UNIVERSITY OF MINDANAO

COLLEGE OF HEALTH SCIENCES EDUCATION

Bachelor of Science in Nursing

ACUTE GASTROENTERITISGROUP 3

Submitted to:
Mrs. Majella Gonzales

July 2021
I. PATIENT’S PROFILE

Patient’s Name: Jayson Cenas

Age: 3 years & 11 months old
Gender: Boy
Height: 106 cms
Weight: 16 kg
Date of Admission: 17th January 2021
Date of Discharged: 20th January 2021
Informant: Mother
Address: Gumalang, Calinan, Davao City
III. DESCRIPTION OF THE DISEASE/ILLNESS

 Acute Gastroenteritis
If you are experiencing diarrhea and vomiting, you can say that you are having the “stomach flu” or
you are having a condition called gastroenteritis. With this condition, your stomach and intestines are
irritated and inflamed that is caused by a viral or a bacterial infection.
Acute gastroenteritis is a disease state that occurs when food or water that is contaminated with
pathogenic microorganisms such as Clostridium perfringes, Vibrio cholera, E. coli, or their toxins is
consumed. This condition has symptoms such as nausea, vomiting, diarrhea, and abdominal pain. The
causes of gastroenteritis are food or water that is contaminated with bacteria or a virus, unwashed
hands after going to the bathroom or after changing a diaper, or having a contact with someone who
has the virus. There are two types of viruses that can cause gastroenteritis. They are (1) rotavirus and
(2) norovirus.
Rotavirus is the most common cause of severe diarrhea among infants and young children. It is a virus that is a genus of
a double-stranded RNA virus in the family Reoviridae. At least every child in the world before turning five years old has
been infected with the virus. The treatment for this infection is giving extra fluids to the child to avoid dehydration, and
sometimes, severe dehydration of a child infected requires taking fluids through IV in a hospital. Early symptoms of this
virus are fever and vomiting and it usually starts within two days of exposure to the virus. Additionally, water diarrhea
can also be experienced. This infection can cause abdominal pain as well. However, in adults who are healthy, symptoms
of this infection can be mild or no symptoms. Rotavirus are common in children aged 3 to 35 months. In young children,
severe diarrhea can lead to dehydration and when left untreated, it can be a life-threatening condition regardless of the
cause.

You will need to see a Children’s

doctor if: Symptoms Adult’s Symptoms

Diarrhea for more than 24 hours Can’t keep liquids down for 24 hours

Bloody stool or has pus Diarrhea for more than two days

High temperature (38.9C or 102F) Blood in vomit or in bowel movements

Tired, irritable, or in pain High temperature (39.4C or 103F)

Dry mouth, dehydration, crying without tears, little to no urination, unusual Dehydration, excessive thirst, dry mouth, little to no urination, severe weakness,
sleepiness, unresponsiveness dizziness on standing, lightheadedness
 Rotavirus vaccines are given to infants. The two vaccines are:
RotaTeq Rotarix

- Given orally in three doses - Given in two doses to infants

- For age 2, 4, and 6 months - Ages 2 months and 4 months

Norovirus on the other hand, is the most common cause of a serious gastroenteritis and also foodborne
disease outbreaks in the US. This virus can cause the sudden onset of severe vomiting and diarrhea and
is highly contagious. It can spread through food or water that is being prepared, or through
contaminated surfaces. After 12 to 48 hours of exposure to the norovirus, symptoms such as diarrhea,
vomiting and stomach pain occur that can also last up until three days. Most people recover without
treatment be that as it may, for certain individuals, especially newborn children or adults who have
underlying disease, vomiting and diarrhea can be severely dehydrating that requires clinical
consideration. Symptoms of norovirus infection includes nausea, vomiting, stomach pain or cramps,
loose or watery diarrhea, feeling ill, low-grade fever and muscle pain. This virus is highly contagious
and can be found in the feces of infected humans and animals. Eating or drinking contaminated food
and water, touching your hand to your mouth after having in contact with a contaminated surface or
object can cause norovirus infection. You can also be infected if you have a close or in contact with a
person who is infected with this virus.
 IV. DEFINITION OF TERMS

Acute Gastroenteritis
• Is one of the most common infectious diseases seen in children, is an inflammation of the stomach and intestines that
accompanies numerous gastrointestinal (GI) disorders. It is one of the main causes of dehydration and can cause life-
threatening complications.
• It is caused by a variety of bacterial, viral, and parasitic pathogens. Stomach flu is not a flu at all. It is usually a viral
illness called gastroenteritis. Stomach flu is most often caused by a virus, but bacteria and parasites may also cause it.
Stomach flu symptoms cause nausea, diarrhea, and sometimes vomiting.
• Inflammation of the stomach and the intestines. Gastroenteritis can cause nausea, vomiting, and diarrhea. Gastroenteritis
has numerous causes, including infections (viruses, bacteria, and parasites), food poisoning, and stress.
• Acute gastroenteritis is a disease state that occurs when food or water that is contaminated with pathogenic
microorganisms (such as Clostridium perfringens, Vibrio cholera, E. coli,) or their toxins is consumed. Some of its symptoms
are nausea, vomiting, diarrhea, and abdominal pain.
 V. ETIOLOGY  
 Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in developing communities. Rotavirus is the most common cause of
acute gastroenteritis worldwide and vaccination will have a major impact on disease rates, morbidity, and mortality. Severely dehydrated or shocked children
usually need intravenous fluids and hospital admission. In the drug history and allergy of Jayson, he was on Vitamin C syrup 1 ml. OD given PO by his parents.
No known allergy to any drug, food or medication. In the birth history antenatal, his mother developed GDM and was managed with insulin therapy during her
pregnancy. Natal: He was born full term at The Gonzales Hospital, via Cesarean Section due to DM, birth weight was about 2.6 kg and cried right after birth.
Postnatal – his mother was informed that Jayson Cenas developed respiratory problems and was admitted for 6 days in NICU. He developed mild jaundice
after 4 days of life for 1 week. In Jayson's feeding history, he was exclusively breastfed until 4 months and started to mix with infant formula. Start weaning at
the age of 6 months and was breastfeed up to 2 years of age. Now, he was on family diet. Gastroenteritis is acquired by person to person spread or ingestion of
contaminated food and drink (food poisoning). Undercooked, or inappropriately stored cooked or processed meats (chicken, beef, pork) and seafood are
common sources of bacterial pathogens. Ingestion of food containing toxins produced by bacterial contaminants (for example, Staphylococcus aureus in ice
cream or Bacillus cerus in reheated rice) causes rapid onset of vomiting or diarrhea (or both). Water may be contaminated with bacteria, viruses, or protozoa
including Giardia lamblia, cryptosporidium, V cholera, and Entamoeba histolytica, which causes amoebic dysentery. General practitioners have an important
role in prevention, through encouraging breastfeeding, recommending and advocating free access to rotavirus vaccination, and educating careers about
personal and food hygiene.
 II. HEALTH HISTORY

