ACUTE GASTROENTERITIS AND FAILURE TO THRIVE

BSN 2G-2d
 Introduction:
Failure to thrive: A child is said to have failure to thrive when they do not meet
recognized standards of growth.
Acute Gastroenteritis: A disease state that occurs when food or water that is
contaminated with pathogenic microorganisms or their toxins is consumed.
Symptoms:

Failure To Thrive: Acute Gastroenteritis:

• lack of weight gain, • nausea,
• delays in reaching  • vomiting,
developmental milestones, • diarrhea,
learning disabilities,
• abdominal pain
• fatigue,
• irritability
• delayed puberty in teens.
 Causative factors:
Failure To Thrive:
• Lack of nutrients Acute Gastroenteritis:
• Poor living conditions • Infection due viruses,
• Parental attitudes bacteria and protozoa
• Exposure to toxins or (parasitic infection)
parasites

Treatment:

Failure To Thrive:
Providing sufficient health Acute Gastroenteritis:
and environmental Re-hydration and
resources to promote maintenance.
satisfactory growth.
 Case description:

The patient was admitted for fever and diarrhea. She was diagnosed with
acute gastroenteritis and failure to thrive. Upon her transfer to the pediatric
ward, careful assessment and observation has revealed that the baby has dry
oral mucous membrane and hyperactive bowel sounds. she was diagnosed
with diarrhea, imbalance nutrition, risk for fluid volume deficit, and risk for
delayed development.
 Patient’s profile:
Name : Patient X
Age/Sex : 1 month/F
Ward : Pediatric ward
Occupation : N/A
Marital status : single
Religion : N/A
Date of admission : May 5, 2022
Admitting diagnosis Acute Gastroenteritis and Failure to thrive
Surgery : N/A
Ethnic Background : Ilokano
Date and time handled 11pm-7am, May 9-11, 2022
Chief complain: Fever

Present History of Illness : A one-month-old patient had been admitted to

the pediatric ward with a chief complaint of fever. According to her mother,
the patient had episodes of watery stool. Prior to admission, the patient had
had a fever. Upon admission, the patient was conscious, crying, in distress,
and irritable and had normal vital signs. The patient was anorexic.

Past History of Illness: Prior to the presenting problem, the patient was
born premature and placed in the NICU for 20 days. She hadn’t completed
her immunizations and had no allergies. The patient was also bottle fed after
her mother had undergone appendectomy. She is completely healthy; no
other signs or symptoms of illness were see
 Family Health History: The patient’s mother stated that they had no health problems
such as asthma, kidney disease, diabetes, or mental illnesses but the patient’s father had
a family history of high blood pressure. No present illness was currently experienced
by any member of the family.

Developmental History: ​The patient was able to move her head from side to side
while lying on stomach. She also had strong reflex movements and made grasp reflex.
The patient also brought her hands near her face and kept her hands in tight fists.

Social and Environmental History: The patient stayed in a Pediatric isolation room.
The patient and the mother shared the same ether bed, with railings. The room had its
own comfort room and an adjacent sink.

Lifestyle and Health Practice: The patient was bottle fed 30mL for every 2 hours and
defecated every after feeding, on the first day. On the second day, the patient defecated
for four times.
 XI. Health Assessment 
A. General Survey

