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A. Background of the Study

• This study deals with the case of a 6 year-old

patient male client (Client Z) who was
admitted at the Pedia Ward of MCU-FDTMF
hospital on January 18, 2010 with a final
diagnosis of Acute Gastritis.
• Client Z experienced abdominal pain with
associated undocumented fever and with no
associated vomiting or loose bowel
movement. Upon seeking medical help, he
was considered to have appendicitis. He was
then advised to be hospitalized together with
the persistence of abdominal pain, for further
• Gastritis is inflammation of the gastric mucosa
caused by any of several conditions, including
infection (Helicobacter pylori), drugs (NSAIDs,
alcohol), stress, and autoimmune phenomena
(atrophic gastritis). Many cases are
asymptomatic, but dyspepsia and GI bleeding
sometimes occur. Diagnosis is by endoscopy.
Treatment is directed at the underlying cause
but often includes acid suppression and, for H.
pylori infection, antibiotics.
• Gastritis is classified as erosive or non erosive based
on the severity of mucosal injury. It is also classified
according to the site of involvement (ie. cardia,
body, antrum). Gastritis can be further classified
histologically as acute or chronic based on the
inflammatory cell type. No classification scheme
matches perfectly with the pathophysiology; a large
degree of overlap exists. Some forms of gastritis
involve acid-peptic and H. pylori disease.
Additionally, the term is often loosely applied to
nonspecific (and often undiagnosed) abdominal
discomfort and gastroenteritis.
• Gastritis may occur suddenly (acute gastritis) or it
can occur slowly over time (chronic gastritis). In
some cases, gastritis can lead to ulcers and an
increased risk of stomach cancer. For most
people, however, gastritis isn't serious and
improves quickly with treatment. Acute gastritis
occurs suddenly and is more likely to cause
nausea and burning pain or discomfort in your
upper abdomen. It is characterized by PMN
infiltration of the mucosa of the antrum and
• The signs and symptoms of gastritis includes a
gnawing or burning ache or pain (indigestion) in
your upper abdomen that may become either
worse or better with eating, nausea, vomiting,
loss of appetite, belching or bloating, a feeling of
fullness in your upper abdomen after eating and
weight loss
• The predicted outcome associated with
acute gastritis is related to the cause of the
gastritis. Most individuals with acute
gastritis recover completely within 48 hours
of starting treatment. Acute gastritis due to
stress or associated with bleeding has a
poorer prognosis and longer recovery times
may be expected.
• Type A gastritis (autoimmune atrophic
gastritis) can result in destruction of a
compound secreted by the stomach
(intrinsic factor) that allows vitamin B12 to
be absorbed. A form of anemia (pernicius
anemia) may result if the individual
becomes deficient in vitamin B12. Injections
of vitamin B12 can alleviate this condition.
B. Rationale for Choosing the Case

• To have further understanding about the

anatomy and physiology of the system involve in
the disease.
• To gain awareness about predisposing factors
leading to the disease and apposite intervention
to prevent it.
• To have familiarity and understanding on the
pathophysiology, diagnosis and management of
the disease
C. Significance of the Study
• Knowledge about this study can help the client
and its relatives understand the acquisition,
development and progress of the disease.
Awareness of these certain type of disease will
enable them to avoid predisposing factors that
can lead to the disease. Moreover studying this
case would contribute for the client’s fast
recovery, and acquisition of new knowledge and
skills not only on the Student Nurse’ part but also
for the client and his relatives.
Awareness of the community about this
disease can be a good help to reduce the
mortality, prevalence and morbidity of this
disease, through developing awareness and
understanding of the said condition. Especially
acute gastritis is prevalent but has a very wide
range of signs and symptoms.
Nursing Profession
Both student nurses and registered nurses
will gain knowledge and skills from this study.
This work would also serve as reference for
further study. This can also help rendering
continuity of care and establishing future care
plan to client with the same case.
D. Scope and Limitation

