Introduction

Acute gastroenteritis occurs when the lining of your stomach is damaged or weak. This allows
digestive acids to irritate the stomach.
Acute gastroenteritis comes on suddenly, and can be caused by injury, bacteria, viruses, stress, or
ingesting irritants such as alcohol, NSAIDs, steroids, or spicy food. It is often only temporary.
(Stevens and Jong textbook of Netter's Infectious Diseases, 2011)
It's commonly called stomach flu; gastroenteritis isn't the same as influenza. Real flu (influenza)
affects only your respiratory system your nose, throat and lungs. Gastroenteritis, on the other hand,
attacks your intestines, signs and symptoms may include but not limited to: Watery, usually non-bloody
diarrhea — bloody diarrhea usually means you have a different, more severe infection, Abdominal
cramps and pain, Nausea, vomiting or both, Occasional muscle aches or headache, Low-grade fever

The most common cause of gastroenteritis are viral or bacterial infection. Noroviruses. Both
children and adults are affected by noroviruses, the most common cause of foodborne illness worldwide.
Norovirus infection can sweep through families and communities. It's especially likely to spread among
people in confined spaces. In most cases, you pick up the virus from contaminated food or water,
although person-to-person transmission also is possible. Rotavirus. Worldwide, this is the most common
cause of viral gastroenteritis in children, who are usually infected when they put their fingers or other
objects contaminated with the virus into their mouths. The infection is most severe in infants and young
children.

Statistics
Global
Acute viral gastroenteritis is a leading cause of infant mortality throughout the world. By age 3
years, virtually all children become infected with the most common agents. Rotavirus causes 2 million
hospitalizations and 600,000-875,000 deaths per year.(National Center for Immunization and Respiratory
Diseases, Division of Viral Diseases,2018)
National
According to Department of Health among 100,000 filipino 4,801(48.01%) suffers from Diarrhea
and gastroenteritis of presumed infectious origin in 2016(Department of Health,2016)
Nursing History
According to the patient’s Guardian (Grandmother) one day prior admission (11/01/19), the
patient was suffering from fever associated with LBM (loose bowel movement) and defecated 10 times
(clear, and watery). Patient also vomited 10 times, non-bloody. That Grandmother also stated that they
did not seek professional help and did not give the patient any medication.

In addition, 2 hours prior to admission (11/02/19) the patient vomited and defecated for 5 times which
made them rush the patient to the hospital (Tarlac Provincial Hospital)

Past medical history

The Grandmother stated that the patient only had a couple colds in the past. No previous
hospitalizations or surgical procedures/accidents.

Vaccine Age given Dose Where Adverse

Reaction

BCG At birth 1

DPT 6 weeks, 12 3
weeks, 14 weeks

OPV 6 weeks, 12 3
weeks, 14 weeks Health center None

Measles 9 Months 1

Heppa B At Birth, 6 weeks, 3

12 weeks

MMR 6 Months, 12 2
Months
Patient profile
PERSONAL DATA

Demographic Data
Name: Patient X
Age: 1 year old
Address: Gerona, Tarlac
Gender: Female
Date of birth: 7/3/2018
Nationality: Filipino
Religion: Catholic
Diagnosis: Acute Gastroenteritis W/ Moderate signs of Dehydration
Date admitted: 11/2/2019
PATHOPHYSIOLOGY
Book Based
Non-potable drinking water/Ingestion of fecally contaminated
food

Virus bacteria Parasite

-Elaboration of toxin
Lysis of enterocytes -Invade epithelial
by Enterotoxigenic
cells
Interference with the pathogens
Brush border function -Cause villus atrophy
-Invasion and
that leads to and eventual
Inflammation of
malabsorption of Malabsorption
mucosa by invasive
electrolytes
pathogens
stimulation of cyclic
Adenosine
Monophosphate (cAMP) Weakened or non-
exposed Immune system
carbohydrate
Malabsorption
Consequences: Severity of Dehydration:
Vomiting Mild
electrolyte Symptoms: thirsty,
imbalance restless
Diarrhea Moderate
metabolic acidosis Symptoms: lethargic,
irritable
Severe
Dehydration
Symptoms: limp, drowsy

Diagnosed with:
GASTROENTERITIS
Patient Based

Source: Brunner & Suddarth's Textbook of Medical-surgical Nursing

Non – Modifiable
• Age – 1 Year old
• Malnutrition – BMI of
13.1 Patient Based Modifiable
•Unsterilized milk bottle
(BMI categories) •Use of tap water
Underweight <18.5 •Poor hygiene
Normal weight 18.5-24.9
Overweight 25-29.9
Obesity 30 or greater

Patient was fed

solid and
contaminated
food

Signs & Symptoms

Fever – Temp of 39.6 °C/103.28°F

Dry skin

Vomiting (Color – White, Odor- Sour)

LBM (Color – Yellow, Consistency – Loose)

Loss of appetite (2 bottles a day but

recently the patient can’t finish 1 bottle)

Laboratories

Hematology Test

Platelet (150,000 – 450,000) - 470,000

RBC (3.50 - 4.70 x10^12/L) - 4.82
Poly (0.55 – 0.63) - 0.702
WBC (4.5-11 x40^g/L) -26.4

Blood Chemistry
Chloride (98.0 – 107.0 meq/L) -111.7

Fecalysis

Color – Yellow

Consistency - Loose

Acute Gastroenteritis W/
Moderate signs of
Dehydration
DIAGNOSTIC PROCEDURES
Hematology Result Form

A complete blood count (CBC) is a blood test used to evaluate your overall health and detect a wide range
of disorders, including anemia, infection and leukemia. A complete blood count test measures several
components and features of your blood, including: Red blood cells, which carry oxygen

Test Result Interpretation

Hemoglobin F 133 -
(120-153)
Hematocrit F 0.375 -
(0.350 – 0.450)
RBC (3.50 - 4.70 4.82 In Dehydration the liquid component of the blood (plasma) is decreased,
x10^12/L) making the Red Blood cells become more concentrated.
Platelet (150,000 470,000 -
– 450,000)
MCV (80 - 96 fl) 77.8 -

MCHC (334 - 355 -

355 g/L)
MCH (27.5 – 27.6 -
32.2 pg)
WBC (4.5-11 26.4 Because there is inflammation of the lining of the intestines the body
x40^g/L) compensates by increasing White blood cells to fight the infection.

