspension 4.0ml TID(8-1-6) Antiprotozoals –
intestinal Amebiasis
o Prozinc drops 1.3ml OD June 27, 2008 Food supplement -
(once daily) contains zinc an
essential mineral that
stimulates the
activities of many
enzymes promoting
normal biochemical
reaction in the body.
Strengthen the
immune system,
support normal
growth and drugs
and help prevent
retardation.

o Fecalysis June 27, 2008 To check for
abnormalities.
o Urinalysis June 27, 2008 To check for
abnormalities.
Diagnostic Examination:
FECALYSIS:
Date: June 28, 2008
Macroscopic appearance:
Color: yellow Consistency: Soft
Microscopic appearance:
Pus cells: none seen /hpf
RBC: none seen /hpf
Fat globules: none seen / hpf

Amoeba:
Cyst: 0-2 /hpf
Result: Positive amoeba

URINALYSIS
Date: June 28, 2008
Color: Yellow
Appearance: Clear
Specific gravity: 1.025
Protein (Albumin): Negative
Glucose: Negative
Bacteria: Few
ANATOMY AND PHYSIOLOGY:
THE DIGESTIVE SYSTEM
Consists of (1) an alimentary canal- a long muscular tube beginning at the lips
and ending at the anus, including the mouth, pharynx (oral and laryngeal portions),
esophagus, stomach, and small and large intestine, and (2) accessory glands that
empty secretions into the tube- salivary glands, pancreas, liver, and gallbladder.

1. Teeth
a. Crown projects above the gum, root below. Dentin (bulk of tooth) surrounds pulp
cavity. Enamel covers dentin of crown; cementum covers dentin of root and
anchors tooth to periodontal ligament.
b. Each quadrant of mouth has eight teeth-two incisors, one canine, two premolars,
and three molars.

2. Esophagus
a. Mucous membrane lined with stratified squamous epithelium rather than simple
columnar epithelium, as in stomach and intestine,
b. Muscular layer of upper third, striated; lower third, smooth; middle, both striated
and smooth.
c. Segment above stomach (indistinguishable anatomically from remainder of
esophagus) functions as sphincter, remaining closed until reflexively relaxed as
peristaltic wave approaches,

3. Stomach
a. Consists of upper fundus, central body, and constricted lower pyloric portion
(antrum).
b. Musculature contains an oblique inner layer of smooth muscle in addition to
external longitudinal and underlying circular smooth muscle layers found
elsewhere in digestive tract.
c. Thick circular muscle in pyloric portion forms pyloric sphincter.
d. Openings: cardia, between esophagus and stomach; pylorus, between stomach
and duodenum.

4. Small Intestine
a. Divided into duodenum, jejunum, and ileum.
b. Surface area, serving absorptive function, increased by:
1. Circular folds (plicae circulares)- permanent, transverse folds.
2. Villi – fingerlike projections
3. Microvilli- processes on free surface of epithelial cells that form the brush order.
c. Invagination of ileum into cecum – the first part of the large intestine –forms
ileocecal valve, which opens rhymthmically during digestion, permitting gradual
emptying of ileum and preventing regurgitation.

5. Large Intestine
a. Extends from the end of the ileum to the anus and is divisible into the cecum,
colon, rectum, and anal canal. The major part is the colon, which consists of
ascending, transverse, descending, and sigmoid portions.
b. The longitudinal muscle of the cecum and colon forms three conspicuous
bands(taeniae coli).
c. Thickene circular smooth muscle of anal canal forms the internal anal sphincter.
Surrounding skeletal muscle forms the external sphincter.

6.Salivary Glands
a. Three pairs (parotid, submaxillary, and sublingual), with ducts opening into the
mouth.
b. Two types of secretions:
1. Serous containing ptyalin –enzyme initiating digestion of the starch.
2. Mucous – viscous, containing mucus, which facilitates mastication.

7. Pancreas
a. Two types of secretory cells in exocrine pancreas:
1. Enzyme- secreting acinar cells.
2. Bicarbonate-and-water-secreting –intralobular duct cells.
b. Pancreatic duct empties pancreatic juice into duodenum.

