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A CARE STUDY ON ACUTE GASTROENTERITIS In Partial Fulfilment Of the Requirements of the Subject: NCM 103 Care of Clients Across

the Lifespan with Problem in Oxygenation, Fluid, Electrolyte and Acid-Base Balance, Metabolism and Endocrine

Submitted to: Ms. Mae M. Seguerra BSN Level III Clinical Instructor (CHH-5C)

Submitted by: Hinoguin, Honey Mae U. Student BSN Level III-E

TABLE OF CONTENT

PAGE

I. INRODUCTION ............................................................................................. II. GENERAL DATA ........................................................................................ III. HEALTH ASSESSMENT A. HEALTH HISTORY
A.1 A.2 A.3 A.4

Biological data .............. Reasons for seeking consultation ............ Current Health Status .............................. Past Health History ............ Family History .........

A.5

B.Gordons Functional Health Patterns .. C.Psychosocial Profile . D.PHYSICAL EXAMINATION ..

IV.ANATOMY AND PHYSIOLOGY OF THE GASTROINTESTINAL TRACT V.CONCEPTUAL FRAMEWORK OF THE PATHOPHYSIOLOGY OF THE DISEASE CONDITION ....................... VI.THEORETICAL FRAMEWORK OF THE PATHOPHYSIOLOGY OF THE DISEASE CONDITION VII.CLINICAL MANAGEMENT

A.MEDICAL MANAGEMENT

A.1 LABORATORY AND DIAGNOSTIC EXAMINATIONS .. A.2 TREATMENT AND PROCEDURE . A.3 MEDICATIONS ( Drug Study Format) A.4 DIET ................................................................................................ B. NURSING MANAGEMENT B.1 NURSING CARE PLAN .. B.2 DISCHARGE PLAN.... VIII.CONCLUSIONS AND RECOMMENDATIONS IX.IMPLICATIONS OF THE STUDY TO:
A. NURSING EDUCATION B.NURSING PRACTICE C.NURSING RESEARCH

APPENDICES: APPENDIX A: PERMIT LETTER APPENDIX B: NCP APPENDIX C: DP APPENDIX D: DRUG STUDY

BIBLIOGRAPHY

I.

INTRODUCTION

Gastroenteritis (also known as gastric flu, stomach flu, and stomach virus, although unrelated to influenza) is marked by severe inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in acute diarrhea and vomiting. It can be transferred by contact with contaminated food and water. The inflammation is caused most often[citation needed] by an infection from certain viruses or less often[citation needed] by bacteria, their toxins (e.g. SEB), parasites, or an adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis resulting from foodborne illness are caused by norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and astrovirus. Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers to become infected during times of rain as a result of contaminated runoff water.

II.

GENERAL DATA

NAME: K.C.G ADDRESS: Deca Homes Minglanilla Cebu AGE: 1 year old SEX: Female BIRTHDATE: April 23,2010 NATIONALISM: Filipino RELIGION: Penticostal CIVIL STATUS: Single OCCUPATION: NA CITIZENSHIP: Filipino ROOM NO: MB1-PEDIA WARD ATTENDING PHYSICIAN: Dr. Nerissa Altobar DATE OF ADMISSION: September 12, 2011 TIME OF ADMISSION: 07: 27 PM

III.HEALTH ASSESSMENT A.HEALTH HISTORY A.1 BIOLOGICAL DATA A case of K.A.G.,female, 1 year old, penticostal,single a resident in Deca Homes Minglanilla Cebu came in for fever and episodes of loose watery stools and vomiting. Morning prior to admission, onset of vomiting about 8 episodes of previously eating food and drink about - cup per episode associated with fever (38.4 c) and had 3 episodes of loose watery yellow stools. A.2 REASON FOR SEEKING CONSULTATION The patient came in for fever,diarrhea and episodes of vomiting.

A.3 CURRENT HEALTH STATUS Patient was admitted at Chong Hua Hospital for the first time due to vomiting and and loose watery stools on September 12,2011 at 07:27 pm .Vital signs were taken with a Blood Pressure of 90/60, heart rate of 160 bpm, respiratory weight of 40 cpm, and temperature of 38.4 degrees Celsius and examined by the Resident on Duty. Patient was admitted under the care of Dr. Nerissa Altobar and a signed consent to care was secured. A.4 PAST HEALTH HISTORY Patient had her complete doses of immunization on BCG, 3 doses DPT,3 doses OPV/IPV, 3 doses HEP B and AMV at a private clinic and Barangay Health Center respectively. No previous hospitalization was noted. A.5 FAMILY HISTORY Members of the Immediate Family Family Member R.V.G M.O.G K.C.G Age 24years old 24 years old 1 year old Position Father Mother Role Head of the family Bread winner of the family daughter