This study will be confined to a 6 years

old, male patient, in pediatric ward of MCU-
FDTMF where the group was exposed last
January 19-20, 2010. And the patient was
admitted last January 18, 2010 with a chief
complaint of abdominal pain associated
with undocumented fever.
The patient is under observation and for
other diagnostic examinations to confirm the
diagnosis. This study is mainly focusing on acute
gastritis, regarding its anatomy and physiology,
pathophysiology of the disease process, the
predisposing factor, management. The major
sources of this information gathered for this
study are the relatives and the patient’s chart.
Health History
General Data
• Client’s Name: Patient Z
• Address: Malabon City
• Date of Birth: June 26, 2003
• Age: 6 Years old
• Religion: Roman Catholic
• Source of Information: Client, Client’s relative and
Client’s chart
• Date of Admission: January 18, 2010, 6:35pm
• Sex: Male
• Nationality: Filipino
• Occupation: None
• Civil Status: Single
B.Chief Complaint
Patient Z was admitted with a chief complaint
of abdominal pain with associated undocumented
C. History of Present Illness
• One week prior to admission, the patient
developed non-productive cough, given
Ambrotex which relieved symptoms temporarily.
• Few days prior to confinement, patient had a
fever of 39oC with associated loss of appetite and
abdominal pain described at epigastric area.
There was also coldness of extremities. Persist of
symptoms prompted consult and subsequent
D.Past Medical History
Client Z has no said past medical history like having
an allergy, asthma or other common disease, but
patient is positive for attention deficit hyperactivity
disorder (ADHD).

• The client has not undergone any operations.
E. Family History

• Client Z has a family history of

asthma and Diabetes Mellitus both
on paternal side.
F. Physical Assessment
Date Assessed: January 20, 2010
G. Patterns of Functioning

Client Z, a 6 year old male, Filipino, Roman

Catholic, born on June 21, 2003, and was
admitted at the MCU-FDTMF Hospital Pediatric
Ward dated January 18, 2010. Interview for
patterns of functioning was conducted on
January 20, 2010
Activity and Rest
Client Z spends most of his tome playing with
his friends at their neighborhood. He usually
wakes up at 5:30 am for schooling, immersing to
recreational activities, playing with his friends
and schoolmates. After school, client Z always
goes straight to their home, to watch television
and to do what a typical school age does. He
sleeps at exactly 10:00 pm and this was done
There are no assessed and observed
problems pertaining to the circulation of the
Ego Integrity
Client Z, were stressed out when making out
assignments and when having argue with his
playmates. His way of handling stress is through
watching television, playing and eating.
Client Z has tenderness on his right lower
quadrant. His usual bowel pattern is once to twice
a day. On his previous admission (January 19) the
client experienced abdominal pain. By the end of
the shift, the client passed a stool.
Food and Fluid
Client Z undergo under “nothing per Orem”
following a soft diet. He takes three meals a day;
and always takes in snacks. In our 6 hour shift, he
is being supplemented by his intravenous fluid of
5% Dextrose in Lactated ringers Solution infusing
at 100cc/hr. his current weight is 29.5 kilograms.
Client Z is on bed rest with bathroom
priviledges, he can bathe with the assistance of
his parents.
Client Z is conscious, alert and coherent. His
eyes ate symmetrical with round pupils reactive
to light. He does not experience any blurring of
vision and difficulty. The patient is positive for
Attention-deficit hyperactivity disorder (ADHD).
Pain and Discomfort
Client Z experienced abdominal pain the
previous day, which radiates to his right lower
quadrant with a pain scale of 7/10 and the
presence of facial grimace. At present he
experiences loss of appetite.
Client Z has no problem in his respiratory
Client Z has no known allergies and has not
yet encountered any injury.
Client Z is a just a preschool child.
Social Interactions
Client Z has only enjoying in playing with his
playmates in the school and in his neighborhood.
Aside from that he used to be with his parents all
the time.
Teaching and Learning
Client Z expects that he will be able to cope up
with his disease and to return at their home as
soon as possible.
H. Impression or Medical Diagnosis

Acute Gastritis
Generic Brand Classific Action indication dosage Side effects Nursing responsibilities
name name ation

Azithro- Zithromax Macrolide Bactericidal Prevent 200mg/5ml Stomach  Inform the patient or the
mycin in certain cramping relatives of the patient to take
Zmax Antibiotic
susceptible bacterial the drug in full course
bacteria infections prescribed. Should not be
Diarrhea taken with antacids

Fatigue  Inform the patient or the

relatives of the patient to
report immediately any side
effects experienced.