 Present History

Jayson Cenas was well until 2 days prior to admission when he started to develop diarrhea. It started at
1:30am and it was sudden in onset and occurred about 7-9 times per day. The diarrhea was watery in
nature, yellowish to brown in color, non-blood stained. His mother had to wear him diapers to reduce
his frequency to go to the toilets. Since then, he had loss of appetite and only ate little amount of foods
and drinks.
On Saturday morning which was 2 days after diarrhea occurred, his mother brought him to the clinic
and the doctor prescribed him Oral Rehydration Solution (ORS).
His mother said that Jayson Cenas appeared lethargic and less active than usual during that period.
She brought him back to the same clinic at the evening on the same day. The doctor ordered
Paracetamol 125mg 1 suppository rectally and Domperidone syrup 4 ml. TID. He was then
referred to The Gonzales Hospital and his parents brought him to the Emergency Room at 8.30pm
and was admitted to Pedia ward 210 bed A at 11:45pm. D5 0.45 NaCl 1 liter started at 65 cc per
hour.
 
 PAST MEDICAL/SURGICAL HISTORY:
He was once admitted to Hospital Selayang at the age of 2 years old due to shortness of breath.
He was suspected to have asthma but after the first attack, he did not have SOB anymore.

 DRUG HISTORY & ALLERGY

He was on Vitamin C syrup 1 ml. OD given PO by his parents. No known allergy to any drug,
food or medication.
 BIRTH HISTORY ANTENATAL
His mother developed GDM and was managed with insulin therapy during her pregnancy. Natal : He was born
full term at The Gonzales Hospital, via Cesarean Section due to DM, birth weight was about 2.6 kg and cried
right after birth. Postnatal – his mother was informed that Jayson Cenas developed respiratory problems and
was admitted for 6 days in NICU. He developed mild jaundice after 4 days of life for 1 week.

 FEEDING HISTORY:
He was exclusively breastfeed until 4 months and started to mix with infant formula. Start weaning at the age of
6 months and was breastfeed up to 2 years of age. Now, he was on family diet.

 IMMUNIZATION HISTORY:
He received last immunization at 1 year and 6 months old. No postponed vaccination or complication after
vaccination. Immunization is complete up to his age.

 FAMILY HISTORY:
He is the youngest out of three siblings. The first and second siblings aged 18 and 8 years old respectively. Both
are females and well. His parents were well and there was no history of chronic illness such as asthma, HPN,
DM or any malignancy run in his family.
VI. GENOGRAM
VI. GENOGRAM

 Interpretation

The diagram shows the medical history and relationship history of Jayson Cenas family. Starting from the
first generation shows the grandparents. The first and second siblings aged 18 and 8 years respectively. Both are
females and well. His parents were well and there was no history of chronic illness such as asthma, HPN, DM or any
malignancy run in his family but his mother developed GDM and was managed with insulin therapy during her
pregnancy. And also his mother claimed that the children in same kindergarten with Jayson Cenas did not have any
symptoms like him. No history of contact in this patient.
 V11. ANATOMY AND PHYSIOLOGY OF THE AFFECTED BODY PARTS
GASTROINTESTINAL TRACT

The gastrointestinal system and its associated organs are required for
life to exist. Digestion is the process through which nutrients are
delivered to each and every cell in our body. If any of these
mechanisms are disrupted, the entire body suffers.
The gastrointestinal tract is a tube that runs from the mouth to the
stomach. Throughout, the structure is essentially the same. The tube
has a lumen, a muscle layer in the middle, and an epithelial cell
layer on the outside. The mucosal integrity of the GI tract is
maintained by these layers. The gastrointestinal tract serves three
primary purposes.
• Transportation
• Digestion
• Absorption of food
Organ Location

• The location of the organs can be divided into four

quadrants: the right upper quadrant, the left upper quadrant,
the left lower quadrant, and the right lower quadrant.

The right upper quadrant contains:

• Liver and gallbladder
• Duodenum
• The head of the pancreas
• The right adrenal gland
• A portion of the right kidney
• The hepatic flexure of the colon
• Portions of the ascending and transverse colon

The left upper quadrant contains:

• Left lobe of the liver
• Spleen
• Stomach
• Body of the pancreas
• Left adrenal gland, a portion of the left kidney
• Splenic flexure of the colon
• Portions of the transverse and descending colon
Organ Location

The left lower quadrant contains:

• • Lower pole of the left kidney
• • Sigmoid colon
• • A portion of the descending colon
• • Left ureter
• • Left ovary and fallopian tube or left spermatic cord

The right lower quadrant contains:

• • Lower pole of the right kidney
• • Cecum and appendix
• • A portion of the ascending colon
• • Right ureter
• • Right ovary and fallopian tube, or right spermatic cord
(Jarvis, 2011).
Mouth
The mouth's mucosal layer is made up of stratified squamous epithelial
cells. These cells slough off and are easily replenished during normal food
chewing. Food is broken down into smaller pieces by the mouth.

The main structures of the mouth include:

 Tongue ‐ a muscle with taste buds covering it. It also aids in the chewing
process and helps to move food into a position where it may be swallowed easily.
 Salivary glands ‐ Saliva is produced by these glands, which moistens food
and aids swallowing. The salivary glands also start the chemical digestion
process by secreting salivary amylase, an enzyme that starts the process of
breaking down carbs. Lingual lipase is the enzyme in saliva that starts the
digestion of lipids. Starch and maltose are broken down by ptyalin and salivary
amylase. Saliva also contains mucus, which aids swallowing, and
Immunoglobulin A (IgA), which contains antibodies that fight bacteria and
viruses.
 Teeth ‐ Food is mechanically broken down into tiny pieces by teeth, making
swallowing and ingesting easier.
 Pharynx ‐ allows the passage of both food and air.
Esophagus

The "food tube" that permits food bolus to move from the mouth
to the stomach is the esophagus. It has no effect on the digestive
system.

