I.

Introduction

Gastroenteritis, also known as infectious diarrhea and gastro,

is inflammation of the gastrointestinal tract—the stomach and intestine. 
Symptoms may include diarrhea, vomiting and abdominal pain. Fever, lack of
energy and dehydration may also occur. This typically lasts less than two
weeks. It is not related to influenza, though it has erroneously been called the
"stomach flu". Gastroenteritis is usually caused by viruses. 
However, bacteria, parasites, and fungus can also cause gastroenteritis. In
children, rotavirus is the most common cause of severe disease. In
adults, norovirus and Campylobacter are common causes. Eating improperly
prepared food, drinking contaminated water or close contact with a person who
is infected can spread the disease. Treatment is generally the same with or
without a definitive diagnosis, so testing to confirm is usually not needed.
Prevention includes hand washing with soap, drinking clean
water, breastfeeding babies instead of using formula and proper disposal
of human waste. The rotavirus vaccine is recommended as a prevention for
children. Treatment involves getting enough fluids. For mild or moderate cases,
this can typically be achieved by drinking oral rehydration solution (a
combination of water, salts and sugar). In those who are breastfed, continued
breastfeeding is recommended. 
For more severe cases, intravenous fluids may be needed. Fluids may
also be given by a nasogastric tube. Zinc supplementation is recommended in
children. Antibiotics are generally not needed. However, antibiotics are
recommended for young children with a fever and bloody diarrhea. Acute
gastroenteritis is a very common disease. It causes significant mortality in
developing countries and significant economic burden to developed countries.
Viruses are responsible for approximately 70% of episodes of acute
gastroenteritis in children and rotavirus is one of the best studied of these
viruses. Oral rehydration therapy is as effective as intravenous therapy in
treating mild to moderate dehydration in acute gastroenteritis and is strongly
recommended as the first line therapy. However, the oral rehydration solution
is described as an underused simple solution. Vomiting is one of the main
reasons to explain the underuse of oral rehydration therapy. Antiemetic are not
routinely recommended in treating acute gastroenteritis, though they are still
commonly prescribed. Ondansetron is one of the best studied antiemetic and
its role in enhancing the compliance of oral rehydration therapy and decreasing
the rate of hospitalization has been proved recently. The guidelines regarding
the recommendation on antiemetic have been changed according to the
evidence of these recent studies.
II. Objective

I. General objectives
This case study aims to come up with in-depth understanding and
will be able to obtain knowledge, develop attitudes towards the care of
a patient with Gastroenteritis and to improve skills in providing a
holistic and comprehensive plan of nursing care and for all the
aspects that contribute to and affect the condition of patients with the
said situation.
II. Specific Objectives
a. Knowledge:
 To define Gastroenteritis
 To be able to know the pathophysiological basis of the
Gastroenteritis
 To determine the signs and symptoms on the current health
history and other manifestations of the patient.
 To discuss the normal functioning of gastrointestinal system
which is involved on the case of our patient.
 To know the laboratory and diagnostic tests the patient had
undergone
b. Skills:
 To make and decide on different nursing care plans.
 Demonstrate communication skills in educating clients with
Gastroenteritis and their significant others
 To better understand the medication given to the patient.
 To explain to the patient the cause or reason of having
Gastroenteritis, laboratory examination, and drug
administration.
 c. Attitude:
 To formulate a discharge plan and prognosis for the
continuous health care even at home and recommendation
for future further researches
 To organize patient’s data to establish good background
information.
 Identify therapeutic methods in caring for a client with
Gastroenteritis

III. Nursing Health History

A. Biographic Data
 Baby Elsa

 1 yr old

 Female
B. Chief Complaint
 passing out watery stools and fever
C. History of Present Illness
 While drinking her usual amount of liquid there was no history of
vomiting.
D. Past Medical History

 N/A
E. Family History of Illness

 N/A
F. Lifestyle

 She became quite unsettled crying a lot

G. Social History

 N/A
H. Psychological Data

 N/A

IV. Physical Examination

A. Vital Signs

 Temperature- 39.9°C

 Fetal Heart Beat-  170-190 beats/min

 Respiratory Rate- 40-80\

 Weight -  2910g
B. Overall Assessment

 Head eyes & Vision / Ear & Hearing/ Nose & Smelling / Mouth & Taste/
Neck
a. Head
 No stated  data
b. Eyes

 No stated data
c. Ears
 No stated data
d. Nose

 No stated data

e. Mouth
 No stated data.

1. Nervous System/ Neurologic function

 Mental status- No stated data
2. Respiratory System 

 Breathing - no stated data

3. Sounds during  breathing - no stated data
 Speech ability- no stated data

4. Chest and the Heart

  Blood Pressure- no stated data
 Breath Sounds- no stated data
 Heart Sound- no stated data

5. Digestive system

 Palpation- Abdomen was slightly distended and slightly painful

upon palpation

6. Genitourinary system

 Stool-  yellowish mucoid watery stools & a  Foul odor.

