College of Health Sciences Education

3rd Floor, DPT Building

Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

UNIVERSITY OF MINDANAO

COLLEGE OF HEALTH SCIENCES EDUCATION

Bachelor of Science in Nursing

In Partial Fulfillment
Of the Requirements in NCM109 Care of Mother and Child at-Risk or
with Problems
(Acute and Chronic)
A Case Presentation on:

Case no. 3

Acute Gastroenteritis

Title of the case

Submitted to:
Mrs. Majella Gonzales

Submitted by:
Modelo, Nova Jane Miral
Mundiz, Jan Charisse
Pacheco, Melanie De Guia
Pendi, Sahria Sinangan
Pobadora, Elyza Jane Leones
Quibuyen, Leji Wensdy Ofecio
Quinonez, Dianne Baldo
Ramalan, Princess Jahedamae Bayao
Reyes, Lois Danielle Casas

July 2021

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 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

CONTENTS Pages

I. Description of the disease/illness 3

II. Definition of terms 5

III. Etiology 6

IV. Health History 7

V. Genogram 9

VI. Anatomy and Physiology of the affected body parts 10

VII. Pathophysiology of the Disease 21

VIII. Medical management 22

Laboratory/Diagnostic Test

Drug studies

XI. Nursing management 39

Nursing Care Plans

Health Teachings 48

XIV. Meal Plan 50

XV. Evidence-based Research Findings related to the disease/illness 53

XVI. References 54

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 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

TABLE OF CONTENTS

Description of the disease/illness

Acute Gastroenteritis

If you are experiencing diarrhea and vomiting, you can say that you are having the “stomach
flu” or you are having a condition called gastroenteritis. With this condition, your stomach and
intestines are irritated and inflamed that is caused by a viral or a bacterial infection.

Acute gastroenteritis is a disease state that occurs when food or water that is contaminated
with pathogenic microorganisms such as Clostridium perfringes, Vibrio cholera, E. coli, or their toxins
is consumed. This condition has symptoms such as nausea, vomiting, diarrhea, and abdominal pain.
The causes of gastroenteritis are food or water that is contaminated with bacteria or a virus,
unwashed hands after going to the bathroom or after changing a diaper, or having a

contact with someone who has the virus. There are two types of viruses that can cause
gastroenteritis. They are (1) rotavirus and (2) norovirus.

A. Rotavirus is the most common cause of severe diarrhea among infants and young
children. It is a virus that is a genus of a double-stranded RNA virus in the family
Reoviridae. At least every child in the world before turning five years old has been infected
with the virus. The treatment for this infection is giving extra fluids to the child to avoid
dehydration, and sometimes, severe dehydration of a child infected requires taking fluids
through IV in a hospital. Early symptoms of this virus are fever and vomiting and it usually
starts within two days of exposure to the virus. Additionally, water diarrhea can also be
experienced. This infection can cause abdominal pain as well. However, in adults who are
healthy, symptoms of this infection can be mild or no symptoms. Rotavirus are common in
children aged 3 to 35 months. In young children, severe diarrhea can lead to dehydration
and when left untreated, it can be a life-threatening condition regardless of the cause.

You will need to see a doctor if:

Children’s Symptoms Adult’s Symptoms

Diarrhea for more than 24 hours Can’t keep liquids down for 24 hours
Bloody stool or has pus Diarrhea for more than two days
High temperature (38.9C or 102F) Blood in vomit or in bowel movements
Tired, irritable, or in pain High temperature (39.4C or 103F)

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 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

Dry mouth, dehydration, crying without Dehydration, excessive thirst, dry mouth,
tears, little to no urination, unusual little to no urination, severe weakness,
sleepiness, unresponsiveness dizziness on standing, lightheadedness

Rotavirus vaccines are given to infants. The two vaccines are:

RotaTeq Rotarix
- Given orally in three doses - Given in two doses to infants
- For age 2, 4, and 6 months - Ages 2 months and 4 months

B. Norovirus on the other hand, is the most common cause of a serious gastroenteritis and
also foodborne disease outbreaks in the US. This virus can cause the sudden onset of
severe vomiting and diarrhea and is highly contagious. It can spread through food or water
that is being prepared, or through contaminated surfaces. After 12 to 48 hours of exposure
to the norovirus, symptoms such as diarrhea, vomiting and stomach pain occur that can
also last up until three days. Most people recover without treatment be that as it may, for
certain individuals, especially newborn children or adults who have underlying disease,
vomiting and diarrhea can be severely dehydrating that requires clinical consideration.
Symptoms of norovirus infection includes nausea, vomiting, stomach pain or cramps, loose
or watery diarrhea, feeling ill, low-grade fever and muscle pain. This virus is highly
contagious and can be found in the feces of infected humans and animals. Eating or
drinking contaminated food and water, touching your hand to your mouth after having in
contact with a contaminated surface or object can cause norovirus infection. You can also
be infected if you have a close or in contact with a person who is infected with this virus.

Definition of terms
Acute Gastroenteritis

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3rd Floor, DPT Building
Matina Campus, Davao City

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Phone No.: (082)300-5456/300-0647 Local 117

 Is one of the most common infectious diseases seen in children, is an inflammation of the
stomach and intestines that accompanies numerous gastrointestinal (GI) disorders. It is
one of the main causes of dehydration and can cause life-threatening complications.

Inflammation- refers to your body's process of fighting against things that harm it, such as infections,
injuries, and toxins, in an attempt to heal itself.
Dehydration- occurs when you use or lose more fluid than you take in, and your body doesn't have
enough water and other fluids to carry out its normal functions.
Bacterial- infections are caused by the transmission of bacteria. You can be exposed to bacteria
from other people, through the environment, or from eating contaminated food or drinking
contaminated water.
Viral- is a proliferation of a harmful virus inside your body. Viruses cannot reproduce without the
assistance of a host.
Parasitic Pathogens-Parasitic diseases are caused by numerous and diverse infectious organisms,
ranging from protozoa to helminths. Many of these pathogens have complex life cycles and require
transmission by vectors, or may involve intermediate hosts.
Nausea- is stomach discomfort and the sensation of wanting to vomit. Nausea can be a precursor to
vomiting the contents of the stomach.
Vomiting- is a forceful discharge of stomach contents. It can be a one-time event linked to something
that doesn't settle right in the stomach.

 It is caused by a variety of bacterial, viral, and parasitic pathogens. Stomach flu is not a flu
at all. It is usually a viral illness called gastroenteritis. Stomach flu is most often caused by
a virus, but bacteria and parasites may also cause it. Stomach flu symptoms cause nausea,
diarrhea, and sometimes vomiting.
Viruses- A microorganism that is smaller than a bacterium that cannot grow or reproduce apart from
a living cell.
Diarrhea- is frequent, loose, and watery bowel movements. Bowel movements, also called stools, are
body wastes passed through the rectum and anus. Stools contain what is left after your digestive
system absorbs nutrients and fluids from what you eat and drink.

 Inflammation of the stomach and the intestines. Gastroenteritis can cause nausea,

vomiting, and diarrhea. Gastroenteritis has numerous causes, including infections (viruses,
bacteria, and parasites), food poisoning, and stress.
 Acute gastroenteritis is a disease state that occurs when food or water that is contaminated
with pathogenic microorganisms (such as Clostridium perfringens, Vibrio cholera, E. coli,)
or their toxins is consumed. Some of its symptoms are nausea, vomiting, diarrhea, and
abdominal pain.

Clostridium perfringens- are one of the most common causes of foodborne illness (food poisoning).
Vibrio cholera- is a species of Gram-negative, facultative anaerobe and comma-shaped bacteria.
The bacteria naturally live in brackish or saltwater where they attach themselves easily to the chitin-
containing shells of crabs, shrimps, and other shellfish.

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 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

Escherichia coli- is a type of bacteria that normally lives in your intestines. It's also found in the gut
of some animals. Most types of E. coli are harmless and even help keep your digestive tract healthy.
But some strains can cause diarrhea if you eat contaminated food or drink fouled water.

