CHAPTER ONE

ASSESSMENT OF PATIENT/FAMILY

1.0. Introduction

Assessment of patient/family is an organized systematic process of collecting both subjective and

objective data based on a complete health history and a general head-to-toe examination. It is

giving information about the patient, his/her family and community characteristics Interviews,

observations and physical examinations are some methods used in assessment. Effective

assessment helps to obtain baseline physical and mental data on patient, supplement, confirm or

question data obtained in the nursing history and obtain data that will help the nurse establish

nursing diagnosis and plan patient care.

1.1. Patient’s Particulars

Patient's particulars are all the details of the client on whom the study is undertaken. They

include the name, age, gender, place of birth, occupation. Mr.D.O.D was born on 13th

December,1979 at Akwatia in the Eastern region to Mr. A.M and Mrs A.D who are still alive. He

is the 2nd born of his parents of which they are five (5). He is fair in complexion, 1.6meters tall,

weighs 50kg and has no physical impairment. Mr. D.O.D has a daughter but not married. He is a

driver and stays at Barracks in Sunyani. Mr.D.O.D is a Christian, speaks Twi and English.

Mr.A.M; his father is his next of kin.

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1.2. Patient/Family’s Medical and Socio-economic History

According to Mr.D.O.D, he has had no surgery and there is no history of diabetes mellitus (DM),

hypertension or any chronic illness in the family. The common illness of the family was malaria

of which they visit the nearest hospital for treatment. There is no genetic illness in the family.

Mr.D.O.D is financially stable. He is a driver who owns his own car and earns good income and

caters for himself and also sometimes gets support from his family members. Both of his parents

are traders. He has only one daughter depending on him but he is not married. Mr.D.O.D has no

known allergies (drugs nor food) and had no problem paying his hospital bills since he was on

National Health Insurance Scheme (NHIS).

1.3. Patient’s Developmental History

Growth is the positive change in size over a period of time.

Development is the qualitative change in which there is an increase in skills or ability to

function. Maturation is the acquisition of new characteristics or competencies that are

transmitted genetically.

Mr.D.O.D was delivered per vagina and had no congenital malformations/abnormalities. He is

the 2nd born of 5 children where 2 are females and 3 are males. He was immunized against the

childhood killer diseases. He was exclusively breastfed for the first 6months of life and was

introduced to family food (rice and stew, porridge etc.) from the 7th month of life plus the breast

milk. He started crawling at the 9th month of life and was able to sit and stand with support at

age 1. He started to say "mama" at age 1yr 6months, stopped breastfeeding at age 2 and started to

walk without support at age 3 and started schooling at age 6. He started schooling at Akwatia

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M/A Basic School, attended Kumasi Senior High and also went to Kumasi Polytechnic.

1.4. Patient’s Lifestyle and Hobbies

According to Mr D.O.D, he wakes up every day at 4:30am, brushes his teeth takes his bath then

eats his breakfast and goes to work afterwards and do some house chores after he returns back

home from work, he takes his supper, bath then go to bed. He sometime does not take supper

before going to bed because he is tired whenever he returns home from late work. He has no

drug or food allergies. His favourite foods are fufu and banku with groundnut soup. He normally

doesn't have leisure time because of work but tries to take some nap and sometimes listens to the

Radio when he gets a little time as his leisure time. He sometimes attends parties when he

doesn’t go to work. He normally sleeps around 10pm each day when he returns from home from

work.

1.5. Patient’s past medical history

According to Mr.D.O.D, he had not suffered from any of the childhood illness, has not had any

accident, has never been hospitalized and has not had any surgery before even though he

sometimes suffers from fever, headache and cough. Whenever he had fever or headache, he

visits the nearest pharmacy for treatment and when symptoms persist, he visits the nearest

hospital for treatment. He has no known allergy to drugs, food, animals and insects.

1.6. Patient’s present medical history

On Wednesday (15/03/2023) in the evening around 6pm after Mr.D.O.D had finished eating he

experienced some sudden abdominal pain and felt weak. He went to a nearby pharmacy shop and

bought some drugs, went home and took in the drugs and slept off. He experienced the same

symptoms (abdominal pain, body weakness) and then started vomiting (2 times) and passing of

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watery stool (3 times) in the morning and came to the Sunyani Municipal Hospital on Thursday

(16/03/2023) in the morning around 8:00am with the complains of abdominal pain, Nausea and

Vomiting, Body weakness and was admitted to the Male Medical Ward by Dr.J.G.A a medical

physician with the diagnosis of Gastroenteritis

1.7. Admission of patient

Mr.D.O.D came to the hospital ambulating in the company of his relatives on 16/03/2023 in the

morning around 8:00am with the complains of abdominal pain, nausea and vomiting and loss of

appetite. He was admitted to the male medical ward through the outpatient department (OPD) at

9:00am by the doctor on duty Dr. J.G.A with the diagnosis of Gastroenteritis. He was brought to

the ward by a student nurse accompanied by his relative. Mr.D.O.D was ambulant, conscious and

alert but slightly weak and in pain. He and his relative were welcomed with a cheerful face and

was given a seat to sit. Patient was introduced to the staffs at the ward and a comfortable bed was

made for the patient. Patient's information was recorded into the admission and discharge book,

daily ward state and changes book. Patient's vital signs were checked and recorded as

temperature of 38.4°C, pulse of 81bpm, respiration of 26cpm and blood pressure of