Poly (0.55 – 0.702 Elevated polys or neutrophil a component of White blood cell indicates
0.63) infections
55 – 63% -
Lympho (0.23 – 0.264 -
35)
23 – 35% -
MXD 0.034 -

Fecalysis

fecalysis is a series of tests done on a stool (feces) sample to help diagnose certain conditions affecting
the digestive tract. These conditions can include infection (such as from parasites, viruses, or bacteria),
poor nutrient absorption, or cancer.

Physical Characteristics
Color Yellow
Consistency Loose
 Urinalysis
Urinalysis or urine testing is used to look for abnormalities such as an excess amount of protein, blood,
pus, bacteria or sugar. A urine test can help detect a variety of kidney and urinary tract disorders,
including chronic kidney disease, diabetes, bladder infections and kidney stones.

Chemical Interpretation Physical Microscopic

Blood: Negative Color: Light Yellow Pus Cells: 0-1 /HPF
Bilirubin: Negative Transparency: Clear Red Cells: 0-1 /HPF
Urobilinogen: Normal
Ketone: ++ As the body don't Epithelial Cells: Rare
Protein: Negative get enough glucose Mucus Threads: Few
Nitrite: Negative due to the patient Bacteria: Few
Glucose: Negative vomiting any Cast/s: -
pH: 6.0 ingested food, the Crystals: -
Specific Gravity: 1.025 body burns fat for
Leukocytes: Negative energy instead. This
Ascorbic Acid: Negative produces a
substance called
ketones, which can
show up in your
blood and urine.

Blood Chemistry
Blood chemistry tests are blood tests that measure amounts of certain chemicals in a sample of blood.
They measure chemicals including enzymes, electrolytes, fats (also called lipids), hormones, sugars,
proteins, vitamins and minerals. Often several chemicals are grouped together and measured at the same
time.

Electrolytes Interpretation
Sodium (135.0 – 148.0 mmol/L 139.8
Potassium (3.50 – 5.30mmol/L 3.85
Chloride (98.0 – 107.0 meq/L 111.7 Loss of bicarbonate stores
through diarrhea or renal
tubular wasting leads to a
metabolic acidosis state
characterized by increased
plasma chloride concentration
and decreased plasma
bicarbonate concentration.
Calcium (8.4 – 10.20 mg/dL) -
Medical Management
NCP: Deficient Fluid Volume related to perfuse bowel movement

Assessment Nursing Planning Intervention Rationale Evaluation

Diagnosis
Subjective: Deficient Fluid Within 6hours of Monitor and document Febrile states decrease body After 6 hours of proper
Volume related proper nursing temperature. fluids by perspiration and nursing intervention and
“kahapon pa kasi to prefuse intervention and increased respiration. This proper health teaching
nag tatae at nag bowel proper health is known as insensible the patient showed
water loss.
susuka yung apo movement. teaching the patient  Guardian showed
ko” and patients proper knowledge
Monitor fluid status in Most fluid comes into the
guardian will show: regarding proper
relation to dietary body through drinking,
 Decrease the water in food, and water hygiene and
intake.
Objective: risk of formed by oxidation of infant nutrition
 Fever – complication foods. Verifying if the
Temp of 39.6 of fluid patient is on a fluid restraint
 Dry skin volume is necessary.
 Vomiting deficit
 Loss of  Guardian
appetite will have
 Irritable proper
Provide comfortable
Drop situations where
environment by
 Watery knowledge patient can experience
covering patient with
stool regarding overheating to prevent
light sheets.
(Yellow and further fluid loss.
proper
loose) hygiene and
infant
Increasing the patient’s
nourishment Emphasize the guardian’s
relevance of knowledge level will assist
maintaining proper in preventing and managing
nutrition and the problem.
hydration.
Teach family members An accurate measure of
how to monitor output. fluid intake and output is an
Instruct them to important indicator of
monitor both intake patient’s fluid status.
and output.
 Republic of the Philippines
Tarlac State University
College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 2 Status by the Accrediting Agency of Chartered College and Universities
in the Philippines (AACCUP). Inc.

A Clinical Case Analysis Presented to the

Faculty of the Department of Nursing, Tarlac State University
Villa Lucinda Campus, Brgy. Ungot, Tarlac City Philippines
In Partial Fulfillment of the Requirements of the Subject

NURSING CARE MANAGEMENT 107

CLINICAL CASE ANALYSIS: Acute Gastroenteritis with

Moderate signs of Dehydration

Submitted by:
Abaro, Lynete B.
Bergonio, Angel Marie
Castro, Patricia Kaye T.
Ebilane, Ryan Loyd
De Lazo, Patricia Lae R.
Garcia, Reena Loren R.
Limon, Panjee Zandra Mae Ng
Marcelo, Ronn Miguel M.
Mesina, Trina B.
Reyes, Hazel Joyce Q.
Santos, Jhon Radley S.
Suyat, Joana Marie F.

Submitted to:
Anne Myrtle M. Lorenzo RN, MAN
Clinical Instructor