 Should administer the drug

on an empty stomach 1 hour
before or 2-3 hours after
meal. Foods affects
absorption of this drug
Lanso- Prevacid Anti- Suppresses Short term 150mg/ml Dizziness  Should administer before
prazole secretory gastric acid treatment of meals.
Prevacd Headache
drug secretion by gastric
IV  Inform patient or the relatives
specific ulcers. Nausea
Proton of the patient to report any
inhibition of
pump Vomiting side effects manifested by the
client after taking this drug.
inhibitor hydrogen- Diarrhea

system of
surface of
the gastric
cells, blocks
the final step
of acid
Acetamino- Supposito  Analgesic Antipyretic: Temporary 200mg/5ml  Rash  Do not exceed the recommended
phen -ries: (nonopiod) reduces fever reduction of
 Unusual
by acting fever  Consult physician if needed for
 Acephen Antipyretic bleeding or children less >3y/o.
directly on
Oral: the  Give drug with food if GI upset
hypothalamic  Yellowing of
 Tempra
heat- the skin and  Discontinue drug if hypersensitivity
 Tylenol regulating eyes
center to
 Changes in
which helps
Site and
of action

Examination: CBC with PLT

Hemoglobin report

Component Result Unit Ref. Values

Erythrocytes NUM------------- 4.87 -----------------------x 10^ 12/L ---------------- 4.6-6.20 X 10 ^12/L
Hemoglobin---------------- ----¯13.20--------------------------- g/dl --------------------------13.5 –18.0 g/dl
Hemoglobin SUBSTC--------¯2.046------------------------- mmol/L ---------------2.09-2.79 mmol/dl
Erythrocytes VOLFR-----------¯0.38-------------------------------------------------------------0.42-0.50
Leukocytes NUMC------------- 21.0------------------------- x 10^g/L--------------------- -4.5-11 X 10^g/L
Segmenters----------------0.85-------------------------------------------------------------------- 0.56
Monocytes------------------0.02---------------------------------------------------------------------- 0.04
Thrombocytes NUMC------------417----------------------- x 10^g/L-------------------------150-400 X 10 ^g/L
MCV----------------------------------78.9---------------------------fl----------------------------------------80-96 fl
MCH---------------------------------- 27------------------------------pg------------------------------------27.31 pg
MCHC------------------------------- 0.35------------------------------------------------------------------ 0.32-0.36
Lab Interpretations
* Deviations on the RBC and WBC count
indicates an underlying infection.

•To render proper management of the disease.

•To prevent the repeat of infections to worsen the
•To manage the disease properly and to render
accurate care.
•To ensure the cline t and family a clear
understanding about the benefits and advantages of
follow up care.
•To eliminate further problems and complications
that can aggravate the disease.
•To provide the client a clear understanding of the
January 19, 2010 Abdominal pain Pain related to
intestine inflammation
secondary to right
lower quadrant
January 19, 2010 Fever Acute pain related to
inflammation at the
January 20, 2010 Loss of appetites Elevated body
temperature related
infection of the suture.
Nursing Care Plan
Problem Nursing Diagnosis Rationale Objectives Interventions Rationale Evaluation