125/72mmHg. After patient was a bit stable, he was then introduced to other patients at the ward

and was well oriented into the ward thus he was shown where the toilet was, where bathroom

was, nurses’ station, talked about the visiting time.Necessary assessment both physical

examination and nursing observations were done. Mr.D.O.D was requested to do the following

laboratory investigations; urine R/E and MRDT, stool culture and sensitivity (C/S) and was later

put on the following treatments:Intravenous Promethazine 25mg stat, injection Buscopan 80mg

stat, intravenous fluid dextrose + sodium chloride (DNS) 1L x 24 hours, intravenous

Ciprofloxacin 400mg tds x 24hours, intravenous metoclopramide 10mg tds x 24 hours,

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intravenous fluid ringers lactate (R/L) 2L x 24hrs. Intravenous line was secured as stat

medications were served as prescribed and was assured to be discharged home if he gets well

and regains his normal state.

Mr.D.O.D was made known that am a student nurse in my final year and as a final year

student it is a task that I choose a patient and do a care study on him/her and that I’m interested

in choosing him for my care study. Mr.D.O.D was assured of competent nursing care

1.8. Patient’s concept of illness

Mr.D.O.D said his illness is not attributed to any supernatural dealings. He believes it is because

of the food he took that precipitated the illness. He was made to believe through quality care he

will regain his strength. He was confident that he will go home well recovered as soon as

possible to continue his daily activities and work.

1.9. Literature review on disease condition

Gastrointestinal Tract (GIT) System consists of the mouth, pharynx (throat), oesophagus,

stomach, small and large intestine, rectum and anus. It is the system responsible for the digestive

function of the body. It digests and absorbs ingested nutrients and excretes waste products of

digestion.

Anatomy and physiology of the stomach

The stomach is a muscular, J-shaped organ in the upper part of the abdomen. It is part of the

digestive system, which extends from the mouth to the anus. The size of the stomach varies from

person to person, and from meal to meal.

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Definition of gastroenteritis

According to Bare & Smeltzer (2012), Gastroenteritis is also called intestinal flu, traveler’s

diarrhea, viral enteritis. Gastroenteritis is an inflammation of the mucosal lining of the stomach

and intestine characterized by diarrhea, nausea, vomiting and abdominal cramping. Acute

episodes usually only last a few days but chronic ones last for more days with dehydration, shock

and collapse especially in children and the elderly.

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Incidence

Gastroenteritis is a leading cause of morbidity and mortality worldwide, accounting for over 1.8

million deaths annually in children aged less than 5 years, the vast majority of which occur in

developing countries (Aron et al., 2011). In the United Nation, gastroenteritis ranks second to

common cold as a cause of lost work time and fifth as the cause of death among young children.

It also can be life-threatening in the elderly and the debilitating people.

Rotavirus was detected from more than 60% of acute gastroenteritis cases during the peak

months. Rotavirus gastroenteritis causes significant morbidity in children younger than five

years of age in Ghana. (Enweronu – Laryea et al, 2012).

It is common in areas of poor sanitary conditions. Three to five billion cases of acute diarrhea

occur yearly, and it is the leading cause of death in many underdeveloped countries.

Approximately 30-50% of visitors to developing countries develops and perhaps returns with

diarrhea. Every year Worldwide rotavirus in children under five causes 111 million of cases of

gastroenteritis and nearly half million deaths 82% of these deaths occurs in the World’s poorest

nations.

In 1980, gastroenteritis from all cause caused 4.6 million deaths in children with most of these

occurring in the third world. Current death rates have come down significantly to approximately

1.5 million deaths annually in the year 2000, largely due to the global introduction of oral

rehydration therapy, internationally, the rate is 5-10 million death each year (Malek et la 2013).

Gastroenteritis is usually common during the raining season due to the increased presence of the

organisms which carries the disease.

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Etiology or causes

Infectious gastroenteritis may be caused by viruses, bacteria, or parasites. (Merck et al, 2017)

Viral gastroenteritis

Viruses are the most common cause of gastroenteritis in children and young adults. They infect

enterocytes in the villous epithelium of the small bowel. The result is transudation of fluid and

salts into the intestinal lumen; sometimes, malabsorption of carbohydrates worsens symptoms by

causing osmotic diarrhea. Diarrhea is watery. Inflammatory diarrhea (dysentery), with fecal

WBCs and RBCs or gross blood, is uncommon. Four categories of viruses cause most

gastroenteritis: norovirus and rotavirus cause the majority of viral gastroenteritis, followed by

astrovirus and enteric adenovirus. (Merck et al, 2017).

The viruses most commonly implicated are;

1. Norovirus

2. Rotavirus

3. Astrovirus

4. Adenovirus

Norovirus infects people of all ages. Large waterborne and foodborne outbreaks occur. Person-

to-person transmission also occurs because the virus is highly contagious. Incubation is 24 to 48

hours. Norovirus or calicivirus is the most prevalent cause of gastroenteritis. Outbreak often

occur between November and April. According to Bare & Smeltzer (2012), Contagion is by

direct contact and fecal oral route.

