OBJECTIVES:

1. Describe the gastrointestinal disorder in children.

2. Assess child with gastrointestinal disorder.
3. Formulate nursing diagnosis for a child with gastrointestinal disorder.
4. Develop expected outcomes for a child with gastrointestinal disorder.
5. Plan nursing care for a child with gastrointestinal disorder.
6. Implement nursing care for a child with gastrointestinal disorder.
7. Evaluate expected outcomes for achievement and effectiveness of care.
8. Identify areas of care related to gastrointestinal disorder.
9. Integrate knowledge of gastrointestinal disorder with nursing process to achieve
child health nursing care.

CASE SCENARIO
A10-year-old boy presents to his primary care provider with a 5-day history of abdominal
pain and a 2-day history of diarrhea and vomiting. He describes the quality of the
abdominal pain as sharp, originating in the epigastric region and radiating to his back,
and exacerbated by movement. Additionally, he has had several episodes of non-
bloody, nonbilious vomiting and watery diarrhea. with as many as eight bowel
movements per day. His mother discloses that several family members at the time also
have episodes of vomiting and diarrhea.

He admits to decreased oral intake throughout the duration of his symptoms. He denies
any episodes of weight loss, fatigue, night sweats, or chills. He also denies any
hematochezia or hematemesis.

Examination of the abdomen reveals tenderness in the epigastric region and the right
lower quadrant on light to deep palpation, with radiation to his back on palpation. There
are no visible marks or lesions on his abdomen. Physical examination is negative for
rebound tenderness, rovsing sign, or psoas sign. The remainder of the examination
findings are negative.

Fecal leukocyte testing and stool cultures were sent. A Gram stain of the pathogen
isolated from stool culture is an infectious etiology is highly suspected given this patient’s
presentation, leading to work-up with fecal leukocytes and stool cultures. The presence
of fecal leukocytes, which was positive in this patient, is a strong indicator of
inflammatory diarrhea. Bacterial stool culture allows for detection of Salmonella,
Shigella, Campylobacter, E. coli O157:H7, Yersinia, Aeromonas, and Plesiomonas.
Complete blood cell count, liver enzyme levels, pancreatic enzyme levels, and urinalysis
results are all within normal limits. diagnose with severe diarrhea diagnose with severe
diarrhea

However, with the worsening of his abdominal pain, further diagnostic study became
imperative and a computed tomographic (CT) scan of the abdomen was obtained to
assess for appendicitis or nephrolithiasis. The CT scan showed a cecum located midline;
the large intestine was on the left side of the abdomen, and the small intestine was on
the right. The appendix was buried deep in the right pelvis, and there was no indication
of appendicitis. Another laboratory examination revealed the following results:

Urinalysis

Color: light yellow

Transparency: Clear

Leukocyte: negative

Nitrite: Negative

Urobilinogen: Normal

Protein: negative

PH: 6.5

Blood: negative

Specific gravity 1.010

Bilirubin: negative

Glucose: negative

Pus cells: 0-3/ HPF

RBC: 0-2

Epithelial cells: few

M. threads Few

Urates: Many

Calcium oxalates crystals: many

Hematology

Hct: 39

Hgb: 130 g/l

RBC: 4.6 x10 12/L

WBC: 11.4 x 10 9/L

Differential count:
Segment: .65

Lymphocyte: .35

Fecalysis

Color: Light brown

Consistency: watery

Odor: Fecaloid

E. Histolytica: cyst 1-3/LPT

Pus cells: 2-8/HPF

Fat Globules: Moderate

Bacteria: Many

The medications prescribed by the pediatrician are as follows:

1. Metronidazole 500 mg tab P.O q 8

2. Metronidazole 300 mg TIV q 8 ANST
3. Cotrimoxazole Embatrin Forte 800 mg/160 mg cap 1 cap. BID
4. Cotrimoxazole Embatrin Forte 5 mg IV BID
5. Paracetamol 325 mg tab 1 tab. Q4 PRN