DATA FROM TEXTBOOK

ACUTE GASTROENTERITIS
A. Description
 Gastroenteritis is an inflammation of the GI
tract; it most commonly affects the small
intestine
 July 22, 2004 - Department of Health (DOH),
declared an epidemic (outbreak) in 45 towns
in Central Pangasinan.
 B. Etiology and Incidence
 Bacterial gastroenteritis is caused by a variety
of bacteria, including, Escherichia coli and
Compylobacter and Shigellosis
 Viral gastroenteritis is caused by various types
of viruses including the rotavirus and
parvovirus-type organisms
 Infants and the aged are particularly prone
Shigellosis, especially in crowded living
situations
 C. Clinical Manifestations and
Diagnostic Findings
Symptoms common to all types of gastroenteritis include:
– Nausea
– Vomiting
– Diarrhea
 Compylobacter - stool specimens are positive for white
blood cell count (WBC) and possibly high red blood cell
count (RBC)
 High WBC and the presence of pus indicate Shigella
 Infection can last anywhere from 2 to 7 days
 If diarrhea and vomiting becomes severe, complications
such as dehydration, orthostatic hypotension, oliguria,
and shock can result
 D. Medical Management
 Oral rehydration therapy in the home environment
 Rehydration therapy in healthcare settings
Medications
– Antiemetics
• Antiemetic drugs may be helpful for vomiting in children.
– Antibiotics
• Antibiotics 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. If
antibiotics are decided on, a fluroquinolone is often used.
– Antimotility agents
• Antimotility drugs have a theoretical risk of causing complications;
clinical experience, however, has shown this to be unlikely. They
are thus discouraged in people with bloody diarrhea or diarrhea
complicated by a fever.
 Diet
 Rapidly reintroducing normal feeding is the
optimal rehydration method for children who
are mildly to moderately dehydrated.
 For older children, the usual advice is to eat
bananas, rice cereals, apples, and toasts (ie,
BRAT diet). Also on the recommended list are
complex carbohydrates (eg, rice, wheat,
bread, cereals), lean meats, yogurt, fruits, and
vegetables.
 E. Nursing Management
1. Administer anti-infective agents, analgesics, and
electrolyte replacement medications such as
potassium, acetate as ordered by the physician.
2. Monitor and manage fluids and electrolytes
3. Observe intake and output
4. Monitor daily weight to identify need for
changes in nutritional methodology
5. Collect stool specimen
6. Provide meticulous perianal skin care
7. Monitor blood pressure to identify orthostatic
hypotension
 HIRSCHSPRUNG’S DISEASE
(CONGENITAL AGANGLIONIC MEGACOLON)
A. Description
 Hirschsprung’s disease is a congenital anomaly
characterized by the absence of nerves to a
section of the intestines. it results in mechanical
intestinal obstruction due to inadequate motility
in an intestinal segment
 It is at least four times more common in boys
than in girls and is seen more commonly in
children with Down syndrome
 It can be acute and life-threatening or chronic
 B. Etiology and Incidence
 Familial
 Congenital Defect
 Failure of the craniocaudal migration of
ganglion nerve cell precursors along the GI
tract between 5th and 12th week of gestation
 C. Clinical Manifestations and
Diagnostic Findings
 Neonates. Failure to pass meconium, reluctance
to ingest fluids, abdominal distention, and bile-
stained vomitus
 Infants. Failure to thrive, constipation, abdominal
distention, vomiting, and episodic diarrhea
 Older Children. Anorexia, visible peristalsis, foul-
smelling and ribbonlike stools, abdominal
distention, palpable fecal mass, malnourishment
or poor growth , signs of anemia, and
hypoproteinuria
 Rectal examination typically reveals a rectum empty of
stool, a tight anal sphincter, and stool leakage
 Ominous signs signifying enterocolitis include
explosive, bloody diarrhea, fever, and severe
prostration
 Barium enema reveals megacolon
 Rectal biopsy reveals absence of ganglionic cells, which
confirms the diagnosis
 Anorectal manometry, whereby a balloon catheter is
inserted into the rectum, records the reflex pressure
response of the internal anal sphincter.
 D. Medical Management
The goals in treatment are 3-fold: (1) to
treat the complications of unrecognized
or untreated Hirschsprung disease, (2) to
institute temporary measures until
definitive reconstructive surgery can take
place, and (3) to manage bowel function
after reconstructive surgery.
 Diet
The patient should have nothing by
mouth before the operation.
Institute tube feeding or formula/breast
milk once bowel function resumes.
High-fiber diets and diets containing
fresh fruits and vegetables may optimize
postoperative bowel function in certain
patients.
 E. Surgical Management
Surgery to remove the ananglionic, non functioning
segment of colon, followed by anastomosis in
three stages:
- temporary colostomy before definitive surgery
to allow bowel to rest and child to gain weight
- reanastomosis by means of an
abdominoperineal pull through about 9 to 12
months later
- closure of the colostomy about 3 months after
the pull through procedure
 F. Nursing Management
1. Assess for and promptly report sign s of enterocolitis
2. Promote adequate hydration
3. Assess bowel functioning
4. Promote adequate nutrition according to the child’s
age and nutritional requirements
5. Administer enemas as prescribed to relieve
constipation
6. Avoid taking temperatures rectally because of the
potential for damaging frail mucosa
7. Decrease discomfort by abdominal distention
8. Educate the child and family
 MEDICAL MANAGEMENT INDICATED
FOR THE PATIENT
Medications:
– Cefuroxime 235mg IV q8
– Metronidazole 40mg IV q8
IV fluids:
– Sept. 24, 2010 – D5LR 1L x 200 cc/hr for 1 hour then shift to
95 cc/hour for 5 hours
– Sept. 25, 2010 – 0.9% NaCl 1L x 8 hours
Diet:
– Sept. 24, 2010 – NPO
– Sept. 25, 2010 – DAT
Vital Signs Monitoring and special orders:
– Every 2 hours
– Strict asepsis and handwashing
Surgery:
– removal of temporary colostomy
SIGNS AND SYMPTOMS