DIPLOMA IN NURSING

(YPIB MAJALENGKA)

Gastroenteritis Acute
(GEA)
Presented By : Dian Hadinata
3/31/2020 1
LEARNING OUTCOME
At the end of the session, the students
should be able to:

 Defined an acute Gastroenteritis

 Explain the Etiology of acute Gastroenteritis
 Explain the Pathophysiology of Acute
Gastroenteritis
 Identify the sign and symptom of Acute
Gastroenteritis
 Explain the treatment and Nursing diagnosis
of Acute Gastroenteritis
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Acute Gastroenteritis (AGE)
 Acute gastroenteritis is defined as
"diarrheal disease of rapid onset, with or
without accompanying symptoms or signs
such as nausea, vomiting, fever or abdominal
pain.

 The hallmark of the disease is increased

stool frequency with alteration of stool
consistency.
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 Cont’d….
 Common and costly clinical problem in
children.

 Requires a careful history and a complete

physical examination to uncover other illnesses
with similar presentations.

 Minimal laboratory testing

 Treatment is primarily supportive and is

directed at preventing or treating dehydration.
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 Cont’d….
 Age-appropriate diet and fluids should be
continued.

 Oral rehydration therapy using a commercial

pediatric oral rehydration solution

 The traditional approach using "clear liquids"

is inadequate.

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 Cont’d….
 Severe dehydration - intravenous
administration of fluids followed by oral
rehydration therapy.

 Antiemetic and antidiarrheal medications are

generally not indicated and may contribute
to complications.

 The use of antibiotics remains controversial.

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 Pathophysiology
 Gastroenteritis involves an inflammation of
the stomach and the intestines; colitis
involves an inflammation of the colon and
the small intestine.

 The most common noninfectious causes of

diarrhea involve food intolerance,
overfeeding, improper formula preparation,
or ingestion of high amounts of sorbitol (a
substance found in sweetened “sugar free”
products).
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Cont’d….
 The priority problem in diarrhea is fluid
and electrolyte imbalance and failure to
thrive.

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Etiology
 Infectious agents (viruses, bacteria and
parasites)

 Viruses, primarily rotavirus species, are

responsible for 70 to 80 percent of
infectious diarrhea cases

 attendance at day care centers and

impoverished living conditions with poor
sanitation.
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Signs and Symptoms
 Diarrhea
- mild or extremely severe

 The stools are watery and are expelled with

force.

 Yellowish green.

 The infant becomes listless, refuses to eat,

and looses weight.
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Cont’d….
 The temperature may be elevated, and the
infant may vomit.

 Dehydration - sunken eyes and fontanelle

and by dry skin, tongue, and mucus
membranes.

 Urination -less frequent.

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Cont’d….
 Escherichia coli - lack of hygiene or poorly
cooked foods

 Salmonella from contaminated food or pet

contact

 Shigella or other organisms.

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Cont’d….
 Clostridium difficile infection - prolonged
antibiotic therapy.

 Giardia lamblia is an intestinal protozoan ---

contaminated water, unsanitary conditions,
and fecal contamination by animals.

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Diagnostic Procedures
Clinical Assessment

 History to elicit information that might

point to other illnesses with similar
presentations.

 Respiratory symptoms such as cough,

dyspnea or tachypnea may indicate the
presence of an underlying pneumonia.

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Cont’d….
 A second goal of the history is to assess
the severity of the symptoms and the risk
of complications such as dehydration.

 The presence or absence of fever, the

amount and type of oral intake, and the
frequency and estimated volume of emesis
or stool are important factors to consider.

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Cont’d….

 Stool characteristics such as the presence

of blood should prompt consideration of
inflammatory bacterial disease and a much
more aggressive work-up and intervention.

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Cont’d….
 The physical examination has two main
functions:
a search for signs of comorbid conditions
and an estimate of the level of dehydration.

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Cont’d….
 The primary tasks are to assess the
adequacy of perfusion and to determine
whether dehydration is severe enough to
cause hemodynamic instability.

 Prolonged skinfold time correlated best

with the degree of dehydration

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Laboratory Assessment
Number of laboratory studies:
 High urinary specific gravity may indicate
significant dehydration

 Serum chemistry measurements such as

electrolyte, blood urea nitrogen and
creatinine levels do not change

 Hemodynamically stable children can be

safely treated with oral rehydration therapy
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Cont’d….
Laboratory studies :
severely dehydrated and receiving
intravenous rehydration therapy.

Serum electrolyte levels hypernatremia or

hypokalemia,

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Cnot’d….
Studies aimed at pinpointing causative agents

 Yet the presence of gross or occult blood in

the stool should raise suspicion of such
pathogens as Shigella species,
Campylobacter species and hemorrhagic
Escherichia coli strains.
 Large numbers of leukocytes on a fecal
smear may also indicate an inflammatory
bacterial process.
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Cont’d….
 Viral studies, such as rotavirus antigen
tests

 Giardia antigen studies and smears for ova

and parasites

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Treatment / Nursing Care
Preventing or treating the dehydration
 Oral rehydration therapy

 Intravenous therapy in rehydrating

 Age-appropriate diet should be resumed as

soon as rehydration is accomplished in
children with mild to moderate dehydration.

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Cont’d….
No Dehydration

 Safely continued on an age-appropriate diet.

 Full-strength milk and other dairy products.

 Adding an oral rehydration solution to the

regular feeding routine provides no extra
benefit,

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Cont’d….
Mild to Moderate Dehydration

 Oral rehydration preparations.