Etiology

Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in
developing communities. The people most at risk of gastroenteritis are infants and young children,
who have an immature immune system, the elderly, who have less efficient immune systems, and
especially those living in nursing homes, children in day care, school children and students living in
dormitories, anyone with a weakened immune system, such as people with HIV/AIDS or receiving
chemotherapy and travelers. The most common cause of gastroenteritis is a viral or bacterial
infection, and less commonly parasitic infection. The viral gastroenteritis causes are norovirus and
rotavirus and Escherichia coli (E. coli), Salmonella and Campylobacter are causes of bacterial
gastroenteritis. Parasitic gastroenteritis is usually caused by Giardia. Rotavirus is the most common
cause of acute gastroenteritis worldwide and vaccination will have a major impact on disease rates,
morbidity, and mortality. Severely dehydrated or shocked children usually need intravenous fluids and
hospital admission. Viral gastroenteritis is the most frequent cause of gastroenteritis outbreaks, which
occur when groups of people are affected at the same time and place. Norovirus outbreaks can affect
both children and adults, while rotavirus mainly affects infants and children. Gastroenteritis is
acquired by person to person spread or ingestion of contaminated food and drink. Undercooked, or
inappropriately stored cooked or processed meats and seafood are common sources of bacterial
pathogens. Ingestion of food containing toxins produced by bacterial contaminants causes’ rapid
onset of vomiting or diarrhea. Water may be contaminated with bacteria, viruses, or protozoa which
causes amoebic dysentery. General practitioners have an important role in prevention, through
encouraging breastfeeding, recommending and advocating free access to rotavirus vaccination, and
educating career about personal and food hygiene.

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 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

Patients Profile

Patient’s Name/Initials : Jayson Cenas

Age : 3 years & 11 months old

Gender : Boy
Height : 106 cms

Weight : 16 kg
Date of Admission : 17th January 2021

Date of Discharged : 20th January 2021

Informant : Mother

Address : Gumalang, Calinan, Davao City

Present Health History

Jayson Cenas was well until 2 days prior to admission when he started to develop
diarrhea. It started at 1:30am and it was sudden in onset and occurred about 7-9 times per
day. The diarrhea was watery in nature, yellowish to brown in color, non-blood stained. His
mother had to wear him diapers to reduce his frequency to go to the toilets. Since then, he had
loss of appetite and only ate little amount of foods and drinks. There was no recent history of
taking outside food or travelling.On Saturday morning which was 2 days after diarrhea
occurred, his mother brought him to the clinic and the doctor prescribed him Oral Rehydration
Solution (ORS). However, the problem was not resolved. His fever and vomiting started a few
hours after he was brought to the clinic. His mother measured the temperature at home and it
was 39.2 ֯ C. His mother said that there was no rash or joint pain and no episode of fit since he
had the fever. No cough or runny nose noted.

The vomiting started on the same time with fever. It occurred once and non-projectile.
His mother described the amount of vomitus was about half of cup, contained fluid but no
blood or bilious with slight offensive smell. There was no history of changing formula milk. His
mother said that Jayson Cenas appeared lethargic and less active than usual during that
period. She brought him back to the same clinic at the evening on the same day. The doctor
ordered Paracetamol 125mg 1 suppository rectally and Domperidone syrup 4 ml. TID. He was
then referred to The Gonzales Hospital and his parents brought him to the Emergency Room
at 8.30pm and was admitted to Pedia ward 210 bed A at 11:45pm. D5 0.45 NaCl 1 liter started
at 65 cc per hour.

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 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City

Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

PAST MEDICAL/SURGICAL HISTORY:

He was once admitted to Hospital Selayang at the age of 2 years old due to shortness of
breath. He was suspected to have asthma but after the first attack, he did not have SOB
anymore.

DRUG HISTORY & ALLERGY He was on Vitamin C syrup 1 ml. OD given PO by his parents. No
known allergy to any drug, food or medication.

BIRTH HISTORY ANTENATAL

His mother developed GDM and was managed with insulin therapy during her pregnancy.
Natal : He was born full term at The Gonzales Hospital, via Cesarean Section due to DM, birth
weight was about 2.6 kg and cried right after birth. Postnatal – his mother was informed that
Jayson Cenas developed respiratory problems and was admitted for 6 days in NICU. He
developed mild jaundice after 4 days of life for 1 week.

FEEDING HISTORY:

He was exclusively breastfeed until 4 months and started to mix with infant formula. Start
weaning at the age of 6 months and was breastfeed up to 2 years of age. Now, he was on
family diet.

IMMUNIZATION HISTORY:

He received last immunization at 1 year and 6 months old. No postponed vaccination or

complication after vaccination. Immunization is complete up to his age

FAMILY HISTORY:

He is the youngest out of three siblings. The first and second siblings aged 18 and 8 years old
respectively. Both are females and well. His parents were well and there was no history of chronic
illness such as asthma, HPN, DM or any malignancy run in his family.

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Genogram

Mr.

Mrs.

48
38
A/W
A/W

Deceased

male Female

8
18
9
Children GDM
Interpretation

The diagram shows the medical history and relationship history of Jayson Cenas family. Starting
from the first generation shows the grandparents. The first and second siblings aged 18 and 8 years
respectively. Both are females and well. His parents were well and there was no history of chronic
illness such as asthma, HPN, DM or any malignancy run in his family but his mother developed GDM
and was managed with insulin therapy during her pregnancy. And also his mother claimed that the
children in same kindergarten with Jayson Cenas did not have any symptoms like him. No history of
contact in this patient.

Anatomy and Physiology of the affected body parts

GASTROINTESTINAL TRACT

The gastrointestinal system and its associated organs are required for life to exist. Digestion is
the process through which nutrients are delivered to each and every cell in our body. If any of these
mechanisms are disrupted, the entire body suffers.
The gastrointestinal tract is a tube that runs from the mouth to the stomach. Throughout, the structure
is essentially the same. The tube has a lumen, a muscle layer in the middle, and an epithelial cell

10
layer on the outside. The mucosal integrity of the GI tract is maintained by these layers. The
gastrointestinal tract serves three primary purposes.
•   Transportation   
 •   Digestion     
•   Absorption of food

Organ Location
The location of the organs can be divided into four quadrants:  the right upper quadrant, the left
upper quadrant, the left lower quadrant, and the right lower quadrant.

The right upper quadrant contains:  

 Liver and gallbladder
 Duodenum
 The head of the pancreas
 The right adrenal gland
 A portion of the right kidney
 The hepatic flexure of the colon
 Portions of the ascending and transverse
colon

The left upper quadrant contains:  

 Left lobe of the liver
 Spleen
 Somach
 Body of the pancreas
 Left adrenal gland, a portion of the left
kidney
 Splenic flexure of the colon
 Portions of the transverse and descending
colon

The left lower quadrant contains:  

 Lower pole of the left kidney
 Sigmoid colon
 A portion of the descending colon

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 Left ureter
 Left ovary and fallopian tube or left spermatic cord

The right lower quadrant contains:  

 Lower pole of the right kidney
 Cecum and appendix
 A portion of the ascending colon
 Right ureter
 Right ovary and fallopian tube, or right spermatic cord (Jarvis, 2011).

Mouth

The mouth's mucosal layer is made up of stratified squamous epithelial cells. These cells
slough off and are easily replenished during normal food chewing. Food is broken down into smaller
pieces by the mouth.
The main structures of the mouth include:

 Tongue ‐ a muscle with taste buds covering it. It also aids in the chewing process and helps to
move food into a position where it may be swallowed easily.
 Salivary glands ‐ Saliva is produced by these glands, which moistens food and aids
swallowing. The salivary glands also start the chemical digestion process by secreting salivary
amylase, an enzyme that starts the process of breaking down carbs. Lingual lipase is the
enzyme in saliva that starts the digestion of lipids. Starch and maltose are broken down by
ptyalin and salivary amylase. Saliva also contains mucus, which aids swallowing, and
Immunoglobulin A (IgA), which contains antibodies that fight bacteria and viruses.
 Teeth ‐ Food is mechanically broken down into tiny pieces by teeth, making swallowing and
ingesting easier.
 Pharynx ‐ allows the passage of both food and air.