7. Reproductive System
 No stated data
8. Musculoskeletal system

 Skin Color- poor skin turgor, dry lips, dry buccal mucosa and
sunken eyeball.

9. Integumentary System
 No stated data
 V. Pathophysiology
Adequate fluid balance in humans depends on the secretion and
reabsorption of fluid and electrolytes in the intestinal tract; diarrhea occurs
when intestinal fluid output overwhelms the absorptive capacity of the
gastrointestinal tract.
The 2 primary mechanisms responsible for acute gastroenteritis are (1)
damage to the villous brush border of the intestine, causing malabsorption of
intestinal contents and leading to an osmotic diarrhea, and (2) the release of
toxins that bind to specific enterocyte receptors and cause the release of
chloride ions into the intestinal lumen, leading to secretory diarrhea.

Rotavirus
 Affects infants and young children who then spread infection to other
children and adults and spread orally.
Novavirus
 Affects any age and highly contagious spread through contaminated
surface, water, food, as well as the infected individuals.
Bacterial gastroenteritis
 Referred to as food poisoning, is the result of bacteria having caused an
infection in the stomach or intestines. Likely be acquired from
consuming food or water that has been contaminated with bacteria or
toxins they produce.
Parasitic gastroenteritis
 Can be transmitted by a foreign organism that has invaded the body. Be
acquired in food or water that has contaminated with feces from infected
animals or humans.

VI. Diagnostic and Laboratory

A complete blood count (CBC), which is used to check your overall health
A blood, breath, or saliva test, which is used to check for H. pylori
A fecal test, which is used to check for blood in your stool
An esophagogastroduodenoscopy, or endoscopy, which is used to look at the
lining of your stomach with a small camera
A gastric tissue biopsy, which involves removing a small piece of stomach
tissue for analysis
An X-ray, which is used to look for structural problems in your digestive
system
Stool tests: These are the most common diagnostic tests performed to identify
the pathogen that has caused gastroenteritis.
These include:
Stool culture: A sample of your stool would be cultured in a specific nutrient
media which allows the selective growth of the pathogen. Culture tests helps in
detecting most common intestinal infections such as- Salmonella,
Campylobacter and Shigella.
Antigen Tests: In this test, the stool sample is studied to detect the antigens
produced by virus such as rotavirus and parasites such as Giardia Lambia and
Entamoeba Histolytica. Rotavirus is the most common cause of gastroenteritis
in children.

VII. Drug Study

Prescribed Classification Indication and Side effect Nursing
Drug, and Contraindication or Adverse responsibility
dosage, Mechanism of reaction
route, Action
frequency,
timing
Drug: Classification: Side effects: Check
paracetamol  Nonsteroidal Special An allergic doctor’s
anti- Precautions: reaction, order 
Trade inflammatory which can
name:  drug Patient with cause a Observe the
cerebrovascular rash and 10 rights of
disease, suspected swelling. medication 
Dosage: 120 CAD, mitral
mg Mechanism of valvular disease. Flushing, Assess the
Slow acetylators.
action: low blood expected
Renal and hepatic
pressure actions, dose
 Paracetamol impairment. and a fast range, side
Route: oral has a central Pregnancy and heartbeat – effects of the
analgesic lactation. Avoid this can medication,
effect that is abrupt withdrawal. sometimes and any
mediated happen precautions
through when to be taken 
Frequency& activation of paracetamol
Timing: descending is given in Provide client
5 ml q4h  serotonergic hospital into education
pathways. a vein in about
Debate exists your arm. medication
about its
primary site of Adverse Advise the
action, which effect:  patient’s
may be low fever family to take
inhibition of with the
prostaglandin nausea, medication
(PG) synthesis stomach with meals
or through an pain, and for better
active loss of absorption &
metabolite appetite; to reduce GI
influencing discomfort.
cannabinoid Dark urine,
receptors. clay-colored Instruct the
stools; or. patient’s
family to take
Jaundice medication
(yellowing of as prescribed
the skin or even after
eyes). feeling better
and not to
double dose.