Patient was admitted in the Pedia Ward wherein she was received cuddled by the
mother while bottle feeding, with an ongoing IVF of D5IMB 57mL and D5050 7mL
for a total of 64 mL to be consumed for 8 hours. She was admitted with a diagnosis of
Acute Gastroenteritis and Failure to Thrive. Patient was born premature and was one
month old. Weight measurement showed that patient is 2.2 kg, two days prior, she was
approximately 1.9 kg. She was afebrile during assessment with distended abdomen and
dry mucous membranes. In prone position, she could turn her head but cannot hold it
for an extended period of time, extreme head lag was also noticed, and knees and hips
tend to be in a flexed position. She also exhibited strong grasp reflex. She was able to
follow objects with her eyes.
 XI. Health Assessment 
B. Head to Toe Assessment
1. Head Hair was well distributed, no presence of bald spots.
2. Eyes Mucous membranes were dry.
3. Ears No tenderness upon palpation.
4. Nose and sinuses With clear nasal discharge. Septum was located midline, no flaring noted, and no
episodes of epistaxis during the shift.
5. Mouth Dry lips and oral mucosa.
6. Neck No signs of any lumps nor masses around her neck.
7. Chest Symmetrical chest wall expansion. No chest in-drawing noted and no bilateral
retractions noted.
8. Cardiac Normal cardiac rate and regular rhythm, no murmurs, no heaves, no thrills.

9. Breast/Chest Skin color was similar with the rest of the body, nipple had no discharges.
10. Abdomen Distended, soft abdomen, with hyperactive bowel sounds. With visible veins on
abdomen area.
11. Genitals Genitals were of normal shape and size. No abnormal discharges and smell.

12. Musculoskeletal With full range of motion, no edema and with full and equal peripheral pulses.

13. Integumentary No pallor, no jaundice, warm to touch.

 Health Assessment:
C. 13 Areas of Assessment:
Sensor Status

a. Visual Status: There was no known visual deficit.

b. Auditory: The patient was responsive to loud sound

c. Olfactory Status: had no reported problems or difficulty in smelling

d. Gustatory Status: The patient had no reported problems or difficulty in

tasting

e. Tactile Status: The patient reacted to touch stimuli.

Motor Status: The patient exhibited some resistance to passive movement such
as when being pulled to sit
 Health Assessment:
C. 13 Areas of Assessment:
Thermoregulatory Status
Date Time Temperature
May 9 11:00 PM 36.8 °C
  2:00 AM 37.2 °C
6:00 AM 36.8 °C
May 10 11:00 PM 37.1 °C
2:00 AM 36.4 °C
6:00 AM 36.6 °C
May 11 11:00 PM 36.7 °C
2:00 AM 36.5 °C
6:00 AM 36.7 °C
 Health Assessment:
C. 13 Areas of Assessment:
Respiratory Status
Date Time RR SPO2
May 9 11:00 PM 46 98%
  2:00 AM 48 96%
6:00 AM 49 97%
May 10 11:00 PM 45 98%
2:00 AM 46 95%
6:00 AM 46 99%
May 11 11:00 PM 46 97%
2:00 AM 48 98%
6:00 AM 46 98%
 Health Assessment:
C. 13 Areas of Assessment:
Circulatory Status
Date Time PR (bpm)
May 9 11:00 PM 129
  2:00 AM 135
6:00 AM 121
May 10 11:00 PM 125
2:00 AM 118
6:00 AM 146
May 11 11:00 PM 120
2:00 AM 130
6:00 AM 137
 Health Assessment:
C. 13 Areas of Assessment:
Nutritional Status:  Patient was being bottle fed every after 2 hours. Infant was
underweight weighing 1.9 kg the two days prior. Had poor skin turgor and dry
mucous membranes around her mouth.

Elimination Status: On the 1st day, the mother stated that the patient defecated
after every feed. On the last day, stool seemed to be already mushy.

Sleep, Rest and Comfort Status: The infant had no problem sleeping and could
rest well

Fluids and Electrolytes Status: The infant had an attached IV fluid of D51MB
and D5050 on her right arm.
 Health Assessment:
C. 13 Areas of Assessment:

Integumentary Status: The patient’s skin was pinkish in color. Upon

assessment patient had a skin turgor of 3 seconds and dry mucous membranes.
Diagnostics:
Procedure Significance/Purpose Date Findings