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Esophagus

The "food tube" that permits food bolus to move from the mouth to the stomach is the esophagus. It
has no effect on the digestive system. The esophagus alone generates mucus, which has the
following properties:
• Aids in the transit of food
• Protect and lubricate the esophagus.
The gastroesophageal or cardiac sphincter is located at the lower end of the esophagus. This
sphincter prevents stomach contents from refluxing into the esophagus.
The patency of this sphincter is influenced by increased gastrin production and certain medicines that
promote parasympathetic activity.
The left gastric artery supplies blood to the esophagus.

Stomach

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 The cardiac area and the fundus, which lead into the stomach's body, are the top parts of the
stomach. The antrum is the bottom portion of the stomach that connects to the pylorus, the stomach's
most distal part. The pyloric sphincter is located at the base of the pylorus and allows chyme to enter
into the small intestine. The stomach's job is to store, churn, and purée food into called chyme:
• Salivary enzymes start the digestion of fats and carbohydrates in the mouth, and it continues in the
stomach.
• The stomach is where protein digestion begins.
• Water, alcohol, and glucose are partially digested in the stomach.
Furthermore, gastric acid is created in the stomach, which eliminates the majority of germs consumed
with food.

Gastric Juices

The cells of the stomach secrete gastric fluids, which aid in chemical digestion. The food
becomes chyme, which is a semi-liquid form of the food.
The work of salivary enzymes starts the digestion of fats and carbs in the mouth, and it continues in
the stomach.
The stomach is where protein digestion begins.
Water, alcohol, and glucose are all digested in the stomach.
In addition, the stomach produces hydrochloric (or gastric) acid, which kills most
microorganisms consumed with food. For the breakdown process, food normally stays in the stomach
for three to four hours. (Krumhardt & Alcamo, 2010).

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Small Intestine

The small intestine reaches out from the pylorus to the ileocecal valve. This made out of the
duodenum, jejunum, and ileum. The essential function of the small intestine is the ingestion of
nutrients and supplements, including electrolytes, iron, sugars, proteins, and fats. Most absorption of
nutrients occurs here. The small intestine additionally retains around 8,000 milliliters (mL) of water
each day (Barron, 2010). Three thousand milliliters of digestive enzymes are emitted in the small
digestive tract daily.   These enzymes include:  
Lipase – divides fats into monoglycerides, glycerol, and fatty acids
Amylase – changes starch to maltose
Maltase – converts maltose to glucose
Lactase – converts lactose into galactose and glucose
Sucrase – changes sucrose into fructose and glucose
Dextrinase – changes over explicit dextrins into glucose

Large Intestine 
 
The large intestine stretches out from the terminal ileum at the ileocecal valve to the rectum at
the terminal ileum, the large intestine becomes the ascending colon, the transverse colon, and then
the descending colon. Following the descending colon is the sigmoid colon and the rectum (Scanlon,
2011). The primary function of the large intestine is water absorption. commonly, the large intestine
retains around about one and one‐ half liters of water each day. It can, in any case, ingest up to six
liters.   The large intestine additionally retains potassium, sodium, and chloride. It produces mucous
which lubricates the intestinal   wall and holds the produced feces together for elimination. The

15
superior and inferior mesenteric arteries and the hypogastric arteries supply the blood supply to the
large intestine. Innervation of the intestine is equivalent to for the stomach (Scanlon, 2011)

Gallbladder

The gallbladder is a pear‐shaped, sac‐like organ joined to the liver that fills in as a storeroom
for bile.It can hold and think around 50 mL of bile. The cystic channel associates the gallbladder to
the regular bile conduit, which ends at the Sphincter of Oddi in the duodenum of the small intestine.
At the point when a huge or fatty meal is devoured, nerve and compound signs (arrival of the enzyme
CCK) cause the gallbladder to contract. This contraction releases bile into the digestive system.  The
gallbladder gets blood from the cystic and hepatic corridor and is innervated by the splanchnic nerve
and the right part of the vagus nerve (Scanlon, 2011)

Bile & Bile Pigments

Bile has three major components:     

•   Water     
•   Bile salts     

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•   Bile pigments Bile salts absorb and emulsify fats and fat‐soluble vitamins (A, D, E, & K).   Bile
pigments are composed primarily of bilirubin, cholesterol, and phospholipids.   Bilirubin is the by‐
product of hemolysis (Scanlon, 2011).

There are Two Types of Bilirubin

Indirect‐Bilirubin ‐ Unconjugated or indirect‐bilirubin: This is bilirubin that is in a lipid‐soluble
structure, and courses in free relationship with the plasma proteins. At the point when red
platelets, or erythrocytes, are separated, the heme is changed over to unconjugated bilirubin
by the cells in the pancreas. It would then be able to tie to egg whites to go to the liver.
Direct‐Bilirubin ‐ Conjugated or direct bilirubin: This is bilirubin that has been taken up by the
liver cells and conjugated to form the water‐soluble bilirubin diglucuronide. Most conjugated
bilirubin ends up in bile. Total bilirubin is the indirect plus the direct bilirubin. When total
bilirubin is elevated and the cause is unknown, direct and indirect bilirubin ought to be
estimated (Krumhardt and Alcamo, 2010).

Liver

The liver is a large organ that is located in the upper right side of the abdomen. The liver has three
lobes: right, left, and caudate. Each of these lobes is subdivided further into eight sections. If infected
or damaged, these parts can be removed via surgery. The lobule, also known as the acinus, is the
functional unit of the liver. Both the portal vein and the hepatic artery give blood to the liver. Almost a
quarter of our circulatory output passes through the liver every second, with the portal vein carrying
the majority of it. The blood passes via the liver's Kupffer cells, which filter out waste and
unwanted pathogens. 2011 (Scanlon).

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Functions of the Liver
Although the liver has hundreds of activities, the most important ones can be divided into five
groups:
1. Conjugation of bilirubin    
 •  Bilirubin is typically produced when red blood cells are destroyed. In the liver, bilirubin is
conjugated or converted to a watersoluble form. This kind of bilirubin can be excreted through the
kidneys.  
•   The accumulation of bilirubin in the body causes jaundice in patients with liver disease.
2. Synthesis and deactivation of clotting factors     
•   All vitamin K-dependent clotting factors, such as II, VI, VII, IX, and X, are produced.       
•   Removes active clotting factors from the body and generates heparin, which prevents
excessive clot formation.     
•   Patients with nutritional issues may develop thrombocytopenia due to faulty coagulation
processes.
3. Detoxification of hormones, ammonia, and drugs     
• Converts a wide range of fat-soluble medicines and chemicals into a water-soluble form that
can be eliminated in the urine.
• Patients with liver disease may experience difficulties excreting some medications, ammonia,
and hormones.
4. Phagocytosis     
• Kupffer Cells, which make up 70% of the body's total macrophages, are found in the liver.     
•   Patients with liver disease have a weakened immune system.
5. Carbohydrate, protein, and fat metabolism     
• . Carbohydrate production, metabolism, and transport maintain appropriate serum glucose
levels.   
•   Even if nutrients are artificially supplied by partial parental nutrition (PPN) or total parental
nutrition (TPN), the liver permits the body to use them properly (TPN). Giving TPN or PPN to a patient
with liver failure may not be enough to make up for their nutritional deficiencies.

