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.
Norovirus
 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 Drug, Classification and Indication and Side effect or Nursing responsibility
dosage, route, Mechanism of Contraindication Adverse reaction
frequency, timing Action

Drug: Paracetamol Classification: Side effects: Check doctor’s order 

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

Prescribed Classification and Indication and Side effect or Nursing responsibility

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

VIII. Nursing Process

Defining Nursing Outcome Nursing Rationale Evaluation
Characteristic Diagnosis Identification Intervention
s

Subjective: Diarrhea After 12 hours Independent: Goals are met as

Watery stools related to the patient will evidenced by:
Crying a lot consumption of show Monitor Monitors vital
leftover food. improvement, patient’s vital signs to The patient shows
and as signs. recognize any stable vital signs.
evidence the problems or
Objective: vital signs will complications. The patient’s stool
Temperature: Rationale: be back to was mushy and less
39.9°C Acute normal, frequent defecation.
gastroenteritis behavior Evaluate Defecation
Pulse rate: is inflammation normalizes, pattern of pattern will
170-190 and/or irritation and the patient defecation. promote
of the digestive will show immediate
Respiratory tract that can alertness. treatment.
rate: cause nausea,
40-80 vomiting,
diarrhea, and/or Assess for These
abdominal pain abdominal assessment
that lasts less pain, findings are
than 14 days. abdominal commonly
When cramping, connected with
symptoms last hyperactive diarrhea. If
14 to 30 days, bowel sounds, gastroenteritis
the condition is frequency, involves the
considered urgency, and large intestine,
persistent loose stools. the colon is not
gastroenteritis. able to absorb
When water and the
symptoms last client’s stool is
longer than 30 very watery.
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 to the

Follow up 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