X-ray Abdominal X-ray is often the first May 05, 2022
exam used to evaluate the source
of acute pain in the abdominal
region and/or lower back. It may
be used to evaluate unexplained
nausea and vomiting.
• Bowel gas pattern is mixed
with gaseous distention
• Flank stripes are bulged
• Bowel Ileus
Procedure Significance/Purpose Date Findings
Urinalysis A urinalysis is usually May 7, 2022 Physical Examination:
ordered when a doctor • Color: Yellow
suspects that a child has • Transparency: Hazy
a urinary tract infection • pH: 7.0
(UTI) or a health problem • Specific Gravity: 1.010
that can cause an Chemical Examination:Negative
abnormality in the urine. Microscopic Examination:
• WBC: 1-2
• RBC: 0-1
• Amorphous Phosphates: Moderate
• Bacteria: Moderate
Procedure Significance/Purpose
Complete Blood A CBC can be done as part of a
Count (CBC) routine checkup to screen for
Urinalysis problems or because a child is
not feeling well. The levels of
red blood cells, white blood
cells, and platelets can provide
doctors with information about
possible problems like anemia,
infections, inflammation, and
other condition
Date Findings
May 05, 2022 • Hemoglobin (Female:
120-160g/L): 104
• Hematocrit (Female: 0.37-0.47):
0.31
• Platelet Count (150-450 X109/L):
701
• White Blood Cells Count: (4.5-
11.0x109/L): 12.5
• Neutrophils: 0.31
• Lymphocytes: 0.46
• Monocytes: 0.19
• Eosinophils: 0.00
• Basophils: 0.04
Procedure Significance/Purpose Date Findings
Fecalysis Fecal analysis is a May 5, 2022 No Intestinal Parasites
noninvasive laboratory Seen
test useful in identifying
disorders of the digestive
tract. These disorders
may include
malabsorption,
inflammation, infection
(bacteria, viruses, or
fungi), or cancer.
Procedure Significance/Purpose Date Findings
Electrolyte Panel An electrolyte panel is a May 05,2022 • Sodium (135-145 mmol/L):
Test blood test that measures the 136.5
levels of seven electrolytes in • Potassium (3.5-5.5 mmol/L):
your blood. Certain 4.90
conditions, including • Chloride (98-108 mmol//L):
dehydration, cardiovascular 115.9
disease, and kidney disease, • Ionized Calcium (1.13-
can cause electrolyte levels to 1.32mmol/L): 1.30
become too high or low.
Procedure Significance/Purpose Date Findings
Confirms diagnosis for May 05,2022 Negative
Reverse-Transcription SARS-CoV-2 whether
Polymerase Chain suspected or with
Reaction (RT-PCR) confirmed infection
Procedure Significance/Purpose Date Findings
Confirms diagnosis for May 05,2022 Negative
Reverse-Transcription SARS-CoV-2 whether
Polymerase Chain suspected or with
Reaction (RT-PCR) confirmed infection
Pathophysiology:
 Treatment/management:
A. Drugs:
a. ampicillin-sulbactam 95 mg IV X 6 hours
b. paracetamol 20 mg  IV X 4 hours
c. Ferrous sulfate drops 0.3 mL OD
d. Dibencozide 1m/cap OD

B. IV
e. D5050
f. Balanced Multiple Maintenance Solution with 5% Dextrose
 Nursing Care Plans:
A. Prioritization of Problems
Nursing Problem Rank Nursing Diagnosis Justification