The esophagus alone generates mucus, which has the following

properties:

• Aids in the transit of food

• Protect and lubricate the esophagus.

The gastroesophageal or cardiac sphincter is located at the lower end

of the esophagus. This sphincter prevents stomach contents from
refluxing into the esophagus.
The patency of this sphincter is influenced by increased gastrin
production and certain medicines that promote parasympathetic
activity.
The left gastric artery supplies blood to the esophagus.
Stomach
The cardiac area and the fundus, which lead into the stomach's body, are the
top parts of the stomach. The antrum is the bottom portion of the stomach that
connects to the pylorus, the stomach's most distal part. The pyloric sphincter is
located at the base of the pylorus and allows chyme to enter into the small
intestine.
The stomach's job is to store, churn, and purée food into called chyme:

• Salivary enzymes start the digestion of fats and carbohydrates in the mouth, and
it continues in the stomach.

• The stomach is where protein digestion begins.

• Water, alcohol, and glucose are partially digested in the stomach.

Furthermore, gastric acid is created in the stomach, which eliminates the majority
of germs consumed with food.
Gastric Juices

The cells of the stomach secrete gastric fluids, which aid in chemical digestion. The food
becomes chyme, which is a semi-liquid form of the food.
The work of salivary enzymes starts the digestion of fats and carbs in the mouth, and it continues in
the stomach. The stomach is where protein digestion begins. Water, alcohol, and glucose are all
digested in the stomach. In addition, the stomach produces hydrochloric (or gastric) acid, which
kills most microorganisms consumed with food. For the breakdown process, food normally stays in
the stomach for three to four hours
Small Intestine
The small intestine reaches out from the pylorus to the ileocecal valve. This made
out of the duodenum, jejunum, and ileum. The essential function of the small intestine is
the ingestion of nutrients and supplements, including electrolytes, iron, sugars, proteins,
and fats. Most absorption of nutrients occurs here. The small intestine additionally retains
around 8,000 milliliters (mL) of water each day (Barron, 2010). Three thousand
milliliters of digestive enzymes are emitted in the small digestive tract daily. These
enzymes include:

Lipase – divides fats into monoglycerides, glycerol, and fatty acids

Amylase – changes starch to maltose
Maltase – converts maltose to glucose
Lactase – converts lactose into galactose and glucose
Sucrase – changes sucrose into fructose and glucose
Dextrinase – changes over explicit dextrins into glucose
Large Intestine

The large intestine stretches out from the terminal ileum at the ileocecal valve to the rectum At the terminal
ileum, the large intestine becomes the ascending colon, the transverse colon, and then the descending colon.
Following the descending colon is the sigmoid colon and the rectum. The primary function of the large intestine is
water absorption. commonly, the large intestine retains around about one and one ‐ half liters of water each day. It
can, in any case, ingest up to six liters. The large intestine additionally retains potassium, sodium, and chloride. It
produces mucous which lubricates the intestinal wall and holds the produced feces together for elimination. The
superior and inferior mesenteric arteries and the hypogastric arteries supply the blood supply to the large intestine.
Innervation of the intestine is equivalent to for the stomach
Gallbladder

The gallbladder is a pear‐shaped, sac‐like organ joined to the liver that fills
in as a storeroom for bile.It can hold and think around 50 mL of bile. The cystic
channel associates the gallbladder to the regular bile conduit, which ends at the
Sphincter of Oddi in the duodenum of the small intestine. At the point when a
huge or fatty meal is devoured, nerve and compound signs (arrival of the
enzyme CCK) cause the gallbladder to contract. This contraction releases bile
into the digestive system. The gallbladder gets blood from the cystic and
hepatic corridor and is innervated by the splanchnic nerve and the right part of
the vagus nerve.
 Bile has three major components:
Bile & Bile Pigments
• Water
• Bile salts
• Bile pigments Bile salts absorb and emulsify fats and fat‐
soluble vitamins (A, D, E, & K). Bile pigments are composed
primarily of bilirubin, cholesterol, and phospholipids. Bilirubin
is the by‐product of hemolysis
There are Two Types of Bilirubin

Indirect‐Bilirubin ‐ Unconjugated or indirect‐bilirubin: This is bilirubin that is in a

lipid‐soluble structure, and courses in free relationship with the plasma proteins. At the
point when red platelets, or erythrocytes, are separated, the heme is changed over to
unconjugated bilirubin by the cells in the pancreas.
Direct‐Bilirubin ‐ Conjugated or direct bilirubin: This is bilirubin that has been taken
up by the liver cells and conjugated to form the water ‐soluble bilirubin diglucuronide.
Most conjugated bilirubin ends up in bile. Total bilirubin is the indirect plus the direct
bilirubin. When total bilirubin is elevated and the cause is unknown, direct and indirect
bilirubin ought to be estimated
Liver

The liver is a large organ that is located in the upper right side of the
abdomen.
The liver has three lobes: right, left, and caudate. Each of these lobes is
subdivided further into eight sections. If infected or damaged, these parts
can be removed via surgery. The lobule, also known as the acinus, is the
functional unit of the liver. Both the portal vein and the hepatic artery give
blood to the liver. Almost a quarter of our circulatory output passes through
the liver every second, with the portal vein carrying the majority of it. The
blood passes via the liver's Kupffer cells, which filter out waste and
unwanted pathogens
Pancreas