8. Liver and Gallbladder
a. Bile secreted by liver is essential for normal absorption of digested lipids. Bile
salts combine with products of lipid digestion to form water-soluble complexes
(micelles) which are absorbed by intestinal cells.
b. Gallbladder concentrates and stores bile.
c. Hepatic duct, formed from the bile duct system of liver, joins cystic duct of
gallbladder to form common bile duct, which empties into duodenum.

Motility of Digestive Tract

1. Swallowing
a. In buccal stage (voluntary) bolus pushed toward pharynx.
b. In pharyngeal and esophageal stages (involuntary) bolus passes through
pharynx into esophagus and through esophagus into stomach.
c. Reflexes raise soft palate, raise larynx, adduct aryepiglottic folds and true
and false vocal cords, and inhibit respiration. When food enters the
pharynx, reflex contraction of the superior constrictor muscle initiates
peristalsis, propelling the food, and relaxation of the upper and lower
esophageal sphincters allows food to pass first into the esophagus and
then into the stomach.
2. Peristalsis in Stomach
a. Mixes contents and forces chime through pylorus.
b. Three waves each beginning every 20 seconds near midpoint of stomach,
lasting about one minute, and ending with contraction of pyloric sphincter
travel down stomach at one time.
c. Rate of emptying determined largely by strength of contractions.
d. Feedback from duodenum regulates gastric emptying. Two control
mechanisms, one neuronal (enterogastric reflex), the other hormonal
(mediated mainly by enterogastrone), inhibit gastric motility.
3. Contractions of the Small Intestine
a. Segmenting: rhythmic contractions along a section dividing it into
segments: primarily mixing action.
b. Peristaltic waves superimposed upon segmenting contractions.
c. Ingestion of food increases ileal peristalsis and frequency of opening of
ileocecal valve (gastroileal reflex).
4. Contractions of Large Intestine
a. Simultaneous contraction of circular and longitudinal muscle, forming
haustra,
b. Infrequent usually two or three times daily of most mass movements
transferring contents from proximal to distal colon and into rectum. Most
commonly occur shortly after a meal (gastrocolic reflex).
5. Defecation reflex
a. Distention of rectum triggers intense peristaltic contractions of colon and
rectum and relaxation of internal anal sphincter.
b. Reflex preceded by voluntary relaxation of external sphincter and
compression of abdominal contents.

Digestion
1. Mouth
a. Enzymatic action: initiation of the digestion of carbohydrate by ptyalin, which
splits starch into the disaccharide maltose. Action in mouth slight, but continues
in stomach until acid medium inactivates ptyalin.
b. Regulation: exclusively nervous- impulses transmitted from center in medulla
activated principally by taste, smell, or sight of food to salivary glands by
parasymphatetic nerve fibers.
2. Stomach
a. Enzymatic action: initiation of protein digestion by pepsin, producing proteoses,
peptones, and polypeptides. Pepsinogen secreted by chief cells converted to
pepsin by autoactivation process in presence of acid secreted by parietal cells.
b. Regulation
1. Cephalic phase- initiated by taste, sight, or smell of food; secretion stimulated
directly or indirectly by the hormone gastrin. Gastrin, released from so called G
cells in the pyloric region of the stomach, stimulates the secretion of an acid-rich
gastric juice.
2. Gastric phase- initiated by food in stomach; secretion triggered directly or
indirectly, as in cephalic phase.
3. Intestinal phase- initiated by digestive products in upper small intestine; mediated
by hormone released by duodenum acting on stomach.
4. Inhibition- strong acid in antrum inhibits gastrin release. Fat, acid, or hypertonic
salt solutions in duodenum stimulate release of hormones which inhibit gastric
secretion.