Diarrhea 1 Diarrhea related to Given the condition that the infant was born
partial non- premature and with weight of 2.2 kg (less than
mechanical bowel body requirements). Diarrhea is a time sensitive
obstruction condition which is a contributory factor leading to
possible death of the infant for the reason that
further continuum of Diarrheal episodes leads to
the depletion of bodily fluids resulting to a
profound dehydration which then results to death.
From Maslow’s hierarchy of needs lower levels are
first to be fulfilled which is the psychological need,
defined as the necessities for survival. Diarrhea
therefore is an urgent need for intervention as it is
directly related to the survival as it poses threat to
the patient’s mortality.
 Nursing Care Plans:
A. Prioritization of Problems
Nursing Problem Rank Nursing Diagnosis
Imbalance nutrition 2 Imbalance nutrition:
less than body
requirements
Justification
According to Maslow’s hierarchy of needs,
physiological needs are to be fulfilled which is
air, water and food that is defined as the necessity
for survival. Nutrition is a physiological need that
needs to be addressed in order to meet the body's
metabolic demands. Imbalanced nutritional status
can lead to prolonged hospital stays due
prevalence of infections related poor
immunological responses of the body.
Imbalanced nutrition during infancy can further
lead to chronic irreversible effects on the child's
growth and development.
 Nursing Care Plans:
A. Prioritization of Problems
Nursing Problem Rank Nursing Diagnosis
Infection 3 Infection related to
inadequate immunity
Justification
Considering that the client is premature it
predisposes her to infection due to her deficient
immune system functions. Early life infections
are significant causes for morbidity and mortality
and if not treated promptly, on the long run it can
develop to life long neurodevelopmental
impairments.` Since the patient is prone to
infection it is essential to maintain a clean
environment. According the Florence
Nightingale's Environmental theory creating a
clean environment will promote good healing,
good health and wellbeing and good patient
outcomes along with the opportunity for
continued development.
 Nursing Care Plans:
A. Prioritization of Problems
Nursing Problem Rank Nursing Diagnosis
Fluid volume deficit 4 Risk for fluid volume Addressing fluid volume deficit is relatively
deficit
Justification
addressing other underlying health concerns e.g.
oxygen saturation, blood pressure, skin turgor,
capillary refill, urine output (volume, color,
specific gravity), dry mucous membranes,
distribution of nutrients in the body, is helpful for
elimination of body waste (defecation, sweating,
toxic substances in the body), return the
extracellular fluid compartment to normal, restore
fluid volume, and correct any electrolyte
imbalances.
According to Virginia Henderson's need theory,
individuals have basic needs that are components
of health. One of the components of health is the
physiological component which includes the need
for adequate fluid.
 Nursing Care Plans:
A. Prioritization of Problems
Nursing Problem Rank Nursing Diagnosis Justification
Risk for delayed 5 Risk for delayed This is our fifth priority since it’s only a potential
development development related problem. Nonetheless, suppose the weight of the
to low weight-for-age patient continues to be low weight-for-age. In that
case, it will lead to slow physical development, such
as motor development, because the baby is not having
enough nutrition, which is necessary to grow and gain
weight faster.

According to the Nursing Need Theory by Virginia

Henderson, it emphasizes the importance of focusing
on human needs so that the progress after
hospitalization would not be delayed. With this theory,
improving health by focusing on the actual problems,
the patient can achieve the appropriate weight for age
and prevent the risk of delayed development.
Therefore, the progress in the child's health would be
continues
 Nursing Care Plans:
NCP 1: DIARRHEA

Diarrhea is characterized as the passage of three or more loose or liquid

stools per day or a more frequent passage than it is normal for the
individual. It remains to be a second leading cause of death for children
under 5 years old and the leading cause for malnutrition for children
under 5 years old
 INTERVENTION AND
PREVENTION
Key measure to prevent diarrhea:

• Sanitation
• Good personal hygiene
• Food hygiene
• Exclusive breastfeeding for the first six months of life
• Rotavirus vaccination

Interventions:

 Rehydration
Monitoring of weight
Bulk diet
 Nursing Care Plans:
NCP 2: IMBALANCE NUTRITION

Like a machine, the body needs to be supplied with the right kind and
the right amount of fuel. Nutrients we ingest through food should be in
adequate amounts to essentially meet our body’s metabolic
demands. The nursing diagnosis Imbalanced Nutrition: Less Than Body
Requirements occurs when the individual’s metabolic and nutritional
demands are not sufficiently supplied.
 Nursing Care Plans:
NCP 2: IMBALANCE NUTRITION