The pancreas is a gland that is both endocrine and exocrine. The

production of: is one of the endocrine functions.
• Insulin
• Glucagon
• Somatostatin
The pancreas' exocrine function is mostly digestive, involving the release
of pancreatic enzymes and bicarbonate.
The pancreas secretes the following digestive enzymes:
• Trypsin
• Lipase
• Amylase
 Enzymes aid in the digestion of carbohydrates, proteins, and lipids. They are generally secreted in
their inactive state into the duodenum. They are converted to their active form in the duodenum and the
digestion process begins.To neutralize these and other enzymes in the duodenum, bicarbonate is
required. The exocrine pancreas secretes bicarbonate to avoid duodenal ulcers and inflammation.
The hepatic and cystic arteries feed blood to the pancreas. The splanchnic nerve and the right branch
of the vagus nerve both innervate the pancreas. Pancreatic enzymes are secreted as a result of vagal
(parasympathetic) activation. The Duct of Wirsung, the principal pancreatic exocrine duct, transports
these secretions. At the Sphincter of Oddi, this duct joins the common bile duct
Biliary Ducts

While not organs themselves, the ducts of the biliary tract are very important in the proper functioning of
the gastrointestinal system and body as a whole. In the liver, bile is collected in the bile calculi, which
eventually become the left and right hepatic ducts, which exit the liver as the common hepatic duct. The cystic
duct allows stored bile to be released from the gallbladder.
The cystic duct and the common hepatic duct meet to form the common bile duct, which eventually
terminates in the duodenum, next to the Duct of Wirsung (from the pancreas) at the Sphincter of Oddi
Obstruction or damage to any of these ducts may result in the improper drainage of bile and pancreatic enzymes.
Complications can include hepatitis, liver failure, pancreatitis, cholangitis, cholecystitis, and others.
VIII. PATHOPHYSIOLOGY OF THE DISEASE (DIAGRAM
FORMAT)
ix. Medical management

Medical and Surgical Management

a. Diagnostic Test/Laboratory Result
Name of laboratory test: Complete blood count
 Name of laboratory test: Urine Analysis
Content Results Normal Value Clinical Significance
Appearance Slightly yellowish Yellow (light/pale to dark/  Dilute urine, for example, is practically colorless due to its low specific
deep amber) gravity, whereas concentrated urine has a high specific gravity and is dark
yellow to amber in coloration.
 The color of  urine can be affected by a variety of things, including food,
medicines, and medical problems.
Ph 6.2 4.5-8.0  The acid-base status of a patient can be determined by measuring the pH of
his or her urine.
 The cause of a urine pH less than 7.0, or acidic in nature, could include
problems such as diarrhea or starvation.
Specific Gravity 1.010 1.005-1.025  A higher specific gravity of 1.035 indicates concentrated urine
 Fixed specific gravity refers to a circumstance in which the specific gravity
of a sample remains constant at 1.010. This is commonly a sign of serious
kidney damage.
Protein 85mg/d 150mg/d  Protein usually not found in the urine of people who have normal renal
function.
 If random urine samples consistently test positive for protein, further testing,
including the collection of a 24-hour urine sample, is recommended.
Glucose 72 mg/d 0 to 0.8 mmol/l (0 to 15  The normal amount of glucose in urine is 0-0.8mmol/L.
mg/dL)  The child has 72 mg/d, which indicates that the patient’s sugar is high.
RBC 2 2 RBCs/hpf  When red blood cells are seen in the urine, this usually means that the renal
glomeruli have been damaged, allowing red blood cells to enter the urine.
WBC 4 4-5 WBCs/hpf  In most cases, a few white blood cells can be seen in the urine. A urinary
tract infection should be considered if there are more than five white blood
cells per high-power field, and further screening should be done.
casts 3 hyaline casts/lpf 0-5 hyaline casts/lpf  Healthy people normally have 0-5 hyaline cast per low power field.
Crystals occasionally occasionally  Normally, a few may be present.

Bacteria none none  To detect whether bacteria are present in the urine, tests for the presence of leukocyte
esterase and nitrites are performed.

Yeast none none  Normally, urine contains very little or no glucose. When blood sugar levels are
extremely high, as they are in uncontrolled diabetes, the sugar leaks into the urine.
When the kidneys are damaged or diseased, glucose can be discovered in the urine.
DRUG/ ACTION ADMINISTR ADVERSE INDICATION/CONTRAINDICAT NURSING CONSIDERATION
DOSAGE/ ATION REACTION ION & CAUTIONS
CLASSIFICATION  

Azithromycin Azithromyci Tablets and oral CNS: dizziness, Mild to moderate susceptible -Alert. Use only to treat infections that are
  n prevents suspension: vertigo, headache, infections including acute bacterial proven or strongly suspected to be caused
  bacteria Take with or fatigue exacerbations of COPD, acute by susceptible bacteria in order to reduce
  from without food   bacterial the development of drug resistant bacteria
  growing by   CV: Palpitations, chest Sinusitis, acute otitis media, and maintain the effectiveness of
interfering Oral pain community acquired pneumonia, azithromycin.
with their suspension:   pharyngitis/tonsillitis, uncomplicated  
protein shake well GI: nausea, vomiting, skin and skin structure, urethritis, -Check for GI discomfort nausea,
synthesis. before use; diarrhea, abdominal cervicitis, chancroid in men. vomiting.
  Binds to refer to pain, dyspepsia,    
Therapeutic class: ribosomal prescribing flatulence,melena,chole Hypersensitivity to other macrolide -Monitor daily pattern of bowel activity
Antibiotic receptor information for static jaundice, antibiotics. History of cholestatic and stool consistency.
Pharmacologic class: sites of dosing pseudomembranous jaundice/hepatic dysfunction  
Azalide macrolide susceptible information. colitis associated with prior azithromycin -Monitor hepatic function test, CBC.
Dosage: 200/5ml, 3.5ml organism,     therapy. Assess for hepatotoxicity: malaise, fever,
Route: PO inhibiting   SKIN: rash, abdominal pain, GI disturbance.
Frequency: OD RNA   photosensitivity
dependent    
protein  
synthesis.
 