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Pancreas

The pancreas is a gland that is both endocrine and exocrine. The production of: is one of the
endocrine functions.  
•   Insulin     
•   Glucagon     
•   Somatostatin
The pancreas' exocrine function is mostly digestive, involving the release of pancreatic
enzymes and bicarbonate.
The pancreas secretes the following digestive enzymes:
•   Trypsin     
•   Lipase    
•   Amylase   
Enzymes aid in the digestion of carbohydrates, proteins, and lipids. They are generally
secreted in their inactive state into the duodenum. They are converted to their active form in
the duodenum and the digestion process begins.
To neutralize these and other enzymes in the duodenum, bicarbonate is required. The
exocrine pancreas secretes bicarbonate to avoid duodenal ulcers and inflammation (Scanlon,
2011).
The hepatic and cystic arteries feed blood to the pancreas. The splanchnic nerve and the right
branch of the vagus nerve both innervate the pancreas. Pancreatic enzymes are secreted as a
result of vagal (parasympathetic) activation. The Duct of Wirsung, the principal pancreatic
exocrine duct, transports these secretions. At the Sphincter of Oddi, this duct joins the
common bile duct (Scanlon, 2011).

Biliary Ducts

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 While not organs themselves, the ducts of the biliary tract are very important in the
proper functioning of the gastrointestinal system and body as a whole.  
In the liver, bile is collected in the bile calculi, which eventually become the left and right
hepatic ducts, which exit the liver as the common hepatic duct.   The cystic duct allows stored
bile to be released from the gallbladder.
The cystic duct and the common hepatic duct meet to form the common bile duct, which
eventually terminates in the duodenum, next to the Duct of Wirsung (from the pancreas) at the
Sphincter of Oddi (Krumhardt & Alcamo, 2010).  
Obstruction or damage to any of these ducts may result in the improper drainage of bile and
pancreatic enzymes.   Complications can include hepatitis, liver failure, pancreatitis,
cholangitis, cholecystitis, and others (Scanlon, 2011).

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Pathophysiology of Acute Gastroenteritis

21
 Ingestion of contaminated food and water that
contains:

Parasites:
Entamoeba histolytica,
Viruses: Giardia lamblia, Bacteria:
Rotavirus, Norovirus, Cryptosporidium Campylobacter jejuni, Salmonella,
Adenovirus, Astroviruses, Shigella, E. coli, Clostridium
Enteroviruses, Astrovirus difficile

Direct invasion of the bowel

wall

Toxins are released

Attempted defecation
(Tenesmus)

Stimulation and destruction of mucusal  pain

lining of the bowel wall  Cramping
 straining
Digestive and absorptive
malfunction

Excessive gas formation Increase peristaltic movement Secretion of fluid and electrolytes in
 Burping the intestinal lumen.
 Passing gas  Chloride
 Pain Mild diarrhea ( 2-3 stools)  Bicarbonate ion
 Sodium
 cramps  Potassium
 bloating
Fluids and electrolytes imbalance

Increased protein in the lumen

Severity of dehydration:
 Mild
Large intestine is overwhelmed and unable to
Symptoms: thirst, dry mucus
reabsorb the lost fluid
membrane, mild tachycardia,
decrease urine output.
 Moderate
Intense diarrhea (>10x)(watery stool) Dry mucus membrane, sunken
eyes, dyspnea, tachycardia,
lethargy, reduced skin turgor
Dehydration  Severe
Symptoms: all of the above-
mentioned symptoms, mottled,
Shock cool limbs, altered
consciousness, signs of shock.
Death

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Medical management

a. Diagnostic Test/Laboratory Result

Name of laboratory test: Complete blood count

Content Results Normal Range Value Clinical Significance

WBC 4.5k/uL 3.3-8.7k/uL  A white blood cell is a test that measures the number of
wbc in your body.

 Having a higher or lower numbers of wbc than normal can

be a sign of an underlying condition.

Hemoglobin 12.5g/dl 12-17g/dl  A decrease or increase in hemoglobin concentration must

be reported as it is a sign of disease requiring
investigations.

 A decrease in hemoglobin concentration is a sign of anemia

while an increase can occur due to reduced oxygen supply.

Platelet count 310uL 140-400uL  If the platelets count is higher or lower than normal it can
be a sign of underlying medical condition.

23
Hematocrit 41% 36-52%  Hematocrit test measures how much of your blood is made
up of red blood cells.

 Hematocrit levels that are too high or low can indicate a

blood disorders, dehydration or other medical condition.

Name of laboratory test: Urine Analysis

Content Results Normal Range Value Clinical Significance

Appearance Slightly yellowish Yellow (light/pale to  Dilute urine, for example, is practically colorless due to its low
dark/ deep amber) specific gravity, whereas concentrated urine has a high
specific gravity and is dark yellow to amber in coloration.

 The color of urine can be affected by a variety of things,

including food, medicines, and medical problems.

Ph 6.2 4.5-8.0  The acid-base status of a patient can be determined by

measuring the pH of his or her urine.

 The cause of a urine pH less than 7.0, or acidic in nature,

could include problems such as diarrhea or starvation.

Specific Gravity 1.010 1.005-1.025  A higher specific gravity of 1.035 indicates concentrated urine.

 Fixed specific gravity refers to a circumstance in which the

specific gravity of a sample remains constant at 1.010. This is
24
 commonly a sign of serious kidney damage.

Protein 85mg/d 150mg/d  Protein usually not found in the urine of people who have normal
renal function.

 If random urine samples consistently test positive for protein,

further testing, including the collection of a 24-hour urine
sample, is recommended.

Glucose 72 mg/d 0 to 0.8 mmol/l (0 to 15  The normal amount of glucose in urine is 0-0.8mmol/L.
mg/dL)
 The child has 72 mg/d, which indicates that the patient’s sugar is
high.

RBC 2 2 RBCs/hpf  When red blood cells are seen in the urine, this usually means
that the renal glomeruli have been damaged, allowing red blood
cells to enter the urine.

WBC 4 4-5 WBCs/hpf  In most cases, a few white blood cells can be seen in the urine.
A urinary tract infection should be considered if there are more
than five white blood cells per high-power field, and further
screening should be done.

casts 3 hyaline casts/lpf 0-5 hyaline casts/lpf  Healthy people normally have 0-5 hyaline cast per low power
field.

25
Crystals occasionally occasionally  Normally, a few may be present.

Bacteria none none  To detect whether bacteria are present in the urine, tests for the
presence of leukocyte esterase and nitrites are performed.

Yeast none none  Normally, urine contains very little or no glucose. When blood
sugar levels are extremely high, as they are in uncontrolled
diabetes, the sugar leaks into the urine. When the kidneys are
damaged or diseased, glucose can be discovered in the urine.

b. Medication/ Drug Study

DRUG/ ACTION ADMINISTRA ADVERSE INDICATION / NURSING CONSIDERATION

DOSAGE/ TION REACTION CONTRAINDICATION
CLASSIFICATION

Azithromycin Azithromyci Tablets and CNS: dizziness, Mild to moderate susceptible -Alert. Use only to treat
n prevents oral vertigo, headache, infections including acute infections that are proven or
bacteria suspension: fatigue bacterial exacerbations of strongly suspected to be
from Take with or COPD, acute bacterial caused by susceptible bacteria
growing by without food CV: Palpitations, Sinusitis, acute otitis media, in order to reduce the
interfering chest pain community acquired development of drug resistant
26
 with their Oral pneumonia, bacteria and maintain the
protein suspension: GI: nausea, pharyngitis/tonsillitis, effectiveness of azithromycin.
synthesis. shake well vomiting, diarrhea, uncomplicated skin and skin
Binds to before use; abdominal pain, structure, urethritis, cervicitis, -Check for GI discomfort
ribosomal refer to dyspepsia, chancroid in men. nausea, vomiting.
receptor prescribing flatulence, melena,
sites of information for cholestatic Hypersensitivity to other -Monitor daily pattern of bowel
susceptible dosing jaundice, macrolide antibiotics. History activity and stool consistency.
organism, information. pseudomembrano of cholestatic
inhibiting us colitis jaundice/hepatic dysfunction -Monitor hepatic function test,
Therapeutic class: RNA associated with prior CBC. Assess for
Antibiotic dependent SKIN: rash, azithromycin therapy. hepatotoxicity: malaise, fever,
Pharmacologic class: protein photosensitivity abdominal pain, GI
Azalide macrolide synthesis. disturbance.
Dosage: 200/5ml, 3.5ml
Route: PO
Frequency: OD