Patients mother claimed that the patients father side had a significant history of asthma, hypertension, cancer and diabetes mellitus but she does not know as to what type of diabetes mellitus condition. She also reported that on her side her mother was also diagnosed with a high sugar level and her father is hypertensive. (SEE APPEDIX B: GENOGRAM) A.6. REVIEW OF SYSTEMS Nutrition and Metabolic Pattern Patients mother claimed that the patients diet is composed of six scoops of cereal (cerelac) per feeding, three times per day. Mashed potato and squash are also incorporated in her diet. Patient is formula fed (Gain Formula Milk). Fruit juices and water were also introduced as part of her daily fluid intake. Patient vitamin supplements include Vitamin C (Ceelin drops/ 1ml /day) and Multivitamins (Growee drops/1ml/day).

Elimination Pattern Patients mother reported that they usually changed diapers at least three times in a day with usually1 to 2 bowel movements. Stool were usually greyish to greenish, soft and formed.The patient had a normal elimination pattern with no difficulty in urinating and defecating. Activity and Exercise Pattern Patients caregiver stated that patient usually starts her day with a bottle of milk before toying around with her toys. Patient usually stays inside the house and seldom goes outside. Sleep and Rest Pattern Patients mother claimed that patient usually sleeps two times in day usually after her morning bath around 9 AM and her afternoon nap is usually 2 PM. At night patient usually retires around 8:30 pm and is usually an early riser. Patient usually rises around 5 to 6 AM. Cognitive and Perceptual Pattern Patient elicited throaty, gurgling sound at 1 month, laughs and squeaks at 2 to 3months, moves head towards sounds at 4 months, said mam when crying at 7 months, can utter the words mama and dada at 8 months, imitates sounds at 9 months, and understands gestures at 10 month to 11 months. Self-perception and self-concept pattern N/A Characteristic patterns of daily living Patients activity includes rising up and sleeping early. She usually had 2 periods of naps during the day usually after she takes a bath and the morning and after lunch. During the day she is cared for by her caregiver for her mother had to work and her father had to attend school. Patient seldom has tantrums and usually is engrossed with playing with her toys or watching the television. During the night she sleeps together with her parents. Role Relationship Pattern Patient is directly under the care of a caregiver because her mother has to work and her father is still attending school. Patient is more attached to her caregiver than her mother. Coping- Stress Tolerance Pattern Value and belief pattern Patients parents are both Penticostal and they believe that everything happens according to Gods plan.

A.7. Psychosocial Profile LIFESTYLE N/A EDUCATION N/A ECONOMIC STATUS Patients mother is a call center agent in convergys, while her father is a graduating physical therapist student at Southwestern University at Urgello Street, Cebu City. They are sometimes supported by patients grandparents of both sides. TRAVEL HISTORY Patient had no significant travel aside from visiting her grandparents on her mother side during her parents free time. A.8. DEVELOPMENTAL DATA Age Developmental Task Behavioural Analysis Patient was seen to be always at her mothers side or her yaya. She appears to be afraid the first time I took her vital signs but as days that follow she always welcomes me with a smile as I entered her room. Always curios as she tries to get the thermometer stuck to her axilla or anything that comes near her grasp. Scientific Basis During this stage they are dependent on the environment, needs security. Explores self and has a natural curiosity. (source: Erik Eriksons eight stages of psychosocial development, http://www.businessballs.co m/erik-erikson-psychosocialtheory.htm)

Infant to Trust versus toddlerhood mistrust (birth to 2 Autonomy years) versus shame and doubt

A.

PHYSICAL EXAMINATION

General: Received patient cuddled by mother, teary eyed with IVF of # 1PLR 500cc and regulated at 60-65 cc/hr infusing well at right arm. Vital signs: Temperature: 38.4 degree Celsius Pulse rate: 118 bpm Respiratory rate: 36 cpm Blood pressure: N/A Skin Skin is cool to touch, has a white skin color, no skin rashes, good skin turgor, no lesions and wounds. Head Head circumference is 45 cm. No presence of lesions, hair color is black and evenly distributed. No presence of scaliness, lumps, and tenderness on the scalp. Face Facial expressions are symmetrical Eyes Eyes are symmetrical; there is no loss of vision. No inflammation detected. Ears Ears are symmetrical. No hearing loss, no lesions, clean, no discharges noted. Nose External structures are symmetrical at midline of the face. Lesions and nasal flaring were not noted. Mouth and Throat Lips are moist, no bleeding of gums, no lesions and inflammation noted. Two lower incisors were noted. Patient does not have any difficulty swallowing and no thyroid gland enlargement was noted.