Interventions:

• Assessing nutritional needs

• Weight monitoring and taking abdominal circumference
• Medication administration
• Monitoring client progress
Health teachings on the importance of the following:
-monitoring weight and nutritional status
-breastfeeding
 Nursing Care Plans:
NCP 3: INFECTION

The invasion and growth of foreign microorganisms in the body such as

bacteria, viruses, yeast and fungi. An infection begins anywhere in the
body leading to a fever or an elevation of the normal body temperature
and elevation of the WBC in the blood.
 INTERVENTION AND
PREVENTION
Key measure to prevent Gastroenteritis:

• Sanitation (Proper disposals and keeping environment clean)

• Good personal hygiene
• Food hygiene
• Good food preparations (ensuring food is cooked before intake)
• Exclusive breastfeeding for the first six months of life

Interventions:

 Rehydration
Fluid replacements
Antibiotics
 Nursing Care Plans:
NCP 4: RISK FOR FLUID VOLUME DEFICIT

Fluid volume deficit (also known as deficient fluid volume or

hypovolemia) describes the loss of extracellular fluid from the body.
Extracellular fluid is the body fluid not contained within individual cells.
It constitutes about 20% of our body weight and includes blood
plasma, lymph, spinal cord fluid, and the fluid between cells.
Importantly, this fluid isn’t just water—it also contains electrolytes and
other essential solutes.

Risk for fluid volume deficit can be used to describe patients who,
while not yet exhibiting serious signs of fluid volume deficit, are at
particular risk of developing the issue.
 Nursing Care Plans:
NCP 4: RISK FOR FLUID VOLUME DEFICIT

Interventions:

• Assessing nutritional needs

• Assessing mucous membranes and bowel sounds
• Monitoring intake and output
• Weight monitoring
• Vital signs monitoring
• Medication administration
• Monitoring client progress
Health teachings on the importance of the following:
-monitoring weight
-monitoring intake and output
 Nursing Care Plans:
NCP 5: Risk for Delayed Development related to Low weight-for-age

When a child's progression through predictable developmental phases

slows, stops, or reverses. Symptoms include slower-than-normal
development of motor, cognitive, social, and emotional skills.

There’s no one cause of developmental delays, but there are some risk

factors. They include:
•Complications at birth: Being born prematurely
• Low weight-for-age
 INTERVENTION
Key measure to prevent developmental delay:
 Be aware of the age-appropriate norms and milestones
 Exposure to a variety of different environments
 Avoid baby devices or gadgets
 Children learn through play
 Positive parenting

Interventions:
 Observation and History taking
Weight monitoring
Vital signs monitoring
Medication administration
Monitoring client progress
Health teachings on the importance of the following:
-follow-up check-up
-getting immunization
-monitoring nutritional status
-breastfeeding
 Nursing Care Plans:
C. Discharged Plan
Health Teaching
Diet/ 1.Encouraged mother to breastfeed.
Nutrition 2.Encouraged mother to breastfeed on demand.
3.Instructed mother not to forget to give her baby vitamins and supplements as
recommended to get the right amount of nutrients necessary for the body.
4.Instructed the mother to maintain the baby’s hydration by increasing fluid intake.

Activity 1. Advised mother to provide infant rest and comfort.

2. Advised mother to provide child adequate amount of sun exposure.
 Nursing Care Plans:
C. Discharged Plan
Health Teaching
Medication 1. Advise mother not to forget to give her baby her vitamins and other medication that
was prescribed by the physician.
Others 1. Instructed mother to immediately contact healthcare provider if there is unusual felt
by the baby.
2. Advised mother to avoid places that are highly polluted such as smoking areas and
central business district (congested areas with heavy traffic, construction sites, and
noise polluted areas).
3. Instructed the mother to burp the baby every after breastfeeding or to follow strict
aseptic technique.
4. Instructed the mother to observe proper hygiene before breastfeeding.