Rotavirus is the most common cause of sporadic, severe, dehydrating diarrhea in young children

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worldwide. Rotavirus is highly contagious; most infections occur by the fecal-oral route. Adults

may be infected after close contact with an infected infant. The illness in adults is generally mild.

Incubation is 1 to 3 days. (Merck et al, 2017).

Its incubation is 24 to 48hours.

Astrovirus: can infect people of all ages but usually infects infants and young children. Infection

is most common in winter. Transmission is by the fecal-oral route its incubation is 3-4days.

Adenoviruses: are the most common cause of childhood viral gastroenteritis, infection occur

years round, with a slight increase in summer. Children less than 2years are primarily affected.

Transmission is by the fecal-oral route and incubation is 3 to 10days.

Bacterial Gastroenteritis

According to Merck et al (2017), bacteria commonly causing gastroenteritis include:

1. Salmonella

2. Campylobacter

3. Shigella

4. Escherichia coli

5. Clostridium difficile

In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis,

with half of these cases associated with exposure to poultry. In children, bacteria are the cause in

about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella,

and Campylobacter species. If food becomes contaminated with bacteria and remains at room

temperature for a period of several hours, the bacteria multiply and increase the risk of infection

in those who consume the food. Some foods commonly associated with illness include raw or

undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses;

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and fruit and vegetable juices. In the developing world, especially sub-Saharan Africa and Asia,

cholera is a common cause of gastroenteritis. This infection is usually transmitted by

contaminated water or food. (Schlossberg, 2015).

Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the

elderly. Infants can carry these bacteria without developing symptoms. It is a common cause of

diarrhea in those who are hospitalized and is frequently associated with antibiotic use.

Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics.

Acute "traveler's diarrhea" is usually a type of bacterial gastroenteritis, while the persistent form

is usually parasitic. Acid-suppressing medication appears to increase the risk of significant

infection after exposure to a number of organisms, including Clostridium difficile, Salmonella,

and Campylobacter species. The risk is greater in those taking proton pump inhibitors than with

H2 antagonists (Schlossberg, 2015).

Parasitic

A number of protozoans can cause gastroenteritis most commonly Giardia lamblia but

Entamoeba histolytica and Cryptosporidium species have also been implicated. As a group, these

agents commonly in the developing world, but this etiology agent causes this type of illness to

some degree nearly everywhere. It occurs more commonly in persons who have traveled to areas

with high prevalence, children who attend day care, men who have sex with men and following

disasters. According to Merck et al (2017), the parasites most commonly implicated are:

1. Giardia

2. Cryptosporidium

Certain intestinal parasites, notably Giardia intestinal is (G. lamblia), adhere to or invade the

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intestinal mucosa, causing nausea, vomiting, diarrhea, and general malaise. The infection can

become chronic and cause a malabsorption syndrome. It is usually acquired via person-to-person

transmission or from contaminated water. Cryptosporidium parvum causes watery diarrhea

sometimes accompanied by abdominal cramps, nausea, and vomiting. In healthy people, the

illness is self-limited, lasting about two weeks. In immunocompromised patients, illness may be

severe, causing substantial electrolyte and fluid loss. Cryptosporidium is usually acquired

through contaminated water.

Mode of transmission

Infectious

According to Lemone & Burke (2004), the infectious organisms usually enter the body in

contaminated water or food. For this reason, gastroenteritis often is called “food poisoning. The

human hand is the main mode of transmission assisted by flies in areas where the condition is

prevalent. Infective materials spread to the hands and then eventually to the mouth resulting in

the condition.

Transmission may occur from drinking contaminated water or when people share personal

objects. Water quality typically worsens during the rainy season and outbreaks are more common

at this time. In areas with four seasons, infections are more common in the winter. Worldwide,

bottle-feeding of babies with improperly sanitized bottles is a significant cause. Transmission

rates are also related to poor hygiene, (especially among children), in crowded households, and

in those with poor nutritional status. Adults who have developed immunities might still carry

certain organisms without exhibiting symptoms. Thus, adults can become natural reservoirs of

certain diseases. While some agents (such as Shigella) only occur in primates, others (such as

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Giardia) may occur in a wide variety of animals (Shors, 2013).

Non-infectious

There are a number of non-infectious causes of inflammation of the gastrointestinal tract. Some

of the more common include medications (like NSAIDs), certain foods such as lactose (in those

who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a non-

infectious source of (often severe) gastroenteritis. Disease secondary to toxins may also occur.

Some food-related conditions associated with nausea, vomiting, and diarrhea include: ciguatera

poisoning due to consumption of contaminated predatory fish, scombroid associated with the

consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of

puffer fish among others, and botulism typically due to improperly preserved food (Schlossberg,

2015).

In the United States, rates of emergency department use for non-infectious gastroenteritis

dropped 30% from 2006 until 2011. Of the twenty most common conditions seen in the

emergency department, rates of noninfectious gastroenteritis had the largest decrease in visits in

that time period (Schlossberg, 2015).

Pathophysiology

Gastroenteritis is usually caused by viruses but can also be caused by bacteria, parasites, and

from the ingestion of contaminated food or water. When these causative organisms get into the

stomach and small intestines, they adhere to the mucosal lining without invading it and produce

toxins

These toxins impair intestinal absorption and create reverse peristalsis in the gastrointestinal tract

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causing an acute onset of nausea and vomiting and watery stools (diarrhoea).