Abdominal Pain related to Infectious agent Within 6 hours of nursing Independent: After 6 hours of
Discomfort intestine intervention, the patient will nursing
inflammation be able to have a 1) Monitor vital signs. 1) To have a intervention, the
Subjective: secondary to right Inflammation of comfortable state and pain baseline patient was
lower quadrant the stomach score will decrease into informatio able to have a
The patient lining n of the
tenderness 3/10. comfortable
verbalized, patient. state and the
“Masaki tang 2) To note the
2) Determine possible pain score
tiyan ko.” Right lower precipitating
pathophysiological decreased into
quadrant factors
Objective: causes of the pain. 3/10.
tenderness contributing to
Expressive the pain felt by GOAL MET
behavior the patient.
Stomach pain
 Restlessn 3) To note the
3) Assessment of pain
ess patient’s
to include location,
 Moaning Abdominal attitude towards
 Crying Discomfort the pain.
frequency and
Painscore: 7/10
Facial grimace
4) Provide adequate 4) To promote
rest. wellness and
prevent fatigue.
5) Use puppets to
demonstate to a child 5) To assist
to enhance client in
understanding of the exploring the
pain. methods of
alleviating pain.
1) To alleviate
1) Administer
the pain felt by
analgesics as
the patient.
indicated by the
Problem Nursing Rationale Objectives Interventions Rationale Evaluation
FEVER Infection After 2 hours of Independent After 2 hours of
nursing nursing
Subjective: Elevated Body Inflammation -assess -to have a
interventions, interventions,
Temperature patient’s vital baseline data of
The patient’s WBC the patient will the patient was
related to signs the patient
mother be able to able to maintain
Infection Cytokines
verbalized, maintain a core -render TSB -to alleviate the a core
“mainit ang Triggers temperature body temperature
-provide bed
katawan ng hypothalamus to within a normal temperature within a normal
anak ko.” stimulate range. range.
-to ensure
increase in body dependent
Objective comfort for the
-administration patient
Cough and
FEVER of antipyretic
chills -to alleviate
hot flushed skin
T: 38.6˚C

PR: 120bpm

RR: 20cpm
Loss of Imbalance Acute gastritis After 5 hours of INDEPENDENT: After 5 hours of
appetite nutrition: less nursing -establish rapport to the -to gain trust of the nursing
Subjective: than body intervention the patient patient intervention, the
“ayokong requirements Diet patient will -to gain cooperation of patient verbalized
kumain kahit related to (eating verbalize the the patient eagerness to eat
yang biscuit” inability to ingest contaminated food) eagerness to eat -assess for drug -some drugs affects the food.
Objectives: food and food. interactions, disease appetite, food intake or
>weakness weakness effects, allergies, use of absorption of the patient
>inability to Ingestion of laxatives, diuretics (side/ adverse effect)
ingest food bacteria -note occurrence of tooth -this may affect the
decay ability to eat of the
Loss of appetite patient
-note age, body built, -it helps determine the
strength, activity/ rest level specific nutritional needs
DEPENDENT: of the patient
-administer multivitamins -to increase the clients
(as ordered by the eagerness to eat and to
physician) provide the nutrients (
vitamins and minerals)
that compensate to the
COLLABORATIVE: loss during the absence
- refer to nutritionist/ of food
dietician -to ensure that the diet
given is balance and
specific for the patients
age group
D. Course in the ward

• On January 19, 2010 client was awake and lying

on bed. He was hooked with 5% dextrose in
lactated ringers solution at 110 cc/hr at 100 level
on his left hand. Client was positioned flat on
bed comfortably.
• At 8:00am, the client vital signs were taken
as follows: BP=100/70mmhg, PR=120,
RR=28, Temp=37.5, instructed the febrile
patients mother to perform TSB at 9:00am,
rehooked IVF to D5LR 500cc at full level
regulated at 110cc/hr, recheck for
temperature, Temp=36.9, afebrile.

• At 11:30am, vital signs taken and recorded

at normal rates. Intake and output was
• On January 20,2010 client was awake,
coherent and sitting on bed, he was hooked
with D5LR solution at 110cc/hr at 220cc
level on his left hand.
• At 8:00am the client vital signs were taken
as follows: BP=120/80mmhg, PR=106,
RR=40, Temp=36.0 normal ranges. The was
energetic but refuse to eat, even small
amount of biscuits.

• At 11:30am, vital signs taken and recorded

at normal rates. Intake and output was