DRUG/DOSAGE/ ACTION ADMINISTRA ADVERSE INDICATION/ NURSING CONSIDERATIONS

CLASSIFICATIO TION REACTIONS CONTRAINDICATI
N ONS
Domperidone It is CNS: dry mouth, Indication: Alert.
Domperidone Is a peripheral recommended headache, migraine, Indicated for Do not take it if it is near the time
dopamine receptor to take oral insomnia, dizziness, the relief of the for the next dose, instead, skip
blocker. It increases domperidone lethargy, irritability. symptoms of the missed dose and resume your
esophageal before meals. nausea and usual dosing schedule. Do not
27
 peristalsis, lower If taken after Gastrointestinal: vomiting. double up the dose to catch up.
esophageal sphincter meals, Abdominal cramps,
pressure, gastric absorption of diarrhea, changes in Gastroesophageal -Verify any medication order and
motility and the drug is appetite, nausea, reflux make sure it’s complete. The
peristalsis and somewhat constipation. disease(GERD) order should include the drug
enhances delayed. name, dosage, frequency and
gastroduodenal Endocrinological: route of administration.
coordination, thereby Hot flushes, mastalgia, Contraindication: -Check the patient medical
Therapeutic class: facilitating gastric galactorrhea. Patient with known record for an allergy or
Anti- sickness emptying and hypersensitivity to contraindication to the prescribed
decreasing small Mucocutaneous: rash, domperidone, in the medication.
Pharmacologic bowel transit time. urticarial, pruritus, presence of - Check that the patient is not
class: D2 receptor stomatitis, conjunctivitis gastrointestinal taking any other medication
antagonist, hemorrhage,
prolactin releaser Urinary: urinary obstruction or
frequency, dysuria perforation and in
Dosage: 4ml patients with a
q 6hrs. Cardiovascular: edema, prolactin-releasing
palpitation pituitary tumor

Musculoskeletal: leg
cramps,

28
.

29
DRUG/DOSAGE ACTION ADMINISTRATI ADVERSE INDICATION/ NURSING CONSIDERATIONS
/CLASSIFICATION ON REACTIONS CONTRAINDIC
ATIONS

Paracetamol Action: Administration: Adverse Indication: -Make sure the patient isn't using
Paracetamol acts as an PO Reactions: To reduce fever any other paracetamol-containing
analgesic by inhibiting - Every 4 CNS: dizziness, and treatment of medications.
the production of pain hours,PRN for headache mild to
impulses in the fever CV: hypertension, moderate pain, -Use a medicine syringe to drip
peripheral nervous - shake the bottle hypotension, including liquid slowly into the side of the
system. Antipyresis is for at least 10 tachycardia, chest headache and child's mouth or use soluble
caused by the inhibition seconds. pain other aches and paracetamol mixed with a drink for
of the hypothalamus GI: nausea, vomiting pain. children who may refuse medicine
Therapeutic class: heat-regulating center. Respiratory: from a spoon.
Analgesic and Its ineffective anti- dyspnea, abnormal Contraindicati
antipyretic inflammatory properties breath sound on: -Assess the therapeutic response.
Pharmacologic class: are due to suppression Skin: skin rash, Contraindicated
Non-opioid of prostaglandin pinpoint red spot on in -In the event of an overdose, seek
Dosage: production in the the skin hypersensitivity medical help right away, even if
250/5ml central nervous Metabolic: to paracetamol the patient appears to be fine,
4ml in every 4hrs system. Paracetamol hypokalemia, and patient with because there is a possibility of
(TEMPRA) is hyperglycemia severe hepatic delayed, serious liver damage.
particularly valuable for dysfunction.
use in patients who do -Children's paracetamol comes in
not tolerate aspirin well a variety of strengths. Parents
because it is less likely must ensure that their children
to cause receive the proper dosage.
gastrointestinal
distress. -You can take paracetamol on an
empty stomach.

30
DRUG/DOSAGE ACTION ADMINISTRATIO ADVERSE INDICATION/ NURSING
/CLASSIFICATION N REACTIONS CONTRAINDICA CONSIDERATIONS
TIONS

31
D5 0.45 NaCl Intravenous There may be redness There may be
When a patient is NPO, dextrose and or soreness at the redness or -Check the vital sign.
maintenance fluids are sodium chloride injection site. Contact soreness at the
used. Water, glucose, salt, solutions are your doctor or injection site. -Always check the IVF and
and potassium make up recommended for pharmacist right away Contact your its injection site.
the maintenance fluids. parenteral if any of these side doctor or
The glucose avoids replenishment of effects continue or pharmacist right -Keep an eye on the
ketoacidosis due to fasting hydration, worsen. away if any of electrolytes and make sure
and lowers the risk of minimum these side effects that it is not dehydrated.
hypoglycemia. carbohydrate continue or
Dehydration and calories, and worsen. -Fluid overload and
electrolyte imbalances are sodium chloride as pulmonary edema are
prevented by water, salt, needed by the possible side effects.
and potassium. patient's clinical
Generic Name: condition.
Sodium chloride .
injection

DRUG/DOSAGE ACTION ADMINISTRATIO ADVERSE INDICATION/ NURSING

/ N REACTIONS CONTRAINDICATIONS CONSIDERATIONS
CLASSIFICATION

32
 Oral rehydration Mild vomiting may Indication: -Assess vital signs, noting
Oral Rehydration Glucose is found in the solution (ORS) is occur when oral For the prevention and peripheral pulses.
salt solution that enables the a powdered therapy has begun, treatment of mild diarrhea.
intestine to absorb the mixture of but therapy should To prevent further -Assess the degree of
water and salts more glucose, be continued with dehydration. dehydration.
efficiently thus potassium frequent, small
preventing or treating chloride, and amounts of solution Contraindication: -Monitor the amount and
diarrhea sodium citrate administered slowly, Oral rehydration salts are consistency of stools that
that is taken Rarely symptoms of contraindicated in patients the child have each day.
orally. They are hypernatremia exhibiting the following
meant for use (dizziness, fast condition: cirrhosis of the -Strict monitor for the intake
after being heartbeat, high blood lower liver, congestive and output of the patient.
dissolved in the pressure, irritability, cardiac failure, nephrotic
required volume muscle twitching, syndrome, acute and -Ensure the infusion of IVF
of water. In 1,000 restlessness, renal failure, ischemic is correct.
Branded name: mL of water, seizures swelling of heart disease,
Hydrite dissolve the full feet or lower legs or adrenocortical -Provide oral care
contents of one weakness). insufficiency,
Dilution: Dissolve package of ORS, hypokalemia, edematous -Assess the therapeutic
powder contents of or roughly 20.5 g sodium retaining effect.
1 sachet or 2 of the conditions, hypertension,
tablets for combination. The peripheral or pulmonary -Notify the physician for
reconstitution in solution should edema, severe vomiting, unusual changes in the
every glass (200 be clear and diarrhea, dehydration patient.
mL) of cool odorless, or a requiring fluid therapy.
drinking water. slight yellow stain
Give as much fluid should be visible. -Do not take ORS sachet
as the child or 4.5 gm if you are allergic.
adult wants until ORS sachet should be
diarrhea or given to children only.
vomiting stops, or

33
as follows:

ADULTS &
CHILDREN above
10 yrs old: Take as
much fluid as
possible
CHILDREN 2-10
yrs old: Give 100-
200 mL solution.
Less than 2 yrs
old: Give 50-100
mL solution.