 
DRUG/DOSAGE/CL ACTION ADMINISTRATI ADVERSE REACTIONS INDICATION/ NURSING CONSIDERATIONS
ASSIFICATION ON CONTRAINDICATION
S
Domperidone It is  CNS: dry mouth, headache, Indication: Alert.
  Is a peripheral dopamine recommended to migraine, insomnia, Indicated for the Do not take it if it is near the time for
Domperidone receptor blocker. It take oral dizziness, lethargy, relief of the symptoms of the next dose, instead, skip the
increases esophageal domperidone irritability. nausea and vomiting. missed dose and resume your usual
peristalsis, lower before meals. If Gastroesophageal dosing schedule. Do not double up
esophageal sphincter taken after meals, reflux disease(GERD) the dose to catch up.
pressure, gastric motility absorption of the Gastrointestinal:
and peristalsis and drug is somewhat Abdominal cramps, diarrhea, -Verify any medication order and
enhances gastroduodenal delayed. changes in appetite, nausea, Contraindication: make sure it’s complete. The order
coordination, thereby constipation. Patient with known should include the drug name,
facilitating gastric hypersensitivity to dosage, frequency and route of
emptying and decreasing Endocrinological: domperidone, in the administration.
Therapeutic class: small bowel transit time. Hot flushes, mastalgia, presence of -Check the patient medical record for
Anti- sickness galactorrhea. gastrointestinal an allergy or contraindication to the
hemorrhage, obstruction prescribed medication.
or perforation and in - Check that the patient is not taking
Pharmacologic class: Mucocutaneous: rash, patients with a prolactin- any other medication
D2 receptor urticarial, pruritus, releasing pituitary tumor
antagonist, prolactin stomatitis, conjunctivitis
releaser
Urinary: urinary frequency,
Dosage: 4ml dysuria
q 6hrs.
Cardiovascular: edema,
palpitation

  Musculoskeletal: leg cramps,

 
 
 
 
DRUG/DOSAGE/CL ACTION ADMINISTRATI ADVERSE INDICATION/ NURSING CONSIDERATIONS
ASSIFICATION ON REACTIONS CONTRAINDICATIO
NS

Paracetamol Action: Administration: Adverse Reactions: Indication: - Make sure the patient isn't using any other
  Paracetamol acts as an PO CNS: dizziness, To reduce fever and paracetamol-containing medications.
  analgesic by inhibiting - Every 4 headache treatment of mild to -Use a medicine syringe to drip liquid slowly
  the production of pain hours,PRN for CV: hypertension, moderate pain, including into the side of the child's mouth or use soluble
  impulses in the peripheral fever hypotension, headache and other paracetamol mixed with a drink for children
  nervous system. - shake the bottle tachycardia, chest aches and pain. who may refuse medicine from a spoon.
  Antipyresis is caused by for at least 10 pain Contraindication: - Assess the therapeutic response.
  the inhibition of the seconds GI: nausea, vomiting Contraindicated in - In the event of an overdose, seek medical help
  hypothalamus heat- Respiratory: dyspnea, hypersensitivity to right away, even if the patient appears to be
Therapeutic class: regulating center. Its abnormal breath paracetamol and patient fine, because there is a possibility of delayed,
Analgesic and ineffective anti- sound with severe hepatic serious liver damage.
antipyretic inflammatory properties Skin: skin rash, dysfunction. - Children's paracetamol comes in a variety of
Pharmacologic class: are due to suppression of pinpoint red spot on strengths. Parents must ensure that their
Non-opioid prostaglandin production the skin children receive the proper dosage.
Dosage: in the central nervous Metabolic: - You can take paracetamol on an empty
250/5ml system. Paracetamol hypokalemia, stomach.
4ml in every 4hrs (TEMPRA) is particularly hyperglycemia
valuable for use in  
patients who do not
tolerate aspirin well
because it is less likely to
cause gastrointestinal
distress.
DRUG/DOSAGE/CL ACTION ADMINISTRATI ADVERSE INDICATION/ NURSING CONSIDERATIONS
ASSIFICATION ON REACTIONS CONTRAINDICATIO
NS
D5 0.45 NaCl Intravenous  There may be Indications - Check the vital sign.
When a patient is NPO, dextrose and redness or soreness at -Used to treat - Always check the IVF and its injection site.
maintenance fluids are sodium chloride the injection site. hypernatremia, - Keep an eye on the electrolytes and make
used. Water, glucose, salt, solutions are hypovolemia. sure that it is not dehydrated.
Contact your doctor
and potassium make up recommended for -Used as maintenance IV - Fluid overload and pulmonary edema are
the maintenance fluids. parenteral or pharmacist right fluid. possible side effects.
The glucose avoids replenishment of away if any of these
ketoacidosis due to hydration, side effects continue Contraindications
fasting and lowers the risk minimum or worsen -Patients with heart
of hypoglycemia. carbohydrate failure, severe renal
Dehydration and calories, and insufficiency, or edema
Generic Name:
electrolyte imbalances sodium chloride with sodium retention
Sodium chloride injection are prevented by water, as needed by the should use caution.
salt, and potassium. patient's clinical -Fluid excess can lead to
condition low metabolic acidosis,
overhydration,
congestion, and
pulmonary edema.
DRUG/DOSAGE/CL ACTION ADMINISTRATI ADVERSE INDICATION/ NURSING CONSIDERATIONS
ASSIFICATION ON REACTIONS CONTRAINDICATIONS
Oral Rehydration salt Oral rehydration  Mild vomiting may - Assess vital signs, noting
Glucose is found in the solution (ORS) is a occur when oral Indication: peripheral pulses.
solution that enables the powdered mixture therapy has begun, For the prevention and treatment - Assess the degree of
intestine to absorb the of glucose, of mild diarrhea. To prevent further dehydration.
but therapy should be
water and salts more potassium dehydration. - Monitor the amount and
efficiently thus preventing chloride, and continued with consistency of stools that the child
or treating diarrhea sodium citrate frequent, small Contraindication: Oral have each day.
that is taken amounts of solution rehydration salts are contraindicated - Strict monitor for the intake and
Branded name: orally. They are administered slowly, in patients exhibiting the following output of the patient.
Hydrite meant for use Rarely symptoms of condition: cirrhosis of the lower - Ensure the infusion of IVF is
after being hypernatremia liver, congestive cardiac failure, correct.
dissolved in the ( dizziness, fast nephrotic syndrome, acute and - Provide oral care
Dilution: Dissolve powder required volume renal failure, ischemic heart disease , - Assess the therapeutic effect.
contents of 1 sachet or 2 heartbeat, high blood
tablets for reconstitution of water.In 1,000 pressure, irritability, adrenocortical insufficiency, - Notify the physician for unusual
in every glass (200 mL) of mL of water, hypokalemia, edematous sodium changes in the patient.
muscle twitching,
cool drinking water. Give dissolve the full retaining conditions, hypertension, Educate the mother about the
as much fluid as the child
contents of one restlessness, seizures peripheral or pulmonary edema, proper sanitation and good hand
or adult wants until
package of ORS, swelling of feet or severe vomiting, diarrhea, hygiene.
diarrhea or vomiting
stops, or as follows: or roughly 20.5 g lower legs or dehydration requiring fluid therapy.
ADULTS & CHILDREN of the wekness
above 10 yrs old: Take as combination. The Do not take ORS sachet 4.5 gm if you
much fluid as possible solution should be are allergic. ORS sachet should be
CHILDREN 2-10 yrs old: clear and given to children only.
Give 100-200 mL solution. odorless, or a
Less than 2 yrs old: Give slight yellow stain
50-100 mL solution. should be visible.
DRUG/DOSAGE/CLASSIFICA ACTION ADMINISTRATI ADVERSE INDICATION/ NURSING
TION ON REACTIONS CONTRAINDICATIO CONSIDERATIONS
NS
Operates in the body by Administration:  CNS: headache, fatigue, Indication: • Obtain a doctor's order.
Generic name: supplying ascorbic acid Route: PO insomnia. These nutritional • Perform hand washing.
as well as reversibly Place in a room Gl: stomach cramps, supplements are used for • Examine the patient's
oxidizing to temperature not nausea and vomiting. the prevention and condition.
dehydroascorbic acid; exceeding 25°C treatment of deficiencies • Give medication at the
treats vitamin C Urinary system: when of vitamin C and zinc. appropriate time.
deficiency in people used in high doses Contraindications and • Notify the mother about
who do not get enough hyperoxaluria and the cautious: the potential side effects of the
vitamin C from their formation of kidney Contraindicated in those medications.
Ascorbic acid + Zinc diets; and replaces zinc stones of calcium oxalate. persons who have shown • Advise the mother to be
in the body. Local reactions: with hypersensitivity to any wary of the drugs' side effects.
intravaginal application - component of this • Return the medication
Brand name:
a burning or itching in the preparation. ticket to the appropriate box for
Ceelin plus
vagina, increased mucous the next appointment.
discharge, redness,
Dosage: 100 mg/10 mg per 5mL Syrup swelling of the vulva.
1-3 years: 2.5 mL (1/2 teaspoonful) Other: Heat sensation
4-8 years :5 mL (1 teaspoonful)
9-13 years: 5-10 mL (1 to 2
teaspoonsful)
Or, as directed by a doctor.
Route: PO
Timing: OD
Classification:
Vitamins
DOCTOR’S ORDER
X. NURSING MANAGEMENT