Inflammatory process then occurs leading to ulceration, bleeding, exudation of protein-rich fluid

and secretion of electrolytes and water. Patient probably runs fever (higher than 38c) as well as

a worm body creating a hostile environment for the virus/bacteria, thereby killing it.

As diarrhoea and vomiting continues, electrolytes and fluid s are depleted leading to dehydration.

When this is not treated, patient can get into shock leading to vascular collapse. Insufficient fluid

in the body leads to poor function of the kidney which eventually leads to renal failure.

Vomiting caused by staphylococcus aureus enterotoxins is probably due to toxins interaction

with abdominal viscera. The vagus and sympathetic nerve then carry this sensory stimulus to the

vomiting centre of the brain to stimulate vomiting.

Incubation Period

Incubation period for gastroenteritis is between twelve hours to ten days. (Merck et al; 2017)

Clinical manifestation of gastroenteritis

Gastroenteritis often involves stomach pain or spasms, diarrhoea and/or vomiting, with non-

inflammatory infection of the upper small bowel, or inflammatory infections of the colon.

The condition is usually of acute onset, normally lasting 1-6 days, and is self-limiting.

1. Nausea and Vomiting

2. Diarrhea

3. Loss of appetite

4. Fever

5. Headache

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 6. Abnormal flatulence

7. Abdominal pain

8. Bloody stools (dysentery – suggesting infection by amoeba, Campylobacter,

Salmonella, Shigella or some pathogenic strains of Escherichia coli [4])

9. Fainting and Weakness

10. Heartburn

11. Lethargic

12. Have signs of dehydration (which include dry mucous membranes)

13. Tachycardia

14. Reduced skin turgor

15. Sunken eyes

16. Weight loss

Types of gastroenteritis

1. Acute

2. Chronic

3. Toxic

Acute gastroenteritis

This may develop in acute illness especially when patient has had a major traumatic injury like

burns and severe infection. The ingestion of irritating food as hot pepper can cause acute

gastroenteritis.

Chronic gastroenteritis

This is caused by intestinal infection caused by recurring of irritating substance such as surgical

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alteration such as short bowel syndrome which reduces the size of the colon leading to decrease

anal status like anxiety or depression over a period of time can lead to chronic gastroenteritis.

Chronic gastroenteritis is characterized by nausea, vomiting, anorexia, diarrhea, non-specific

fever and dehydration.

Toxic Gastroenteritis

It occurs as a result of ingestion or corrosive poison and substances that counteract the protective

function of the mucosal lining of the gastrointestinal tract. Ingestion of poison like mercury,

ammonia and carbon dioxide can lead to the condition. Drugs like aspirin and other non-steroidal

anti-inflammatory drugs, cytotoxic agents, caffeine, corticosteroids and indomethacin when

taken can in large doses can lead to toxic gastroenteritis

Diagnostic investigations

1. Patient history

2. Physical examination

3. Full Blood Count (FBC)

4. Blood film for malaria parasites

5. Abdominopelvic ultrasonography

6. KFT (Kidney function test)

7. Stool culture and sensitivity (C/S)

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Management

Medical Management

The main objectives of the medical management of gastroenteritis are fluid electrolyte

replacement and bed rest. It is considered as a medical emergency in the acute phase to prevent

death. The interventions are aimed at;

1. Oral Rehydration Therapy.

The primary treatment of gastroenteritis in both children and adults is rehydration, that is,

replenishment of water and electrolytes lost in the stools. Oral fluid of electrolyte solution such

as oral hydration salt is use to replace fluid loss.

2. Antiemetic drugs.

They are used to reduce/control vomiting. Example Metoclopramide, Promethazine,

Prochlorperazine. They can be given orally, intramuscularly or as rectal suppository.

3. Antibiotics

They are not usually used for gastroenteritis, although they are sometimes used if symptoms are

severe such as dysentery or a susceptible bacterial cause is isolated or suspected. Examples of

antibiotics are; metronidazole, ciprofloxacin, tetracycline.

4. Analgesics

They are given to relief pain. Example injection buscopan.

5. Antidiarrheals

Examples like bismuth subsalicylates are typically used as the first line of defence against

diarrhoea. If necessary, other antidiarrheals such as camphorated opium tincture (paregoric),

16
diphenoxylate with atropine and loperamide may be ordered.

6. Antipyretics.

They are used to relief fever, example paracetamol.

7. Intravenous fluids

They are given in moderate and severe dehydration to correct fluid and electrolyte imbalance.

Examples are IV Ringers Lactase and Dextrose saline.

8. Sedatives

They are given to facilitate sleep, example diazepam.

Surgical Intervention

1. In cases of intestinal perforation laparotomy may be done for exploration purposes.

2. Enterectomy may also be performed to excise the portion of the intestine that is affected

beyond repair.

Nursing management

The nursing management of gastroenteritis is based on assessment findings and patient health

problems identified. The management of gastroenteritis in general and as indicated in medical

literature is directed towards:

1. Restoration of normal vital signs

2. Decrease of bowel activities

3. Maintenance of hydration and electrolyte status

4. Maintenance of nutritional status

5. Relieve of abdominal pain

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Psychological care

Reassurance

Patient reassured psychologically to allay any fear and anxiety and to relieve his thoughts about

the disease condition. To ensure psychological care, the following measures should be put in

place.