3. Intestine
a. Enzymatic action- fat digestion and continuation of carbohydrate and protein
digestion.
1. Pancreatic lipase splits fat into monoglycerides, fatty acids, and glycerol.
2. Pancreatic amylase converts starch and glycogen into maltose. Intestinal
disaccharidases split maltose, sucrose, and lactose into their constituent
monosaccharides,
3. Pancreatic enzymes trypsin and chymotrypsin both endopeptidases split proteins
and the products of pepsin digestion into peptides. Peptidases split peptides into
amino acids.
b.. Regulation of pancreatic secretion: by vagus nerve during cephalic and gastric
phase of gastric secretion and by two duodenal hormones-cholecystokinin-
pancreozymin and sectetin. Vagus stimulation and cholecystokinin-pancreaozymin
stimulate enzyme secretion; secretin stimulates bicarbonate secretion.
Absorption
1. Occurs almost exclusively in the small intestine.
2. Simple sugars, amino acids, short-chain fatty acids, and glycerol are absorbed
into blood stream via capillary network of villi. Products of lipid digestion are
absorbed as chylomicrons into intestinal lymphatics via central lacteal of villi.

Digestion process- the digestive system prepares food for consumption by the cells
through five basic activities:

1. Ingestion- is an active, voluntary process of taking in food. Food must be placed
in the mouth before it can be acted on.
2. Propulsion is movement of food along the digestive tract. Swallowing is one
example of food movement that depends largely on the propulsive process called
peristalsis. Peristalsis is involuntary and involves alternating waves of contraction
and relaxation of the muscles in the organ wall to squeeze food along the tract.
3. Digestion- the breakdown of food by both chemical and mechanical processes.
4. Absorption- the passage of digested food from the digestive tract into the
cardiovascular and lymphatic systems for distribution to cells. For absorption to
occur, the digested foods must first enter the mucosal cells by active or passive
transport processes. The small intestine is the major absorptive site.
5. Defecation- the elimination of indigestible substances from the body.
VI. NURSING ASSESSMENT

NURSING SYSTEM REVIEW CHART

NAME: x DATE: June 29, 2008
Vital Signs:
HR: 90bpm RR:20cpm BP: 110/80 mmHg Temp: 37.2ºC Height: 5” Weight:46 kg