NURSING CARE PLAN FOR ACUTE GASTROENTERITIS

Name: Jayson Cenas Age: 3 years & 11 months Gender: Male

Chief Complaint: Severe diarrhea associate with fever and vomiting Final Dx: Acute Gastroenteritis
Time of Admission: January 17, 2021 at 11:45 pm Admitting Physician:
Admitting Dx: Severe Diarrhea Attending Physician :
 Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
January 17, 2021 Diarrhea That within  Obtain baseline vital signs and  Fluid and electrolyte imbalances After 24 hours
11:45 pm related to 24hrs span of monitor every 2–4 hours. can alter vital body functions. of span of
infectious nursing care,    Aids in the diagnosis and in nursing care the
Objective: process. the child’s  Observe stools for amount, color, monitoring the child’s status. child’s bowel
bowel function consistency, odor, and frequency.  Frequent defecation and some function returns
diarrhea for 2 days will be   infectious organisms can cause to
with toileting for restored to  Test stools for occult blood. bleeding. normal.
 
about 7-9 times per normal.  Rapid notification of the physician
 Monitor results of stool culture and
day sample for ova and parasites. will facilitate treatment.
January 19, 2021    Helps prevent transmission of
(Saturday)  Wash hands well before and after contact microorganisms.
- His fever and with the child.  Prevents exposure of other patients
vomiting started a   and staff.
few hours after he  Isolate the child until the cause of the  The child may be weak,
was brought to the diarrhea is determined. incontinent, physically impaired,
clinic.   or
- His mother  Assist the child with toileting and anxious and require assistance to
measured the hygiene. use the bathroom.
temperature at    Provides necessary fluids and
home and it was  Administer prescribed oral rehydration nutrients.
and intravenous solutions.
39.2 ֯ C  Ensures early intervention
 
Vital signs:
 Notify the physician if diarrhea persists,
T- 36°C stool characteristics change, or other
PR- 96 bpm symptoms of dehydration/electolyte
RR- 31bpm imbalance occur.
BP-117/45mmgh
 
  
Potential Nursing Diagnosis
Cues & Nursing Objectives Nursing Intervention Rationale Evaluation
Evidences Diagnosis  
January 17, Risk for That within 8hrs • Monitor the child intake • Intake: 4 cups of fluid, Goal Met
2021 deficient fluid span of nursing and output. including water and  
11:45 pm volume related care client will milk. Ensure output; at After the 8 hours
  to insufficient maintain urine- least 5mg/kg per hour. span of nursing
Objective: oral fluid intake specific gravity • Monitor for sign and • This is to monitor and care, child was
- loss of   within normal symptoms of give immediate action able to:
appetite to eat   range as evidenced dehydration, dizziness, after showing sign and  
and drink   by the following and weakness; and intake symptoms of - maintain his oral
    indicators: versus output. dehydration. fluid intake
Vital signs: (Carpenito, L.,   • Provide a list of • Appealing fluids: - there is no sign
T- 36°C (2013), - Increase fluid alternative fluids popsicles, frozen juice and symptoms of
PR- 96 bpm Handbook of intake to specified (appealing fluids: bars, water, milk. dehydration
RR- 31bpm Nursing amount according popsicles, frozen juice
BP- Diagnosis (14th to age and bars, water, milk). • To monitor possible
117/45mmgh ed). J.B metabolic needs. • Weigh client daily, a 2% dehydration.
Lippincott - No sign and to 4% weight loss  
Company.) symptoms of indicates mild
dehydration dehydration.
 