1. Patient and relatives should be reassured not to panic because the condition will be

controlled as are in place for it.

2. Patient and family should be made to understand that he is in the hands of competent

medical and nursing personnel and with their maximum cooperation, the condition can be

managed.

3. Explain all procedures as well as management well to patient and relatives to gain their

co-operation.

4. Allow patient and relatives to ask questions and express their feelings.

5. Answer question asked by patient and relatives in clear and simple terms.

6. Provide diversional therapy such as watching of television, listening to music and news

on the radio to divert patient’s attention from the disease condition (Smeltzer & Bare,

2010).

Position

The patient is assisted to assume a comfortable position such as semi-fowlers position or position

which is not contraindicated to patient’s condition to promote comfort, rest and to promote or

facilitate breathing. Extra pillows provided to enhance comfort at painful areas (Smeltzer &

Bare, 2010).

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Effective Pain Management

Pain can be intense. Patient is taught of pharmacologic and non-pharmacologic measures to

control and reduce the severity of pain episodes. These include physical and occupational

therapy, physiotherapy, cognitive-behavioral therapy and support groups. Patient provided with

videos and pamphlets to distract him of the pain (Gill & Valerie, 2010).

Observation

1. Patient vital signs that are temperature, pulse, blood pressure and respiration are

monitored four hourly or as ordered to assess any improvement or deterioration in the

patient’s condition.

2. Patient is also observed for signs and symptoms of the disease condition such as

vomiting, rapid heart rate, coma, weakness sunken eyes, dry mouth and tongue etc. to

know whether patient is responding to treatment or not.

3. Observe patient urine and faeces for color, odor, amount and consistency or any

abnormality.

4. Monitor the flow of intravenous infusion to prevent fluid overload and symptoms of

circulatory overload such as dyspnea would be observed.

5. Observe signs of complications and take appropriate measures.

6. Observe for desired and side effects of drugs administered.

Rest and sleep

1. Provide a well laid bed free from creases and cramps to facilitate sleep

2. Assist patient to perform passive and active exercises to make patient active and improve

blood circulation

3. Provide guided imageries to prevent patient from fall

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 4. Ensure bedrest to aid in energy regain

5. Schedule all nursing activities to prevent undue disturbances of the patient

6. Restrict visitors during periods of rest to ensure adequate rest

Personal Hygiene

1. Provide patient with bed bath twice daily, if bed ridden to remove dirt, improve

circulation, refresh and help him/her to relax.

2. Provide patient with mouth care to prevent oral infections being transmitted into the

alimentary canal and to prevent halitosis.

3. Care for pressure areas using a barrier cream to stimulate circulation and prevent the

development of pressure sores.

4. Change bed linen when soiled to make patient feel comfortable in bed.

5. Encourage patient to wash hands after visiting the toilet, before and after eating to

prevent possible infection when handling food and water

6. Encourage the use of good drinking water to avoid infection by microbes.

Nutrition

1. Serve easily digestible food so that by the time the patient decides to sleep, digestion

would have been completed.

2. Avoid gas forming foods such as eggs, beans and cabbage which would cause

abdominal distention.

3. Give patient a well-balanced diet containing high carbohydrate to provide energy.

4. Protein and vitamins are also needed to repair worn out tissues and boost the immune

system.

5. Serve food in bit. If patient cannot tolerate food by mouth due to vomiting, a

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 nasogastric tube is passed.

6. Glucose drinks and other fluids that the patient can tolerate should be served.

7. Advise patient to avoid the intake of alcohol and other stimulates like tea, coffee

which might cause further erosion of the mucosal lining of the alimentary tract.

8. Spicy foods should be avoided since it irritates the bowl lining.

9. Perform oral hygiene before and after meals.

Exercise

The patient is advised to undertake mild or moderate exercises as his condition can permit

example flexion of his legs and arms to promote circulation and prevent stiffness of joints and

constipation. Patient was also assisted to sit up in bed and walk around the hospital ward (Gill &

Valerie, 2010).

Elimination

1. Ensure that patient’s meal contains adequate roughage to prevent constipation

2. Encourage patient to take in more fluids to enhance bowel movement.

3. Serve patient with bedpan and urinal on request to ensure bowel movement and

hygiene

4. Observe the amount, Colour and odor of stool and urine to know patient’s status

for dehydration

5. Provide vomitus mug by patient’s bedside if patient is vomiting to prevent patient

from vomiting onto herself

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Health Education

1. Educate patient on the cause and predisposing factors of the condition.

2. Educate patient/ family on the signs and symptoms of the condition, side effects of

drugs and how to take the medications.

3. Educate client to always wash hands especially after visiting the toilet.

4. Educate patient and family about proper storage, preparation and cooking of food and

good hygiene to help prevent gastroenteritis.

5. Education is given on nutritional diet to help meet patient’s nutritional status.

i. Nutrition diet should include vitamins to improve the immune system, protein to

repair worn out tissues and carbohydrates to provide energy.

ii. Consult dietician for further assessment and recommendations regarding food

preferences and nutritional support.

iii. Plan diet with patient to ensure compliance.

iv. Provide companionship during meal time, discourage beverages that are

caffeinated or carbonated as these decrease patient appetites and leads to early

satisfaction.