An [X] is placed in the area of abnormality. Comment at the space provided. Indicate the location of
the problem in the figure using [X].
EENT: ________________
[ ] impaired vision [ ] blind ____________
[ ] pain redden [ ] drainage
[ ] gums [ ] hard of hearing [ ] deaf ________________
[ ] burning [ ] edema [ ] lesion teeth ________________
[ ] assess eyes ears nose ________________
[ ] throat for abnormality [ x ] no problem ________________
RESP: ________nausea &
[ ] asymmetric [ ] tachypnea [ ] barrel chest
[ ] apnea [ ] rales [ ] cough vomiting_________
[ ] bradypnea [ ] shallow [ ] rhonchi ________________
[ ] sputum [ ] diminished [ ] dyspnea __________D5L5
[ ] orthopnea [ ] labored [ ] wheezing @40gtts.min______
[ ] pain [ ] cyanotic ________________
[ ] assess resp. rate, rhythm, pulse blood
[ ] breath sounds, comfort [x [ x]] no
noproblem
problem
________________
CARDIOVASCULAR: ________________
[ ] arrhythmia [ ]x tachycardia
] tachycardia[ []numbness
]numbness ________________
[ ] diminished pulses [ ] edema [ ] fatigue ________________
[ ] irregular [ ] bradycardia [ ] mur mur ________________
[ ] tingling [ ] absent pulses [ ] pain
Assess heart sounds, rate rhythm, pulse, blood ________________
Pressure, circ., fluid retention, comfort ________________
[x
[ ]]no
noproblem
problem ________________
GASTROINTESTINAL TRACT: ________________
[ ] obese [ ] distention [ ] mass ________________
[ ] dyspagea [ ] rigidity [] [ ]pain
pain
[ ] assess abdomen, bowel habits, swallowing ________________
[ ] bowel sounds, comfort [x [ x]] no
noproblem
problem ________
GENITO – URINARY AND GYNE
[ ] pain [ ] urine [ ] color [ ] vaginal bleeding
[ ] hematuria [ ] discharge [ ] nucturia
[ ] assess urine frequency, control, color, odor, comfort
[ ] gyne bleeding [ ] discharge [x [ x ]] no
no problem
problem
NEURO:
[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure
[ ] lethargic [ ] comatose [ ] vertigo [ ] treamors
[ ] confused [ ] vision [ ] grip
[ ] assess motor, function, sensation, LOC, strength
[ ] grip, gait, coordination, speech [x [ x ]] no
no problem
problem
MUSCULOSKELETAL and SKIN:
[ ] appliance [ ] stiffness [ ] itching [ ] petechie
[ ] hot [ ] drainage [ ] prosthesis [ ] swelling
[ ] lesion [ ] poor turgor [ ] cool [ ]]wound flushed[ ] flushed
[ ] atrophy [ ]x ]pain
pain[ [] ]ecchymosis
ecchymosis[ [] ]diaphoretic
diaphoretic[ ]moist
moist
[ ] assess mobility, motion gait, alignment, joint function
[ ] skin color, texture, turgor, integrity [ x] ]no noproblem
problem
SUBJECTIVE OBJECTIVE
Communication:
[] hearing loss Comments “walay problema [] glasses [] languages
[] visul changes akong pandungog ug pananaw” [] contact lens [] hearing aide
[x] denied as verbalized by the patient. R L
Pupil size: 3mm [] speech difficulties
Reaction: Pupil equally round and reactive to light and
accomodation
Oxygenation:
[] dyspnea Comments “dili man ko ga lisod Resp. [x] regular [ ] irregular
[] smoking history ug ginhawa” Describe: the pt’s respiration is regular 20cpm
NONE as verbalized R symmetrical
[] cough the patient L symmetrical
[x] denied
________________________
Circulation:
[] chest pain Comments “dili man pud ga Heart Rhythm [x] regular [] irregular
[] leg pain sakit akong lawas” as verbalized Ankle Edema ________________________
[]numbness of by the patient
extremities Pulse Car. Rad. DP. FEM*
[x]denied R + 90bpm + Not Obtain
L + 90bpm + Not Obtain
Comments right and left pulse are palpable

*if applicable
Nutrition:
Diet : low fat diet [] dentures [x] none
[] N [] V Comments “wala man pud
Character problema sa akong pagkaon” Full Partial W/ Patient
[] recent change in as verbalized by the patient
weight, appetite Upper [] [] []
[] swallowing
difficulty Lower [] [] []
[x] denied
Elimination: Comments: “mayayo man Bowel sounds __aud____
Usual bowel pattern [] urinary frequency Pud akong pagkalibang ug
4x a day 3 times a day Pagpangihi, wala man Abdominal distention
[] constipation [] urgency Problema” as verbalized Present [] yes [] no
remedy [] dysuria By the patient Urine* (color,
[] hematuria ___________________ consistency, odor)
Date of Last BM [] incontinence ____________________ dark yellow
June 27, 2008 [] polyuria ____________________ no foley bag catheter in
[x] Diarrhea [] foley in place ____________________ place
character [x] denied *if they are in place?
watery brown
MGT. of Health & Illness:
[] alcohol [x] denied Briefly describe the patient’s ability to follow treatments (diet,
(amount, frequency) meds, etc.) for chronic health problems (if present).
_____________________________
[] SBE Last Pap Smear ________________ The pt was follows her regular diet and follow to take her
LMP: ______________________ medicine.

SUBJECTIVE OBJECTIVE
Skin Integrity:
[x] dry Comments: “wala man pud ko [x] dry [] cold [] pale
[] itching nag katol2x sa akong panit” as [] flushed [] warm
[] other verbalized by the patients [] moist [] cyanotic
[] denied *rashes, ulcers, decubitus (describe size, location, drainage)
no rashes, ulcerations, lesions, pigmentation seen.
Activity/Safety:
[] convulsion Comments “wla may problema [] LOC and orientation the patient is oriented to the place,
[] dizziness di sad ko ga lisod ug lihok-lihok date and time
[] limited motion ” as Gait: [] walker [] cane [] other
Of joints verbalized by the pt
IDEAL NURSING MANAGEMENT