 Cues & Nursing Objectives Nursing Intervention Rationale Evaluation
Evidences Diagnosis  
January 17, • Review the child’s • This is to know if if
2021 medication. they contribute to
11:45 pm dehydration or
  require increase
Objective: • Discuss the fluid intake. 
- loss of importance of good • A lack of fluid might
appetite to eat dental hygiene. result in a dry, sticky
and drink mouth. Mouth
  hygiene encourages
Vital signs: drinking and
T- 36°C •  Cover the patient with alleviates the pain of
PR- 96 bpm light sheets to create a dry mucous
RR- 31bpm relaxing environment. membranes.
BP- • To avoid further
117/45mmgh fluid loss, avoid
conditions where the
patient may
overheat.
Cues & Evidences Nursing Diagnosis Objectives Nursing Intervention Rationale Evaluation
January 17, 2021 Risk for impaired Within 4 hours span • Establish • It enables you GOAL MET.
11:45 pm skin integrity r/t of care the client rapport. to comprehend your
irritation caused by should maintains a patient's emotions The client's skin
Objective: frequent stooling. good skin condition • Assess and effectively remains in good
-diarrhea for 2 days as evidence by perineal and communicate with condition after 4
with toileting for client skin in perianal areas for them. It allows you hours of care, as
about 7-9 times per perineal and signs for irritation to connect with seen by the client's
day perianal areas or excoriation with your patients and perineal and
remain intact. every diaper can help you perianal areas
change. provide better remaining intact.
Vital signs: treatment. • Uses only 2
T- 36°C • Change diapers.
PR- 96 bpm diapers as soon as • The earlier the
RR- 31bpm they become wet problem is
BP-117/45mmgh and soiled. detected, the sooner
appropriate
interventions can be
made to ensure the
skin remains intact.
Cues & Evidences Nursing Diagnosis Objectives Nursing Intervention Rationale Evaluation

January 17, 2021 • Cleanse the • This helps

11:45 pm buttocks gently keep skin clean and
(pat, do not rub) dry.
Objective: with water or • Diarrheal
-diarrhea for 2 days immerse in tepid stools are very
with toileting for water to cleanse. irritating to the
about 7-9 times per Avoid using soap if skin. Rubbing the
day possible. skin every time, the
diaper is changed
• Do not use would irritate it
Vital signs: commercial baby further. Soap dries
T- 36°C wipes with alcohol skin by removing
PR- 96 bpm or perfume or baby normal
RR- 31bpm powder on irritated moisturizing skin
BP-117/45mmgh or excoriated skin. oils, thereby
• increasing the
potential for
irritation and skin
breakdown
Cues & Evidences Nursing Diagnosis Objectives Nursing Intervention Rationale Evaluation

January 17, 2021 • If not • These

11:45 pm contraindicated, products are
apply protective painful to irritated
ointments such as
Objective: skin. Baby powder
Vaseline, A&D, or
-diarrhea for 2 days zinc oxide when cakes and is
with toileting for the child the child difficult to remove.
about 7-9 times per is wearing diaper. • These
day • Leave the diaper measures protect
area open to air if skin from
possible (but not in irritations.
Vital signs: the presence of • This practice
T- 36°C explosive diarrhea. facilitates drying
PR- 96 bpm Reapply protective and healing.
ointment before
RR- 31bpm putting the diaper on. • This increases
BP-117/45mmgh • Instruct family the likelihood of
members in the family using
appropriate skin care these techniques at
methods. home.
 
Health Teachings Plan
1. Perform proper hygiene every day.
2. Get your child back to a normal diet slowly.
3. Make sure your child gets plenty of rest.
4. Avoid giving your child over-the-counter anti-diarrheal medications, unless advised by your doctor.
5. Help your child rehydrate. Give your child an oral rehydration solution, available at pharmacies without a
prescription.
6. Contact your healthcare provider if your children continue to vomit or have diarrhea, even after treatment.
7. Give your child plenty of liquids such as water.
8. Don't give your child soft drinks and fruit juices.
9. Seek your health care provider if your child has been exposed to a source of bacterial diarrhea through
travel or food.
10. Don’t give over-the-counter diarrhea medicines unless your child’s healthcare provider tells you to.
11. Wash your hands before and after caring for your sick child.
12. Clean your surroundings.
13. Use antibacterial cleaner or bleach when cleaning your home.
14. Ask for immunizations for the disease.
15. See a doctor for medications because children younger than five aren’t given drugs for diarrhea.
16. When hungry, first try eating soft foods like bananas, apple sauce and broth soups.
17. After 24 hours recovery from vomiting, you can go back to a normal diet.
18. Refrigerate leftover food immediately.
19. In discharge care, administer the medication to your child as directed by your physician if there is prescribed
medication.
20. Make a list of the medications given, the amount, time and day the child drink it. This will serve as a baseline data for
the physician for a follow-up checkup.
21. Always check the medication. Some medications have a mix of drug that is not allowed for children and can cause life-
threatening risks.
22. Parents should follow the follow-up visits the physician scheduled.
Meal Plan
 EVIDENCED-BASED RESEARCH FINDINGS RELATED TO THE DISEASE/ILLNESS
 Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in developing communities. In developed countries it
is a common reason for presentation to general practice or emergency departments and for admission to hospital. Dehydration, which may be
associated with electrolyte disturbance and metabolic acidosis, is the most frequent and dangerous complication. Optimal management with oral
or intravenous fluids minimizes the risk of dehydration and its adverse outcomes. Routine use of antibiotics, antidiarrheal agents, and
antiemetics is not recommended and may cause harm. Prevention is the key to controlling gastroenteritis, and recently licensed, highly effective
rotavirus vaccines will have a major effect on public health. Acute gastroenteritis, diarrhea or vomiting (or both) of more than seven days
duration, may be accompanied by fever, abdominal pain, and anorexia.
 Diarrhea is the passage of excessively liquid or frequent stools with increased water content. Patterns of stooling vary widely in young children,
and diarrhea represents a change from the norm. Worldwide, 3-5 billion cases of acute gastroenteritis and nearly 2 million deaths occur each
year in children under 5 years. In the United States, gastroenteritis accounts for about ∼10% (220 000) of admissions to hospital, more than 1.5
million outpatient visits, and around 300 deaths in children under 5 annually, with a cost of around $1bn (£0.5bn; €0.8bn). In the same age
group in Australia, about 10 000 hospital admissions, 22 000 visits to emergency departments, and 115 000 general practice consultations occur
annually for rotavirus alone, with an estimated cost of $A30m (£12m; €18m; $23m).
 In the United Kingdom, 204 of 1000 consultations with general practitioners in children under 5 are for gastroenteritis, and the annual hospital
admission rate in this group is about seven per 1000 children. Children in childcare settings are often infected but asymptomatic and may
unwittingly transmit infection. Children with poor nutrition are at increased risk of complications. In the north end of Australia, Aboriginal and
Torres Strait Islander children have increased rates of admission for gastroenteritis, malnutrition, comorbidity, and electrolyte disturbance
(especially hypokalemia) and a longer hospital stay than their non-indigenous counterparts. The cost of gastroenteritis to the community is huge
but often underestimated if costs to the family, including lost time at work, are not considered
SUMMARY