DRUG / ACTION ADMINISTRATI ADVERSE REACTIONS INDICATIONS/CONTRAIN NURSING

DOSAGE/ ON DICATIONS & CAUTIONS CONSIDERATIONS
CLASSIFIC
ATION

Generic Operates in the Administration: CNS: headache, fatigue, Indication: -Obtain a doctor's order.
name: body by Route: PO insomnia. These nutritional
supplying Place in a room Gl: stomach cramps, supplements are used for -Perform hand washing.
34
 ascorbic acid as temperature not nausea and vomiting. the prevention and
well as reversibly exceeding 25°C treatment of deficiencies of -Examine the patient's
oxidizing to Urinary system: when used vitamin C and zinc. condition.
dehydroascorbic in high doses hyperoxaluria
acid; treats and the formation of kidney Contraindications and -Give medication at the
vitamin C stones of calcium oxalate. cautious: appropriate time.
Ascorbic deficiency in Contraindicated in those
acid + Zinc people who do Local reactions: with persons who have shown -Notify the mother about the
not get enough intravaginal application - a hypersensitivity to any potential side effects of the
Brand vitamin C from burning or itching in the component of this medications.
name: their diets; and vagina, increased mucous preparation
Ceelin plus replaces zinc in discharge, redness, swelling -Advise the mother to be wary
the body. of the vulva. of the drugs' side effects.
Dosage:
100 mg/10 -Return the medication ticket to
mg per 5mL the appropriate box for the
Syrup Other: Heat sensation next appointment.
1-3 years:  
2.5 mL (1/2
teaspoonful)
4-8 years :5
mL (1
teaspoonful)
9-13 years:
5-10 mL (1
to 2
teaspoonsfu
l)
Or, as
directed by
a doctor.
35
Route: PO
Timing: OD
Classificati
on:
Vitamins

Date/Time Doctor’ order Rationale

01/17/21
 Cleared for admission  To plan and provide the care to the patient.
11:55PM
 Admit to pediatric ward  To be able to provide the patient with the specific care
needed.

36
  Secure consent  To have an ethical consideration as all patient has the
right to be consented in all procedure to be done.

 VS q4  To obtain baseline data and to evaluate the stability of

the patient's health status.

DIAGNOSTIC:
 Intake and Output of the patient is very important to
 I/O cc/cc and record monitor as it give information about the patient I
condition.

 Diet As Tolerated to maintain nutritional status of the

 DAT client.

 These intravenous solutions are used as sources of

 IVF: D5 O.45 NaCI 1 L @ electrolytes, calories and water for hydration.
65cc/hr

 To assess blood components and clotting factors A

typical drop or increase in average counts unveiled by a
 CBC, platelet count complete blood count may indicate an underlying
disease that necessitates further investigation.

 To trace and quantify various compounds that cross

through the patient's urine.
 Urinalysis
 To determine which pathogens may have caused the
disease condition.
 Fecalysis
37
 `MEDICATIONS
 Azithromycin 200/5mL 3.5 ml
PO OD
 Paracetamol 250/5ml 4ml. PO
q4 PRN foe fever
 Vitamin with zinc syrup 5 ml OD
 REFER ACCORDINGLY
01/18/21
 IVF rate decrease to 49cc/hr
5:45AM
 ORS sachet at volume per
volume replacement
Still for UE and SE
 IVF TF: D5 O.45 NaCI 1 liter as
SR
 Continue management
 An antibiotic that is being used to treat and prevent
certain types of bacterial infections.
 Antipyretic medication that aids in the treatment of fever.
 A nutritional supplement used to treat and prevent
vitamin C and zinc deficiency.
 In order for the patient to be properly assessed,
monitored, and evaluated.
 Fluid replacement.
 Used to replace water losses at the onset of
diarrhea to prevent dehydration.
 To provide proper fluid therapy.
 To continue the care for the patient and to ensure
38
 fast recovery.
4:30PM
 Domperidone syrup 4ml PRN q6  Indicated for the relief of the symptoms of nausea and
hrs vomiting

 Increase OFI  standard error side effect to replace lost fluids and
01/19/21 keep the patient hydrated.

8:00AM  Still for SE

 Continue present management  To continue the care for the patients and ensure
the recovery of the patient.

 Continue IVF rate @ 49cc/hr  For fluid replacement.

 DAT  Diet As Tolerated to maintain nutritional status of

the client.

 Continue the medication  Compliance with medication will avoid any

medication errors and complications.

 Give last dose of Arithromycin  Accurate compliance for medication order avoids
01/20/21 and D/C medication errors and complications.

8:00AM  IVF rate decrease to 25cc/hr.  For Fluid Replacement.

and C&T

39
  In order for the patient to be properly assessed,
 Refer accordingly monitored, and evaluated.

 MGH with BHM  Allow patients to continue their recovery by bringing

10:45AM medications home.

 Give health teachings  To ensure that the mother has received the
necessary information and that the recovery process
continues.

 Send bills to the accounting

office  To compute all of the expenses that need to be
paid, as well as to inform and make payments from
the patients.

40
Nursing Management NURSING CARE PLAN
Name: Jayson Cenas Age: 3 years & 11 months Gender: Male
Chief Complaint: Severe diarrhea associate with fever and vomiting Final Dx: Acute Gastroenteritis Time of Admission: January 17, 2021 at 11:45
pm
Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
Diarrhea related That within 8 hrs.  Obtain baseline vital  Fluid and electrolyte Goal Met
Objective: to infectious span of nursing signs and imbalances After 8 hours of span of
process. care, the patients can alter vital body nursing care my patient’s
-diarrhea for 2 days will not manifest in functions. bowel function returns to
with toileting for pending infection  monitor every 2–4  Aids in the diagnosis and Normal by not having fever
about 7-9 times per and the patient’s hours. in and the temperature will
day bowel function will monitoring the child’s return to normal (36°C).
be restored to status.  Patient will be taking
- His fever and normal to prevent antibiotic regularly
vomiting started a the diagnosis.  Wash hands well before  Helps prevent
few hours after he . and after transmission of
was brought to the contact with the child. microorganisms.
clinic.
- His mother
measured the
temperature at
home and it was
39.2 ֯ C  Isolate the child until the  Prevents exposure of other
cause of the diarrhea is patients
Medication: determined. and staff.
Azithromycin
200/5ml 3.5 ml PO  The child may be weak,
daily incontinent, physically

41
Paracetamol 125mg impaired, or
1 suppository anxious and require
rectally assistance to
use the bathroom.
Domperidone syrup  Provides necessary fluids
4 ml  Assist the child with and
toileting and nutrients.
Vital signs: hygiene.
T- 39.2°C  Ensures early intervention

 Administer prescribed
oral rehydration and
intravenous solutions.

42
 Assessment
Objective:
- diarrhea for 2 days with
toileting for about 7-9 times
per day
- His fever and vomiting
started a few hours after
he was brought to the
clinic.
- His mother measured the
temperature at home and it
was 39.2 ֯ C
Medication:
Azithromycin 200/5ml 3.5
ml PO daily
Paracetamol 125mg 1
suppository rectally
Domperidone syrup 4 ml
NURSING OBJECTIVES NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS
Deficient Fluid Within 4 hours span  Establish  It allows you to connect GOAL MET.
Dehydration r/t fluid of care, the client rapport with your patients and
loss due to fever, would exhibit can help you provide Within my 4 hours span of
vomiting and adequate hydration  Assess Vital better treatment. care my patient exhibits
diarrhea. and alertness and Sign q4h or adequate hydration and
responsiveness, more often.  Dehydration can quickly nutritional intake as
controlled diarrhea lead to shock in young evidenced by alertness and
and temperature children in whom a falling responsiveness, controlled
decrease at normal BP is a late sign of diarrhea and temperature
rate. shock. decrease at normal rate
(36.8) and no excessive
 Take  Rectal temperature vomiting during my shift.
Temperature measurements stimulate
in axilla. stooling if the child has
diarrhea, they cause
further irritation.
 Examine the  substantial weakening,
turgor of the and even death in small
patient children, chronically ill
across the people, and the elderly.
sternum for
symptoms of
dryness,
tongue.
increased  Liquids with a large
thirst, fever, number of simple sugars
or dizziness, can exacerbate osmotic
and provide effects associated with
43
 appropriate diarrhea and vomiting.
patient care.
 Although the child may
 Do not give be receiving
clear liquids maintenance fluid, he
such as apple may still be dehydrated
juice, soda, because of diarrhea,
gelatin or vomiting and/or
sports drink. insensible water losses.