-contain glucose or glucose polymers as
their carbohydrate.

 "clear liquids"

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Cont’d….
 Drinks such as colas, ginger ale, apple juice
and even commercial sports drinks (e.g.,
Gatorade) are inappropriately high in
carbohydrates and osmolality.

 Tea should not be used because of its low

sodium content, and chicken broth is
contraindicated because of its high sodium
content.
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Cont’d….
 Children who are vomiting -- treated with
oral rehydration therapy.

 Oral solution is administered by the

caregiver in controlled amounts (one or
two teaspoons every one to two minutes,
with gradual increases in amount as
tolerated),

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Cont’d….
 As long as ileus has been ruled out, an oral
rehydration solution may be given through
a nasogastric feeding tube in a child who is
hemodynamically stable but unwilling or
unable to drink adequately because of
continued vomiting.

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Cont’d….

Severe Dehydration
 Intravenous therapy

 Medical emergency and require immediate

and aggressive intravenous therapy to
restore intravascular volume.

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Cont’d….
 Normal saline solution or Ringer's lactate
should be given in a rapid intravenous
bolus
of 20 mL per kg.

 Intraosseous line

 Nasogastric tube

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NURSING DIAGNOSIS

1. Deficient Fluid Volume related to diarrhea

(gastrointestinal [GI]) losses, inadequate
intake
2. Impaired Skin Integrity related to irritation
caused by frequent, loose stools
3. Risk for Infection related to
microorganisms invading GI tract

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NURSING INTERVENTIONS
1. Deficient Fluid Volume related to diarrhea
(gastrointestinal [GI]) losses, inadequate intake
(Subjective and Objective Data)
Dry mucous membranes
Loss of skin turgor
Sunken eyes, sunken fontanel
Rapid, thready pulse; rapid breathing; lethargy
Weakness

Expected Patient Outcomes

Child exhibits signs of adequate hydration.
The following NOC concepts apply to
these outcomes
•Nutritional Status: Food and Fluid Intake
•Weight Control
•Hydration

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NURSING INTERVENTIONS
1. Administer oral rehydration solutions (ORSs) for both
rehydration and replacement of stool losses
2. Give ORS frequently (every 5-10 minutes) in small
amounts (1-2 teaspoons), especially if child is vomiting
(vomiting, unless severe, is not a contraindication to using
ORS).
3. Administer and monitor intravenous (IV) fluids as
prescribed (for severe dehydration and vomiting).
4. Administer antimicrobial agents as prescribed to treat
specific pathogens causing excessive GI losses.
5. After rehydration, offer child regular diet as tolerated.
6. Alternate ORS with a low-sodium fluid such as water,
breast milk, lactose-free formula, or half-strength lactose-
containing formula for maintenance fluid therapy (see
Table 29-3).
7. Maintain strict record of fluid intake and output (urine,
stool, and emesis).
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NURSING INTERVENTIONS
8. Monitor urine specific gravity every 8 hours or as indicated to
assess hydration.
9. Weigh child daily.
10. Assess vital signs, including temperature, skin turgor, mucous
membranes, and mental status every 4 hours or as indicated.
11. Administer antipyretics for fever.
12. Discourage intake of (clear) fluids such as fruit juices,
carbonated soft drinks, and gelatin (these fluids usually are
high in carbohydrates, low in electrolytes, and have a high
osmolality); gelatin may be given once the child is rehydrated.
13. Instruct family in providing appropriate therapy, monitoring
intake and output, and assessing for signs of dehydration to
ensure optimum results and improve compliance with the
therapeutic regimen.

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NURSING INTERVENTIONS
2. Impaired Skin Integrity related to
irritation caused by frequent, loose stools
(Subjective and Objective Data)
•Excoriated skin
•Skin breakdown
•Pain

Expected Patient Outcomes

•Child will have no evidence of skin
breakdown.
The following NOC concepts apply to
these outcomes
•Tissue Integrity
•Wound Healing

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NURSING INTERVENTIONS
 Change diaper frequently.
 Cleanse buttocks gently with bland, nonalkaline
soap and water or immerse child in a bath for
gentle cleansing.
 Apply barrier ointment such as zinc oxide to
area.
 Expose slightly reddened intact skin to air
whenever possible.
 Avoid using commercial baby wipes containing
alcohol on excoriated skin.
 Observe buttocks and perineum for infection.
 Apply appropriate antifungal medication if
infection is present.
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NURSING INTERVENTIONS
3. Risk for Infection related to
microorganisms invading GI tract
(Subjective and Objective Data)
•Loose stools
•Fever
•Lethargy
•Decreased appetite
•Vomiting
•Stomach pain

Expected Patient Outcomes

•Child will not exhibit signs of GI infection.
•Infection will not spread systemically or to
others.
The following NOC concept applies to
these outcomes
•Infection Status
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NURSING INTERVENTIONS
 Implement enteric isolation or other hospital
infection control practices, including appropriate
disposal of stool and laundry and appropriate
handling of specimens.
 Maintain frequent and careful hand washing.
 Use superabsorbent disposable diapers.
 Obtain stool sample for cultures, ova, and parasites,
as prescribed.
 Attempt to keep infants and small children from
placing hands to mouth and eyes (and objects in
diaper area).
 Teach children, when possible, protective measures
such as hand washing after using toilet.
 Instruct family members and visitors in isolation
practices, especially hand washing.
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Conclusion
 Definition ??
 Etiology ??
 Pathophysiology ??
 Sign and symptom ??
 Treatment and Nursing diagnosis ??

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QUESTION AND ANSWER
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