 Rotavirus is the most common cause of acute gastroenteritis worldwide and vaccination will have a major
impact on disease rates, morbidity, and mortality. Most children are not dehydrated and can be managed at
home. Dehydration, metabolic acidosis, and electrolyte disturbance can be prevented and treated by fluid
therapy. Most children with mild-moderate dehydration can be treated with oral or enteral rehydration using low
osmolality oral rehydration solutions. Severely dehydrated or shocked children usually need intravenous fluids
and hospital admission.
 Drugs are usually unnecessary and may do harm. General practitioners have an important role in prevention,
through encouraging breastfeeding, recommending and advocating free access to rotavirus vaccination, and
educating carers about personal and food hygiene. Gastroenteritis is an inflammation of the lining of the
intestines caused by a virus, bacteria, or parasites. Viral gastroenteritis is the second most common illness in
the U.S.
 The cause is often a norovirus infection. It spreads through contaminated food or water or by contact with an
infected person. Symptoms of gastroenteritis include diarrhea, abdominal pain, vomiting, headache, fever, and
chills. Most people recover with no treatment. The most common problem with gastroenteritis is dehydration.
This happens if you do not drink enough fluids to replace what you lose through vomiting and diarrhea.
Dehydration is most common in babies, young children, older adults, and people with weak immune systems.
 REFLECTION

 Acute gastroenteritis is a cause of dehydration because of diarrhea and vomiting that's why as soon as possible it must be treated. Every
client who experienced dehydration with acute gastroenteritis should be given an oral rehydration solution. Oral rehydration solution is a
mixture of electrolytes and carbohydrates which is dissolved in water. It is given to the client to replace the losses of salts and water in
your body by vomiting and diarrhea.
 Acute gastroenteritis, on the other hand it is the attack of the intestines causing sign and symptoms of diarrheal disease of rapid onset, with
or without nausea, vomiting, fever, or abdominal pain and in some cases, there was a bloody stool also the client will experience muscle
ache or headache. The most common causes of gastroenteritis are norovirus and rotavirus. It is also a viral or bacterial infection, and less
commonly parasitic infection. The most cases for gastroenteritis are for the young children.
 The virus will spreads in contaminated food or water and to prevent it you must have a food hygiene and proper hand hygiene or hand
washing. What I’ve learn about gastroenteritis is, it may cause client to become dehydrated and it is risky for the client because if it is not
be rehydrated some of organ will malfunction.
 Every client who experienced dehydration with acute gastroenteritis should be given an oral rehydration solution. Oral rehydration solution
is a mixture of electrolytes and carbohydrates which is dissolved in water. It is given to the client to replace the losses of salts and water in
your body by vomiting and diarrhea. Proper meals will help the client to rehydrate and heal the intestine, and avoid food that will worsen
your health like fatty food. Gastroenteritis is an illness triggered by the infection and inflammation of the digestive system. Typical
symptoms include abdominal cramps, diarrhea and vomiting. In many cases, the condition heals itself within a few days.
 CONT,

 The main complication of gastroenteritis is dehydration, but this can be prevented if the fluid lost in vomit and diarrhea is replaced. A
person suffering from severe gastroenteritis may need fluids administered intravenously (directly into the bloodstream via a vein the setup
is often referred to as a ‘drip’). Some of the causes of gastroenteritis include viruses, bacteria, bacterial toxins, parasites, particular
chemicals and some drugs. It is important to establish the cause, as different types of gastroenteritis respond to different treatments.
 Diagnostic methods may include medical history, physical examination, blood tests, and stool tests and the treatment for the gastroenteritis
includes plenty of fluids, oral rehydration drinks, available from your pharmacist, admission to hospital and intravenous fluid replacement,
in severe cases, antibiotics, if bacteria are the cause, drugs to kill the parasites, if parasites are the cause, and avoiding anti-vomiting or
anti-diarrhea drugs unless prescribed or recommended by your doctor, because these medications will keep the infection inside your body.
 If You Have Gastroenteritis, stop eating for a few hours, sip liquids instead of drinking a large amount at once, to prevent dehydration,
take note of urination. Dizziness and lightheadedness also are signs of dehydration. If any of these signs and symptoms occur and you
can’t drink enough fluids, seek medical attention. Ease back into eating, gradually begin to eat bland, easy-to-digest foods, such as soda
crackers, toast, gelatin, bananas, rice and chicken. Get plenty of rest. In some cases, adults can take over-the-counter medicines such as
loperamide link (Imodium) and bismuth subsalicylate link (Pepto-Bismol, Kaopectate) to treat diarrhea caused by viral gastroenteritis.
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- Martin. Paul, BSN, R.N. (2019, April 10). 4 Gastroenteritis Nursing Care Plans.
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 Submitted by:
Modelo, Nova Jane Miral
Mundiz, Jan Charisse
Pacheco, Melanie De Guia
Pendi, Sahria Sinangan
Pobadora, Elyza Jane Leones
Quibuyen, Leji Wensdy Ofecio
Quinonez, Dianne Baldo
Quisol, Joana Paula Masaglang
Ramalan, Princess Jahedamae Bayao
Reyes, Lois Danielle Casas
July 2021