Risk for fluid volume deficit related to excessive losses through normal routes (frequent
diarrhea, vomiting)

Desired outcomes/evaluation criteria – a patient will:

Maintain adequate fluid volume as evidenced by moist mucous membranes,
good skin turgor, and capillary refill; stable vital signs; balanced Intake and Output with
urine of normal concentration/am
INTERVENTIONS RATIONALE
INDEPENDENT
 Monitor Intake and Output. Note  Provides information about overall fluid
number, character, and amount of balance, renal function, and bowel
stools; estimate insensible fluid losses, disease control, as well as guidelines for
e.g., diaphoresis. Measure urine fluid replacement.
specific gravity; observe for oliguria.
 Assess vital signs (BP, pulse,  Hypotension (including postural),
temperature). tachycardia, fever can indicate response
to and/or effect of fluid loss.
 Indicates excessive fluid loss/resultant
 Observe for excessively dry skin and dehydration.
mucous membranes, decreased skin
turgor, slowed capillary refill.
 Indicator of overall fluid and nutritional
 Weigh daily status.
 Colon is placed at rest for healing and to
 Maintain oral restrictions, bed rest. decreased intestinal fluid losses.

 Observe for overt bleeding and test  Inadequate diet and decreased
stool daily for occult blood. absorption may lead to vitamin K
deficiency and defects in coagulation,
potentiating risk for hemorrhage.
 Note generalized muscle weakness or  Excessive intestinal loss may lead to
cardiac dysrhytmias. electrolyte imbalance, e.g., potassium,
which is necessary for proper skeletal
and cardiac muscle function. Minor
alterations in serum levels can result in
profound and/or life-threatening
COLLABORATIVE symptoms.
 Administer parenteral fluids, blood
transfusions as indicated.  Maintenance of bowel rest requires
alternative fluid replacement to correct
losses/anemia. Note: fluids containing
sodium may be restricted in presence of
 Monitor laboratory studies, e.g., regional enteritis.
electrolytes (especially potassium,  Determines replacement needs and
magnesium) and ABGs (acid-base effectiveness of therapy.
balance).

 Administer medications as indicated:
 Antidiarrheal e.g., dipphenoxylate  Reduces fluid losses from intestines.
(Lomotil), loperamide (Imodium),
anodyne suppositories.

 Antiemetics, e.g., trimethobenzamide  Used to control nausea and vomiting in
(Tigan), hydroxyzine (Vistaril), acute exacerbations.
prochlorperazine (Comparazine);
 Antipyretics, e.g., acetaminophen  Controls fever, reducing insensible
(Tylenol); losses.

 Electrolytes, e.g., potassium  Electrolytes are lost in large amounts,
supplement (KCl-IV;K-Lyte, Slow-K); especially in bowel with denuded,
ulcerated areas, and diarrhea can also
lead to metabolic acidosis through loss of
bicarbonate (HCO3).
IDEAL NURSING MANAGEMENT

Knowledge deficient regarding condition, prognosis, treatment, self-care, and discharge
needs as related to unfamiliarity with resources and information misinterpretation.

Desire outcomes/evaluation criteria- the significant others will:

Verbalize understanding of disease processes, possible complications.

INTERVENTION RATIONALE
INDEPENDENT
 Determine the mother’s perception of  Establishes knowledge base and
disease process. provides some insight into individual
learning needs.

 Review disease process, cause/effect  Precipitating/aggravating factors are
relationship of factors that precipitate individual; therefore, the mother needs
symptoms, and identify ways to to be aware of what foods, fluids, and
reduce contributing factors. lifestyle factors can precipitate
Encourage questions. symptoms. Accurate knowledge base
provides opportunity for the mother to
make informed decisions/choices about
future and control of chronic disease.
Although most others know about their
own disease process, they may have
outdated information or misconceptions.

 Review medications, purpose,  Promotes understanding and may
frequency, dosage, and possible side enhance cooperation with regimen.
effects.