Respiratory Breathing is regular. Chest wall are symmetrical. Productive cough was noted. Gastrointestinal Diet of patient was prepared by her mother and was on aspiration precaution. Feeding consisted of formula milk, juices and cereals. No nausea and vomiting were noted. Genitourinary Patient is not experiencing any difficulty in urinating. No foul discharges were noted Endocrine Skin distribution is normal and no enlargement of any organ was noted. Musculoskeletal Patient had no restriction in moving especially when changing positions. Cardiovascular Patients chest is symmetrical and with no tenderness noted. No pulsations were visible. White blood cell count and platelet were elevated as seen on patients hematologic report indicating inflammation or infection. Psychiatric No tantrums were noted.

IV.

Anatomy and Physiology

Oral cavity The oral cavity or mouth is responsible for the intake of food. Esophagus The esophagus is a muscular tube of approximately 25cm in length and 2cm in diameter. It extends from the pharynx to the stomach after passing through an opening in the diaphragm. Stomach The stomach is a J shaped expanded bag, located just left of the midline between the esophagus and small intestine. It is where the digestion of food continue its process. Small intestine The small intestine is where most chemical digestion takes place. Most of the digestive enzymes that act in the small intestine are secreted by the pancreas and enter the small intestine via the pancreatic duct. After further digestion, food constituents such as proteins, fats, and carbohydrates are broken down to small building blocks and absorbed into the body's blood stream. Large Intestine The large intestine is horse-shoe shaped and extends around the small intestine like a frame. It consists of the appendix, cecum, ascending, transverse, descending and sigmoid colon, and the rectum. It has a length of approximately 1.5m and a width of 7.5cm.

The rectum is the final 15cm of the large intestine. It expands to hold fecal matter before it passes through the anorectal canal to the anus. Thick bands of muscle, known as sphincters, control the passage of feces. The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal surface is flat with several deep intestinal glands. Numerous goblet cells line the glands that secrete mucous to lubricate fecal matter as it solidifies. The functions of the large intestine can be summarized as:

The accumulation of unabsorbed material to form feces. Some digestion by bacteria. The bacteria are responsible for the formation of intestinal gas. Reabsorption of water, salts, sugar and vitamins.

Liver The main roles of the liver in digestion are in the production of bile and metabolism of nutrients. Gall bladder The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior surface of the liver's right lobe. It consists of a fundus, body and neck. It empties via the cystic duct into the biliary duct system. The main functions of the gall bladder are storage and concentration of bile. Pancreas The pancreas completes the job of breaking down protein, carbohydrates, and fats using digestive juices of pancreas combined with juices from the intestines.

VI.Theoretical Framework of the Pathophysiology of Acute Gastroenteritis Acute gastroenteritis is usually caused by bacteria and protozoa. In the Philippines, one of the most common causes of acute gastroenteritis is E.histolytica. The pathologic process starts with ingestion of fecally contaminated food and water. The organism affects the body through direct invasion and by endotoxin being released of the organism. Through these processes the bowel mucosal lining is stimulated and destroyed the eventually lead to attempted defecation or tenesmus as the body tries to get rid of the foreign organism in the stomach. The client with acute gastroenteritis may also report excessive gas formation that may leads to abdominal distention and passing of flatus due to digestive and absorptive malfunction in the system. Feeling of fullness maybe relieved only when the patient is able to pass a flatus. As the destruction of the bowel continues the mucosal lining erodes due to toxin, direct invasion of the organism and the action of the hydrochloric acid of the stomach. As the protective coating of the stomach erodes the digestive capabilities of the acids helps in destroying the stomach lining. Pain or tenderness of the abdomen is then felt by the patient. When the burrows of ulceration reaches the blood vessels in the stomach bleeding will be induced. Dysentery may be characterized by melena or hematochezia depending on the site and quantity of bleeding that may ensue. Signs of bleeding may be observed also through hematemesis. As the bowel is stimulated by the organism and its toxin, the intestinal tract secretes water and electrolytes in the intestinal lumen. The body secretes and therefore lost Chloride and bicarbonate ions in the bowel as the body try to get rid of the organism by increasing peristalsis and number of defecation. Sodium and water reabsorption in the bowel is inhibited with the lost of the two electrolytes. Mild diarrhea is characterized by 2-3 stool, borborygmi (hyperactive bowel sound), fluid and electrolyte imbalance and hypernatremia. When the condition continue to progress, protein to the body is excreted to the lumen that further decreases the reabsorption and the body become overwhelmed that leads to intense diarrhea with more than 10 watery stool. Serious fluid volume deficit may lead to hypovolemic shock and eventually death.