6. Educate patient on the need to prevent infection in order to prevent gastroenteritis.

7. Educate patient on the need and how to take prescribed drugs correctly after

discharge.

8. Encourage patient to take in adequate amount of folic rich foods like green leafy

vegetables to prevent anemia.

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 9. Advise patient to take in foods that contain high amount of roughage, protein and

carbohydrate to prevent constipation, repair worn out tissues and provision of energy

respectively.

Prevention

1. Washing of hands after using toilet with soap and running water, before handling of

food, after touching animals and before eating.

2. Keeping your kitchen consistently clean.

3. Meat should be washed and properly cooked. Vegetables and salads should

thoroughly wash before eating.

4. Avoid eaten cold foods

5. Chopping boards, knives and other utensils should be washed thoroughly in hot soapy

water.

6. Drinking bottled water while traveling abroad and getting recommended vaccines

Complications of gastroenteritis

According to Eckhardt (2011) have listed the following as the possible and common

complications of gastroenteritis;

1. Dehydration

2. Fluid and electrolyte imbalance

3. Hypovolemic shock

4. Cardiac failure

5. Vascular collapse

6. Ulcerative colitis

7. Acute renal failure

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8. Hypokalemia

9. Anemia

10. Peritonitis

11. Endocarditis

12. Peptic ulcer

13. Septicemia

14. Hypernatremia

15. Gastroesophageal reflux

16. Mal-absorption

17. Nutritional disorder

1.10. Validation of data

Validation of data is the act of confirming the data that has been collected to keep the data free

from error or misinterpretation. From Mr.D.O.D’s health history, clinical manifestations, results

of diagnostic tests, there is the evidence to confirm that his condition is Gastroenteritis and the

data also suggest patient's disease condition was as a result infection. Data collected from patient

were cross-checked with patient’s folder, laboratory investigation and physical assessment of

which it was free from errors, biases and misinterpretation, which therefore makes the data valid.

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 CHAPTER TWO

ANALYSIS OF DATA

2.0. Introduction

Analysis of data is the second phase of the nursing process. It includes comparing data that was

collected with established standards, a list of patient/family strength, health problems and

nursing diagnoses. The relevant data is collected and compared with the literature review.

2.1. Comparing data with standards

Test and investigations are done to detect any abnormalities and help to treat patient based on the

cause. Comparing data with standards consists of the various tests conducted on the patient.

These includes

1. Diagnostic investigations

2. Causes of disease

3. Clinical features

4. Treatment

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5. Complications of disease

All these findings are compared with the normal values from the literature review.

2.1.1 Diagnostic investigations/tests

The following diagnostic investigations were conducted/carried out

1.MRDT(Malaria Rapid Diagnostic Test)

2. Patient history

3. Physical examination

4. Urine routine examination (R/E)

5. Stool culture and sensitivity (C/S)

Table 2.1 Comparing diagnostic investigations carried out on my patient with those

outlines in the literature review

Diagnostic tests in literature review Diagnostic test carried out on my patient

Physical examination Done for my patient

Patient history Done for my patient

Gastric analysis Not done for my patient

Full blood count (FBC) Not done for my patient

Enterectomy Not done for my patient

Stool R/E,C/S Done for my patient

KFT (Kidney Function Test) Not done for my patient

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Table 2.2 Diagnostic investigation carried out on my patient with interpretations

Date Specimen Investigation Results Normal value Interpretation Remarks

17/03/202 Urine Urine R/E It is normal because No intervention is
3 there is no presence of required
There should be leukocyte and it has
Leukocytes Negative no leukocyte in the normal colour
urine which indicates there
is no infection or
inflammation
somewhere in the
urinary tract
Colour Clear Clear
17/03/202 Blood Blood film for No Malaria There should be No presence of malaria No Intervention is
3 malaria parasite seen no malaria parasite. required.
parasites parasite in
blood No Intervention
required indicating
patient does not have
malaria
17/03/202 Stool Widal TO<1/20 TO <1/20 No antibody for No treatment was given
3 Agglutination TH<1/20 TH<1/20 salmonella typhoid
Test was found indicating

27
Negative There should be the absence of typhoid
no fever
No agglutination or
agglutination no antibody for
the typhoid
fever

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2.2. Causes of patient’s condition compared with literature review

With reference to the text book, laboratory investigation and his history, his condition was

caused by bacteria infection.

Table2.3 Comparing clinical features to those exhibited by my patient

Clinical features in literature Clinical features exhibited by my patient

Abdominal pain Experienced by my patient

Loss of Appetite Experienced by my patient

Nausea and vomiting Experienced by my patient

Dehydration Not experienced by my patient

General body weakness Not experienced by my patient

Mild- moderate diarrhoea Experienced by my patient

Fever Experienced by my patient

Melena Not experienced by my patient

Treatment: are the measures put in place in other to treat/cure the disease

29
Table2.4. Comparing of patient’s treatment to literature review.

Drugs in literature Drugs given to my patient

Sedatives Not given
Antibiotics Intravenous Ciprofloxacin 400mg tds ×24hrs
was given
Analgesics Intravenous Paracetamol 1g tds x 24hrs was
given
IV fluid Intravenous fluid Ringer lactate (R/L) 2L x
24hrs was given
Antiemetics Intravenous metoclopramide 10mg tds x 24
hours was given
Antidiarrhea Oral rehydration salt (ORS) 100mls tds x
24hrs
Antipyretics Intravenous Paracetamol 1g tds x 24hrs was
given