 Stress importance of good skin care,  Reduces spread of bacteria and risk of
e.g., proper hand washing techniques skin irritation/breakdown, infection.
and perineal skin care.

 Emphasize need for long-term follow-  Patients with IBD are at risk for
up and periodic reevaluation. colon/rectal cancer, and regular
diagnostic evaluations may be
required..
IDEAL NURSING MANAGEMENT

Hyperthermia related to dehydration as evidenced by increase in body
temperature higher than normal range.

Desired outcomes/evaluation criteria- patient will:
Demonstrate temperature within normal range, be free of chills.

INTERVENTION RATIONALE
Independent
 monitor patient  Temperature of 102F-106F (38.9C- 41.1C)
temperature(degree and suggests acute infectious disease process.
pattern); note shaking Fever pattern may aid in diagnosis; e.g.,
chills/profuse diaphoresis. sustained or continuous fever curves
lasting more than 24 hour suggest
pneumococcal pneumonia, scarlet or
typhoid fever; remittent fever (varying only
a few degrees in either direction) reflects
pulmonary infections; intermittent curves or
fever that returns to normal once in 24-hour
period suggests septic episode, septic
endocarditis, or tuberculosis (TB). Chills
often precede temperature spikes.
Note: Use of antipyretics alters fever patterns
and may be restricted until diagnosis is made
or if fever remains higher that 102F (38.9C).
 Monitor environmental  Room temperature/number of blankets
temperature; limit/add bed should be altered to maintain near-
linens as indicated. normal body temperature.
 Provide tepid sponge baths;  May help reduce fever. Note: use of
avoid use of alcohol. ice water/alcohol may cause chills,
actually elevating temperature. In
Collaborative addition, alcohol is very drying to skin.

 Administer antipyretics, e.g.,  Used to reduce fever by its central
acetylsalicylic acid (ASA) action on the hypothalamus; fever
(aspirin), acetaminophen should be controlled in patients who
(Tylenol). are neutropenic or asplenic. However,
fever may be benefial in limiting growth
of organisms and enhancing
autodestruction of infected cells.
 Provide cooling blanket.  Used to reduce fever, usually higher
than 104F-105F (39.5C-40C), when
brain damage/seizures can occur.
REFERRALS:
None of us can not escape disease. Children are very susceptible to illness that
is why I imparted knowledge to the patient to continue eating nutritious foods and
vitamins. As much as possible report to the physician immediately if there are any
unusualities may observe because diarrhea can be dangerous in Children.
Children, especially those younger than 6 months of age and those with other
health risks, need special attention when they have diarrhea because they can become
dehydrated. Because a child can die from dehydration within a few days, the main
treatment for diarrhea in children is rehydration. Quickly Careful observation of the
child's appearance and how much fluid he or she is drinking can help prevent problems.
And lastly I told her to follow-up the rural health center for his complete
immunization.

Evaluation:

In the case of x, immediate intervention was given because the mother observed the
condition of her child. A thorough history was taken to document the onset and
frequency of diarrhea. Exposure to contaminated food or water is initiated with the
patient where drinking water might be contaminated. Physical examination helps the
physician to identify underlying systemic disease. The doctor ordered for some
diagnostic tests to find the cause of diarrhea which include the fecalysis where
positively amoebiasis was detected. Urinalysis was also ordered to provide more
specific data.

Treatment for diarrhea includes restoration of fluid and electrolyte balance,
management of signs and symptoms and treatment of causative factors.
BIBLIOGRAPHY:

o Smeltzer, S, et al Medical-Surgical Nursing. 10 th Edition Lippincott Williams and
Wilkins (2004)
o Luckman and Sorensen, Medical-Surgical Nursing. 3rd Edition W.B. Saunders
Company (1987)
o Jacob, S, et al Structure ad Function in Man. 5th Edition W.B. Saunders
Company (1982)
o Kozier, B, et al Fundamentals of Nursing. 7th Edition Pearson Education South
Asia PTE LTD Philippines 2004
o http://heath.yahoo.com/ency/healthwise