Prescribed Classification Indication and Side effect Nursing

Drug, and Contraindication or Adverse responsibili
dosage, Mechanism of reaction ty
route, Action
frequency,
timing
Drug:  Classification: Indication: Side Check
azithromyc effects: doctor’s
in Macrolide Use only to treat order 
 Antibiotics infections that are Nausea,
Trade Ophthalmologi proven or strongly vomiting,
name:  cal Anti-
suspected to be diarrhea, Observe
infective caused by strange the 10
susceptible bacteria taste in the rights of
in order to reduce mouth, or medication 
the development of stomach
Mechanism of drug-resistant pain may Assess the
Dosage: action: bacteria and occur. expected
50 mg maintain the Diaper actions,
Azithromycin effectiveness of rash may dose range,
Route: is a macrolide azithromycin occur in side effects
 intraveno antibiotic young of the
us  under the children. medication,
azalide group. Dizziness and any
It inhibits Contraindication: and precaution
RNA- drowsiness s to be
dependent Hypersensitivity to may occur taken 
Frequency protein macrolide less
& synthesis by antibiotics. History frequently, Provide
Timing: binding to the of hepatic especially client
10 mg qd 50s ribosomal dysfunction/cholest with higher education
ANST for 7 subunit, atic jaundice doses about
days preventing the following previous medication
translocation antibiotic use Adverse
of peptide effect: Advise the
chains. Headache, patient’s
dizziness, family to
paraesthesi take the
a, pruritus, medication
rash, with meals
diarrhea, for better
vomiting, absorption
abdominal & to reduce
pain, GI
nausea, discomfort.
flatulence,
dyspepsia,
dysgeusia. Instruct
the
patient’s
family to
take
medication
as
 prescribed
even after
feeling
better and
not to
double
dose.

Prescribed Classification Indication and Side effect or Nursing

Drug, and Contraindicatio Adverse responsibilit
dosage, Mechanism n reaction y
route, of Action
frequency,
timing
Drug:  Classification Indication: Side effects: Check
D5 IMB : Fluid & fever, doctor’s
 Hypertonic electrolyte infection at order 
Solution maintenance the site of
Generic therapy. injection, Observe the
name:  blood clot or 10 rights of
Balanced inflammation medication 
Multiple surrounding
Maintenanc Mechanism the site of Assess the
e Solution of action:  Special injection, expected
with 5% Precaution: leakage of actions, dose
dextrose D5 IMB is a Na fluid into the range, side
maintenance metabisulfite surrounding effects of the
of fluid and may cause tissues medication,
electrolyte allergic-type (extravasation) and any
especially for reactions , and. precautions
Dosage: 150 the patient including too much fluid to be taken 
mL who needs anaphylactic in the blood
calories and symptoms & (hypervolemia) Provide
Route: IV hydration. It life-threatening . client
contain high or less severe education
Frequency& concentratio asthmatic about
Timing: q8h n solute episodes in medication
relative to susceptible
another patients. Advise the
solution (e.g. patient’s
 the cell’s family to
cytoplasm) take the
When a cell medication
is placed in a with meals
hypertonic for better
solution. The absorption &
water to reduce GI
diffuses out discomfort.
of the cell,
causing the
dell to
shrivel.

VIII. Nursing Process

Defining Nursing Outcome Nursing Rationale Evaluati

Characterist Diagnosis Identificati Interventio on
ics on n
Subjective: Diarrhea After 12 Independe Goals
Watery related to hours the nt: Monitors are met
stools consumptio patient will Monitor vital signs as
Crying a lot n of leftover show patient’s to recognize evidence
food. improveme vital signs. any d by:
nt, and as problems or
evidence complicatio The
Objective: the vital ns. patient
Temperatur Rationale: signs will shows
e: Acute be back to Evaluate stable
39.9°C gastroenteri normal, pattern of Defecation vital
tis is behavior defecation. pattern will signs.
Pulse rate: inflammatio normalizes promote
170-190 n and/or , and the immediate The
irritation of patient will treatment. patient’s
Respiratory the digestive show stool
rate: tract that alertness. Assess for was
40-80 can cause abdominal These mushy
nausea, pain, assessment and less
vomiting, abdominal findings are frequent
diarrhea, cramping, commonly defecatio
and/or hyperactiv connected n.
abdominal e bowel with
pain that sounds, diarrhea. If
lasts less frequency, gastroenteri
than 14 urgency, tis involves
days. When and loose the large
symptoms stools. intestine,
last 14 to the colon is
30 days, the not able to
condition is absorb
considered water and
persistent the client’s
gastroenteri stool is very
tis. When watery.
symptoms
last longer
than 30
days, it is
considered
chronic.
 IX. Discharge Plan
Medications Advise the patient to continue prescribed home
medications to ensure optimum recovery.
Should be taken regularly as prescribed. On exact
dosage, time, frequency, making sure that the purpose of
medications is fully disclosed by the health care provider.

Exercise  Instruct the patient to balance activities

 Exercise should be promoted in a way by stretching
hand and feet every morning.
 Encourage patient to keep active to adhere to
exercise program and to remain as self- sufficient
as possible.
Treatment  Use of drugs as prescribed by the doctor
 Discuss the purpose of treatments to be done and
continue at home
 Instruct the patient to follow the advice of
physician or other health care provider

Health Teaching  Proper hygiene and hand washing, food and water
preparation, intake of adequate vitamins especially
vitamin C-rich foods to strengthen the immune
response and increasing of oral fluid intake should
be conveyed.

OPD  Instruct patient to have regular follow up check up

Follow up to the doctor.

Diet  Good nutrition and adequate fluids are necessary.

 Laxative containing food should be avoided.
 To include fruits especially banana in the diet is
significant