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Table 2.5 Pharmacology of drugs

Date Drug Route and Classificatio Desired effect Actual action observed Side effect
dosage n
16/03/202 Ringers Intravenous Maintain Patient was hydrated and Fluid overload, pulmonary
3 Lactate (R/L) (IV) Isotonic normal fluid maintained electrolyte oedema
2Litres Solution and electrolyte balance None was observed
balance
16/03/202 Intravenous Antipyretic To reduce Patient attain a normal rash, liver damage. None
3 Paracetamol (IV) temperature temperature within observed
1g tds ×24hrs Non-narcotic expected time
analgesics

17/03/202 Ciprofloxacin Intravenous Antibiotics To treat Patient was free from headache, fever, skin rashes,
3 (IV) infections infections Nephrotoxicity, Gastro
400mg tds intestinal upset
×24hrs None was observed
18/03/202 Oral Per oral Isotonic Contains Patient was relieved of Fluid overload, pulmonary
3 Rehydration Solution sodium, diarrhoea and was well oedema, Electrolyte imbalance
Salt (O.R.S) chloride and hydrated
1 sachet of anhydrous None was observed
ORS was glucose. It is
prepared with use to replace

31
600mls of lost fluid and
purified electrolyte.
water. Also enhance
Given the absorption
Liberally of water and
electrolyte to
help treat
diarrhoea

32
2.4. Surgical treatment

No surgical treatment was recommended for my patient

2.5. Complication

My patient did not experience any complications listed in the medical literature on the condition

Gastroenteritis. In reference to the literature, Mr.D.O.D didn’t develop any of the complications

during his admission and after discharge due to good nursing and medical care rendered to him.

2.6. Patient’s health problems

Health problem of patient takes into account the actual or potential problems identified by the

health team and those exhibited by the patient. The following were the health problems

1. Abdominal pain (16/03/2023)

2. Fever ((38.4°C) (16/03/2023)

3. Diarrhea (17/03/2023)

4. Nausea and vomiting (17/03/2023)

5. Loss of appetite (18/03/2023)

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2.7. Patient/family strengths

Strength is the ability of the patient/family to help in the achievement of health goals set for early

recovery. Strength includes;

1. Patient was able to tell the location of pain (abdominal pain).

2. Patient could tolerate nursing care provided

3. Patient could verbalize the times he had passed stool and state of the stool.

4. Patient could tolerate oral fluid intake.

5. Patient could tolerate small amount (5 spoons) of food served.

2.8. Nursing diagnosis

Nursing diagnosis is a definite statement of a patient's health problems that can be influenced

by nursing intervention (Weller. B. F, 2009). Nursing diagnosis made on my patient includes:

1. Impaired body comfort (abdominal pain) related to irritation of the gastric mucosa.

2. Alteration in body temperature (hyperthermia) related to infection process.

3. Alteration in bowel movement (diarrhoea) related to inflammation of intestinal mucosa.

4. Risk for deficient fluid and electrolyte imbalance related to Nausea and vomiting.

5. Risk for nutritional imbalance (less than body's requirement) related to loss of appetite.

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 CHAPTER THREE

PLANING FOR PATIENT AND FAMILY CARE

3.0 Introduction

Nursing care plan is part of the nursing process which is involved in the services rendered on an

individual basis. Planning is the process of thinking about and organizing the activities required

to achieve a desired goal (Anderson, 2009). This involves the setting of patient/family care

objectives/outcome criteria and outlining the nursing care strategies on the nursing care plan.

3.1 Objective/Outcome Criteria

1. Patient will attain normal body comfort within 24hrs as evidenced by patient verbalizing, he

feels comfortable and nurse observing patient expresses relaxed facial expression.

2. Patient will attain normal body temperature within 24hrs as evidenced by patient verbalizing

that she is no more warm touch and nurse observing patient has a normal temperature of 36.3 oC

when checked

3. Patient will attain a normal bowel movement within 48hours as evidenced by patient

verbalizing that diarrhoea has ceased and nurse observing that patient passed semi-formed stools.

4. Patient will maintain normal body fluid and electrolyte balance throughout period of

hospitalization as evidenced by nurse observing patient is well hydrated and patient verbalizing,

she no longer feels nauseatic, do not vomit and don't complain of thirst.

35
5. Patient will maintain normal nutritional status throughout period of hospitalization as

evidenced by patient verbalizing ability to eat and nurse observing that patient maintains normal

body weight of 50kg by weighing patient with a weighing scale.