 Assess  This is an indicator of

hydration adequate hydration.
status q4h.

 Maintaining good
 Ensure that hygiene reduces the risk
the child is of perianal excoriation
receiving at while also enhancing
least comfort.
maintenance
fluids.  These could aid in the
prevention of outbreaks
and the spread of
 Teach the infectious diseases
mother the transmitted through
importance of feces.
adequate
perianal
hygiene for
her child.

44
Name: Jayson Cenas Age: 3 years & 11 months Gender: Male
Chief Complaint: Severe diarrhea associate with fever and vomiting Final Dx: Acute Gastroenteritis
Cues & Evidences Nursing Diagnosis Objectives Nursing Intervention Rationale Evaluation

Hyperthermia -That within 3 hours -Establish rapport with the -Establishing rapport for a Goal Met
Subjective: related to span of nursing care, patient and guardian. better cooperation.
-Fever started a few dehydration. Jayson will be able to -After three hours of
hours after he was display: -It helps the nurse identify nursing intervention, my
brought to the clinic -Monitor temperature the changes in the patient’s patients temperature will
 Temperature temperature. return to normal as
Objective: within normal evidenced by:
-Temperature of range
39.2C  Promote -Monitor respiratory and -Hyperventilation may be a. Temperate within
-Lethargic and less normothermia pulse rates. present. Dysrhythmia may normal range
active  Adequate fluid be present due to effects of b. Other vital signs are
and nutritional hyperthermia in blood. within normal range
Medication: intake
-Paracetamol
250/5ml -Record fluid loss like urine, -Deficiency in fluids and
-4ml PO q 4hrs and vomiting. electrolytes may be present
PRN due to dehydration.

-Promote bed rest. -Reduces body heat

production.

-Provide cool circulating air -Dissipates heat by

45
 using a fan.
- Adjust and monitor
environmental factors like
room temperature and bed
linens as indicated.
- Determine the patient’s
age and weight.
- Monitor fluid intake and
urine output.
- Eliminate excess clothing
and covers.
Cues & Evidences Nursing Diagnosis Objectives Nursing Intervention
convection.
- Room temperature may be
accustomed to near normal
body temperature and
blankets and linens may be
adjusted as indicated to
regulate temperature of the
patient.
- Extremes of age or weight
increase the risk for the
inability to control body
temperature.
- Fluid resuscitation may be
required to correct
dehydration.
- Exposing skin to room air
decreases warmth and
increases evaporative
cooling.
Rationale Evaluation
46
 Risk for impaired Within 4 hours span  Establish rapport.  It allows you to GOAL MET.
skin integrity r/t of care my patient connect with the
Objective: irritation caused by should maintain a patient and can The client's skin remains in
-diarrhea for 2 days frequent stooling. good skin condition provide better good condition after 4
with toileting for as evidence by treatment. hours of care, as seen by
about 7-9 times per client skin in the client's perineal and
day perineal and  Assess perineal  The earlier the perianal areas remaining
perianal areas and perianal problem is detected, intact.
remain intact. areas for signs the sooner appropriate •Uses only 2 diapers.
for irritation or interventions can be
excoriation with made to ensure the
every diaper skin remains intact.
change.

 Change diapers  This helps keep skin

as soon as they clean and dry.
become wet and
soiled.

 Cleanse the  Diarrheal stools are

buttocks gently very irritating to the
(pat, do not rub) skin. Soap dries the
with water or skin thereby increasing
immerse in tepid the potential for
water to cleanse. irritation and skin
Avoid using soap breakdown.
if possible.

 Do not use  These products are

47
 commercial baby painful to irritated skin.
wipes with Baby powder cakes
alcohol or and is difficult to
perfume or baby remove.
powder on
irritated or
excoriated skin.

 If not  These measures

contraindicated, protect skin from
apply protective irritations.
ointments such
as Vaseline,
A&D, or zinc
oxide when the
child the child is
wearing diaper.

 Leave the diaper  This practice facilitates

area open to air if drying and healing.
possible (but not
in the presence
of explosive
diarrhea. Reapply
protective
ointment before
putting the diaper
on.
 This increases the
 Instruct family likelihood of the family
members in using these techniques
appropriate skin at home.
48
care methods.

49
 Health Teaching Rationale

1. Wash your hands before and after caring for your sick child.  To prevent you from catching germs and from spreading them too.

2. Perform proper hygiene every day.  Use soap and water, wash your hands before you prepare or eat food
to prevent or avoid pathogens.

3. Get your child back to a normal diet slowly.  Children with gastroenteritis should be returned to a normal diet as
rapidly as possible.

4. Make sure your child gets plenty of rest.  Rest as much as possible. The illness and dehydration may have
made your child weak and tired.

5. Help your child rehydrate. Give your child an oral rehydration

solution.  Give your child an oral rehydration solution to prevent dehydration &
maintain hydration status.
6. Contact your healthcare provider if your children continue to vomit
or have diarrhea, even after treatment.  To promote health and to prevent diseases and deliver health care.
7. Give your child plenty of liquids such as water.
 It is important to replace the water to prevent yourself from becoming
dehydrated.

 You are not allowed to give your child any juices or soft drinks because
8. Don't give your child soft drinks and fruit juices.
it can cause stomach upset and it can make worse.
9. Don’t give over-the-counter diarrhea medicines unless your child’s
healthcare provider tells you to.  Be cautious with medications about using them, it is important to check
with a physician especially for children.
10. Clean your surroundings. Use antibacterial cleaner or bleach when
cleaning your home.  To prevent the germs, bacteria and viruses to spread.

50
  Immunizations for gastroenteritis helps protect babies and children
11. Ask for immunizations for the diseases.
against diarrhea and vomiting.
12. See a doctor for medications for the disease.  Children younger than five aren’t given drugs for diarrhea.

13. When hungry, try eating soft foods like bananas, rice, applesauce  Soft foods like bananas, rice, applesauce and toast (BRAT) provides
and broth soups. firmer stools, soft foods are also gentle on the stomach and it reduces
nausea.
14. After 24 hours of recovery from vomiting, child can go back to a  Try eating easy to digest foods.
normal diet.
 Refrigeration slows the growth of bacteria.
15. Refrigerate leftover food immediately.
 If the parent think that the medication is not working, notify the
16. In discharge care, administer the medication to your child as physician.
directed by the physician.

17. Make a list of the medications given, the amount, time and day the
 This will serve as a baseline data for the physician when there is a
child drink it.
follow-up visit.
18. Make sure to check the medication.
 Some medications such as loperamide (antimotility agents) are
contraindicated in the treatment of acute gastroenteritis in children
because of the lack of benefit and the increased risk of side effects. It
can also cause life-threatening risks.
19. Parents should follow the follow-up visits the physician scheduled.
Always remember to follow the physician’s order.
 To ensure that the patient is already okay and for the parent to know if
there are still any needed medications.