36
Table 3.1 NURSING CARE PLAN

Date and Nursing Objective/ Nursing Nursing Interventions Evaluation

time Diagnosis Outcome criteria Orders
16/03/202 Impaired body Patient will attain 1. Assess 1. Patient's level of pain was Goal fully met as
3 @ 8am comfort normal body patient's level assessed using the Numerical patient verbalizes the
(abdominal pain) comfort within of pain Rating Scale (NRS) from 0-10 feeling of no pains on
related to 24hrs as evidenced 2. Provide bed with 0 meaning no pain and 10 17/03/2023 @ 8am
irritation of the by rest meaning severe pain
gastric mucosa 1. Nurse observing 3. Reassure 2. Comfortable bed was provided
that patient patient and patient was assisted to assume
expresses a relaxed 4. Ensure a comfortable position O. I
facial expression quiet 3. Patient was reassured of
2.Patient verbalizing environment competent nursing care
that she feels 5.Serve 4. Quiet environment was assured
comfortable prescribed by lowering TV sets and radio
medications 5. Prescribed medications such as
Injection Buscopan 80mg stat
administered

Table3.2

37
Date and Nursing Objective/Outcome Nursing Orders Nursing Interventions Evaluation
time Diagnosis criteria

16/03/2023 Alteration in Patient will attain a 1. Reassure 1. Patient and relatives were Goal fully met as
@ 6pm body normal body patient and reassured of competent nursing care patient's temperature
temperature temperature within relatives 2. Patient's temperature was checked was normal(36.5oC)
(hyperthermia) 24hours as every 2hrs to notice if there is any when checked on
related to evidenced by 1. 2. Monitor improvement in his body 17/03/23 @ 6am
infection Patient verbalizing temperature temperature
process. that he is no more every 2hrs 3. Cold drinks like Fanta and orange
warm to touch 3. Give cold juice were served to help reduce his
2. Nurse observing drinks temperature.
that patient has a 4. Open nearby 4. Nearby windows were opened to B. S
normal body windows. improve ventilation in the room to
temperature of 5. Administer allow fresh air.
36.5ºC when prescribed 5. Prescribed antipyretic of
checked antipyretic. Intravenous paracetamol 1g tds x
24hrs was administered.

38
Table 3.3

Date and Nursing Objective/Outcome Nursing Orders Nursing Interventions Evaluation

time Diagnosis criteria
17/03/2023 Alteration in Patient will attain a 1. Reassure patient 1. Patient and relatives were Goal fully met as
@ 10am bowel normal bowel and relatives reassured of competent nursing evidenced by
movement movement within care patient
(diarrhoea) 48hours as evidence 2. Monitor and record 2. Patient’s intake and output was verbalizing a
related to by; a) Patient intake and output monitored decrease in the
inflammation verbalizing that 3. Patient was encouraged to take frequency of the
of the diarrhoea has seized 3. Encourage intake of in more oral fluids to keep her watery stool
intestinal b) nurse observing more oral fluids hydrated 19/03/2023
mucosa that patient passed 10 am
semi-formed stools. 4. Serve spice-free 4. Spice-free food served in bits
foods in bits and at and at regular intervals O. I
regular intervals

39
 5. Prescribed oral rehydration salt
5. Serve prescribed (ORS) 100mls was served as
medication prescribed

6. Administer 6. Intravenous Fluid Ringers

prescribed IV fluids Lactate (R/L) 1L was administered

Table 3.4

Date and Nursing Objective/Outcome Nursing Orders Nursing Interventions Evaluation

time Diagnosis criteria
17/03/2023 Risk for Patient will maintain 1.Assess for signs 1.Signs of dehydration was Goal fully met as
@ 10am deficient fluid normal fluid and of dehydration assessed patient did not
and electrolyte electrolyte balance 2.Keep away all 2. All nauseating articles were exhibit any signs of
imbalance within the period of nauseating articles kept out of sight of patient. dehydration within
related to hospitalization as from sight of 3.Patient was reassured of the period of
Nausea and evidenced by patient competent nursing care hospitalization on
vomiting 1.Nurse observing 3.Reassure patient 4.Frequent oral care was 20/03/2023 @
patient is well 4.Provide frequent provided for the patient (mouth 10am
hydrated oral care rinsed as and when patient
2.Patient verbalizing 5.Encourage intake vomits)
she no longer fell of more oral fluids 5.Patient was encouraged to
nauseatic, do not take in more oral fluids to keep

40
 vomit and do not 6.Administer her hydrated O. I
complain of thirst prescribed IV 6. IV Fluid Ringers Lactate
fluids (R/L) 1L was administered to
maintain normal fluid and
electrolyte balance

Table 3.5

Date and Nursing Objective/ Nursing Orders Nursing Interventions Evaluation

time Diagnosis Outcome criteria

41
18/03/2023 Risk for Patient will 1. Assess 1. Patient's nutritional status Goal fully met as
@ 10:30am nutritional maintain normal patient's was assessed evidenced by patient
imbalance nutritional status nutritional status 2. Diet was planned with being able to eat all food
(less than throughout the 2. Plan diet with patient taken into served to her on
body's period of patient consideration her likes and 20/03/2023 @ 10:30am
requirement) hospitalization as 3. Provide dislikes
related to loss evidenced by frequent oral care 3. Patient's mouth was rinsed
of appetite 1. Patient 4.provide small before and after eating
verbalizing the frequent feeding 4. Food was provided in small O. I
ability to eat 5. Provide food quantities to improve appetite
2. Nurse observing on time 5. Food was served as patient
that patient 6. Serve food in desired
maintains normal an attractive 6. Food was served in an
body weight of manner attractive manner to improve
50kg by weighing patient's appetite
patient with a
weighing scale

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