51
Breakfast Lugaw (1/2 cup) 100
(8:00- Boiled egg: chicken (1pc) 86
8:30AM) Tomato (1/2 cup) 45
Carrot: cooked (1/2 cup) 45
Orange fruit (1pc) 40
Milk powdered (1 cup) 280
Banana (1pc) 40
Lunch rice (1/2 cup) 100
(12:00- tilapia prito (1 pc) 41
12:30PM) watermelon (1 slice) 40 Meal Plan
Snack (2:30- Turon (1pc) 40
Week 1
3:30PM) Calories
Monday
Dinner Rice (1/2 cup) 1,328
100
(6:00- Shrimp sinigangLugaw
3pc ( (1/2 cup)
1 cup) 100
53
7:00PM) Unsweetened Milk powdered
orange (½ cup)
juice (1cup) 140
120
Breakfast (8:00-8:30AM)
Cooked petsayBanana
(½cup) (1 pc) 4045
Wednesday Prito Bangus boneless(1 slice) 41
1,212
Breakfast rice (1 cup)
cereals (1/2 cup) 100
100
(8:00- milk powderedchicken:
(1 cup) laman (1slice) 86280
Lunch
8:30AM)(12:00-12:30PM)
tinola compose of: beans (1/2 cup)
string 45
kangkong
bangus boneless (1 slice)ginisa (1/2 cup) 4541
camote leaves (½ cup ) 45
Snack (2:30-3:30PM)
petsay (½cup) Bananacue (1/2 pcs) 4045
Banana (1pc) 40
Lunch rice (1/2cup) rice (1/2 cup) 100
100
(12:00- papaya (1 slice)chop suey (½ cup)
Dinner (6:00-7:00PM) 40
251
12:30PM) lean pork, wellbanana
trimmed 1MBX(cooked)
(1slice) 4046
squash fruit: cooked (½) 45
Tuesday 1,175
ripe mango (1 slice) 40
Snack (2:30- Turon (1pc) 40
3:30PM) Unsweetened orange juice (1cup) 120
Dinner Rice (½ cup) 100
(6:00- sotanghon with cooked carrots (1 cup) 90
7:00PM) watermelon (1 slice) 40
Thursday
1,143
Breakfast prito tilapia (1 slice) 41
(8:00- Banana (1pc) 40
8:30AM) Milk powdered (1 cup) 280
lugaw (1/2cup) 100
adobo string beans (½) 45
Lunch Pork pata (1 slice) 86
(12:00- Rice (1/2 cup) 100
12:30PM) Bamboo shoot (1/2cup) 45
Upo (1/2 cup) 45
Banana (1slice) 40
Snack( 2:30- Ensaymada (1pc) 100
3:30)
Dinner Rice (1/2) 100
(6:00-7:00) Sinigang compose of shrimp, kangkong, string beans (1/2 bowl) 53
Apple fruit (small 1pc) 78
Friday
1, 397
Breakfast cereals (1/2 cup) 100
(8:00-8:30) milk powdered (½) 140
chicken: laman (1 slice) 41
ginisa compose of squash, camote leaves, egg plant (1 cup) 135
banana (1 pc) 40
Lunch rice (1/2 cup) 100
(12:00- prito bangus boneless (1 slice)s 41
12:30) banana (1pc) 40
Snack (2:30- Maruya (¼pcs) 40
3:30) Unsweetened orange juice (1/3 cup) 40
Dinner Rice (1/2cup) 52 100
(6:00-7:00) Chop suey (1cup) 502
Apple fruit (small 1pc) 78
Saturday 1,242
Evidenced-based Research Findings related to the disease/illness

Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in
developing communities. In developed countries it is a common reason for presentation to general
practice or emergency departments and for admission to hospital. Dehydration, which may be
associated with electrolyte disturbance and metabolic acidosis, is the most frequent and dangerous
complication. Optimal management with oral or intravenous fluids minimizes the risk of dehydration
and its adverse outcomes. Routine use of antibiotics, antidiarrheal agents, and antiemetics is not
recommended and may cause harm. Prevention is the key to controlling gastroenteritis, and recently
licensed, highly effective rotavirus vaccines will have a major effect on public health. Acute
gastroenteritis, diarrhea or vomiting (or both) of more than seven days duration, may be accompanied
by fever, abdominal pain, and anorexia. Diarrhea is the passage of excessively liquid or frequent
stools with increased water content. Patterns of stooling vary widely in young children, and diarrhea
represents a change from the norm. Worldwide, 3-5 billion cases of acute gastroenteritis and nearly 2
million deaths occur each year in children under 5 years. In the United States, gastroenteritis
accounts for about ∼10% (220 000) of admissions to hospital, more than 1.5 million outpatient visits,
and around 300 deaths in children under 5 annually, with a cost of around $1bn (£0.5bn; €0.8bn). In
the same age group in Australia, about 10 000 hospital admissions, 22 000 visits to emergency
departments, and 115 000 general practice consultations occur annually for rotavirus alone, with an
estimated cost of $A30m (£12m; €18m; $23m). In the United Kingdom, 204 of 1000 consultations
with general practitioners in children under 5 are for gastroenteritis, and the annual hospital
admission rate in this group is about seven per 1000 children. Children in childcare settings are often
infected but asymptomatic and may unwittingly transmit infection. Children with poor nutrition are at
increased risk of complications. In the north end of Australia, Aboriginal and Torres Strait Islander
children have increased rates of admission for gastroenteritis, malnutrition, comorbidity, and
electrolyte disturbance (especially hypokalemia) and a longer hospital stay than their non-indigenous
counterparts. The cost of gastroenteritis to the community is huge but often underestimated if costs to
the family, including lost time at work, are not considered.

53
References:
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https://www.bonheurmd.com/gastroenteritis-diet/

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https://www.medlabcorp.com/patients/reading-your-own-cbc/

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Individualizing Client Care Across the Life Span. 9th edition, 298-299

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Individualizing Client Care Across the Life Span. 9th edition, 298-299.

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library/azithromycin-oral-suspension-immediate-release

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gastroenteritis#:~:text=Acute%20gastroenteritis%20is%20a%20disease,%2C%20diarrhea
%2C%20and%20abdominal%20pain. - P.S. Panesar, V. Bali, in Encyclopedia of Food and
Health, 2016.

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gastroenteritis#:~:text=Acute%20gastroenteritis%20is%20a%20disease,%2C%20diarrhea

54
 %2C%20and%20abdominal%20pain. - P.S. Panesar, V. Bali, in Encyclopedia of Food and
Health, 2016

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20351300#:~:text=A%20rotavirus%20infection%20usually%20starts,symptoms%20or
%20none%20at%20all. -
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Jersey: Upper Saddle River
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nursing/ care-plans/3/

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https://medlineplus.gov/gastroenteritis.html

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Jersey: Upper Saddle River

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https://www.muramed.com/store/detail/hydrite-ORS

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- NIDDK (2018). Treatment of Viral Gastroenteritis (“Stomach Flu”). USA. Retrieved from
https://www.niddk.nih.gov/health-information/digestive-diseases/viral-
o gastroenteritis/treatment

- Ohio, H. (2019, September 19). Clinical drug information. Mims. Retrieve form
https://www.mims.com/philippines/drug/info/domperidone?mtype=generic

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HTTPS://WWW.RXLIST.COM/ASCORBIC-ACID

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ACID

55
- Southern Cross (2018). Gastroenteritis - causes, symptoms, treatment. New Zealand.
Retrieved from https://www.southerncross.co.nz/group/medical-library/gastroenteritis

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%20plus#2%20Dosage%20and%20administration causes-symptoms-treatment.

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%20plus#2%20Dosage%20and%20administration

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https://www.unilab.com.ph/ceelinplus?
utm_medium=social&utm_source=google&utm_campaign=2021%20sem
%20lead&gclid=CjwKCAjwrPCGBhALEiwAUl9X09nHRgPZGf5peZtnl1qMRSbsW6vJUzuHw94
ePj3Vaeq3PjWxhhJFJhoCuJQQAvD_BwE

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https://assets.unilab.com.ph/uploads/Common/Products/Ceelin-Plus/ceelin_plus.pdf

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https://assets.unilab.com.ph/uploads/Common/Products/Ceelin-Plus/ceelin_plus.pdf
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plus?utm_medium=social&utm_source=google&utm_campaign=2021%20sem
%20lead&gclid=CjwKCAjwrPCGBhALEiwAUl9X09nHRgPZGf5peZtnl1qMRSbsW6vJUzuHw94
ePj3Vaeq3PjWxhhJFJhoCuJQQAvD_BwE

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York: The McGraw-Hill Companies, Inc., The Professional Book Group. Retrieved from
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u/docview/189250610/se-2?accountid=31259.

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