I. INTRODUCTION Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in acute diarrhea. The inflammation is caused most often by infection with certain viruses, less often by bacteria or their toxins, parasites, or adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis as foodborne illness are due to norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and astrovirus. Different species of ba cteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present. Some types of acute gastroenteritis will not resolve without antibiotic treatment, especially when bacteria or exposure to parasites are the cause. Physicians may want to diagnose the cause by analyzing a stool sample, when stomach symptoms remain problematic. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year and is a leading cause
Transcript
I. INTRODUCTION
Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving both
the stomach and the small intestine and resulting in acute diarrhea. The inflammation is
caused most often by infection with certain viruses, less often by bacteria or their toxins,
parasites, or adverse reaction to something in the diet or medication. At least 50% of
cases of gastroenteritis as foodborne illness are due to norovirus. Another 20% of cases,
and the majority of severe cases in children, are due to rotavirus. Other significant viral
agents include adenovirus and astrovirus.
Different species of ba cteria can cause gastroenteritis, including Salmonella,
clinical problem in children. It is a largely self-limited disease with many etiologies. The
evaluation of the child with acute gastroenteritis requires a careful history and a complete
physical examination to uncover other illness with similar presentations. Minimal
laboratory testing is generally required. Treatment is primary supportive and is directed at
preventing or treating dehydration. When positive, an age-supportive diet and fluids
should be continued. Oral rehydration therapy using a commercial pediatric oral
rehydration solution is preferred approach to mild or moderate dehydration. The
traditional approach using “clear liquids” is inadequate. Severe dehydration requires the
prompt restoration of intravascular volume through the intravenous administration of
fluids followed by oral rehydration therapy. When rehydration is achieved, an aged-
appropriate diet should be promptly resumed. Anti-emetic and anti-diarrheal medications
are generally not indicated and may contribute to complications.
Acute gastroenteritis remains a serious health issue, and is responsible for over
50,000 hospitalizations of children. In developing countries, acute gastroenteritis is the
leading cause of death for infants. Acute gastroenteritis should thus be taken seriously,
and people should not hesitate to seek medical treatment for especially seniors and
children who have been ill for more than a day.
In the Philippine Health Statistics, gastroenteritis range as number 10 in the ten
leading causes of infant mortality, with the rate of 0.5 and percentage of 4.1 cases in the
Philippines by the year 2004 this was updated last February 12, 2008.
Last January 6, 2010, we encountered a patient with such kind of infection. This
patient has caught our attention and has given the opportunity to study his case. The
objective of this study is to help us understand the disease process of gastroenteritis and
to orient ourselves for appropriate nursing interventions that we could offer to the patient.
This approach enables us to exercise our duties as student nurses which is to render care.
We were given the chance to improve the quality of care we can offer and to pursue our
chosen profession as future nurses.
II. OBJECTIVES OF THE STUDY
A. GENERAL OBJECTIVES:
This study aims to fully understand the underlying causes of diseases of Acute
Gastroenteritis and to express familiarity and to offer an effective nursing care to a patient
diagnosed with Acute Gastroenteritis through understanding the patient history, disease
process and management.
B. SPECIFIC OBJECTIVES:
1. To know the other complications that affects Acute Gastroenteritis.
2. To determine the present and past clinical history of the patient.
3. To perform a thorough assessment, through Nursing Health History, Physical Assessment,
and the interpretation of the laboratory examination done on the patient.
4. To show the laboratory examinations results with corresponding normal values, actual result
from the patient.
5. To trace and understand the pathophysiology of the Acute Gastroenteritis.
6. To use the nursing process use to identify nursing problems and provide the appropriate
nursing care plan.
7. To provide nursing interventions to the patient with Acute Gastroenteritis.
8. To have knowledge to the client medication and be familiar to that medication.
9. To formulate a workable nursing care plan on the subjective and objective cues gathered
through nurse-patient interaction to be able to help the patient recover.
III. NURSING HISTORY
A. HISTORY OF PRESENT ILLNESS
The present condition started 3 days prior to admission when patient had 6 episodes of yellowish, non-blood streaked, mucoid stool, non-foul smelling amounting to 1 tsp per bowel movement. Watery lined stool was accompanied with fever and productive cough as well as vomiting, 4 episodes of previously injected milk amounting to ½ cup per bout. No consultations done, (+) meds given are Paracetamol (Tempra) 10 ml, Carbocentric (Solmux), and Cotrimoxazole (Kathrex) 2 ml BID x 3 days.
One day prior to admission, still with four (4) episodes of LBM now watery based. Few hours prior to admission, still with above condition accompanied with high grade fever (40 C), difficulty of breathing and circumoral cyanosis. No seizures noted. He was brought to East Avenue Medical Center and was advised admission but due to no vacancy, he was brought to Dr. Jose Fabella Memorial Hospital hence admission.
B. HISTORY OF PAST ILLNESS
According to the patient’s mother, he had completed his vaccinations including BCG, DPT, OPV, MMR and Hepatitis B vaccine. The client had cough, colds and fever occurring eight (8) times last year and didn’t have an otitis media. The patient had never been any of the childhood diseases such as measles, mumps and chicken pox. The patient has no history of any accident or injury. He was not hospitalized before and does not take any medications or supplements to maintain health.
C. FAMILY HISTORY
Father: Age – 42 years oldOccupation – Security GuardEducational Attainment - High School Graduate
Mother: Age – 30 years oldOccupation – HousewifeEducational Attainment – Elementary Graduate
According to the patient’s mother, their family have history of hypertension, diabetes mellitus and asthma.
PATIENT’S PROFILE
NAME: Jerome Niel Guillamac Basibasi
BED NO: Gastro-27
AGE: 1 year old and 5 months
GENDER: Male
ADDRESS: 173 Old Balara, Tandang Sora, Quezon City
BIRTHDAY: August 20, 2008
BIRTHPLACE: Bulacan
OCCUPATION: N/A
NATIONALITY: Filipino
CIVIL STATUS: Child / Single
RELIGION: Roman Catholic
DATE OF ADMISSION: January 2, 2010
TIME OF ADMISSION: 5:00 am
ATTENDING PHYSICIANS: Dr. Gregorio / Dr. Ballesteros
CHIEF COMPLAINT: LBM & vomiting; days PTC – (+) productive cough accompanied by fever & watery nasal discharge, no consult done, meds: Paracetamol
ADMITTING DIAGNOSIS: Acute Gastroenteritis with some Dehydration
FINAL DIAGNOSIS: Acute Gastroenteritis with some Dehydration
IV. PHYSICAL ASSESSMENT
Date assessed: January 06, 2010General assessment: neat, conscious and coherentNutritional Status: Fairly nourishedInitial vital signs: T=36.3 C, RR=34, PR=120Height: 34 ½ inchesWeight: 9.6 kgChest circumference: 19 ½ inches / 50 cm
Area Assessed Technique Normal Findings Actual Findings Evaluation
Body Structure
Stature
Symmetry
Inspection
Depends(Short & Tall)Symmetrical
Tall
Symmetrical
Normal
Normal
Skin
Color Inspection Light brown, tanned skin (vary according
to race)
Tanned skin Normal
Lips, nail beds, soles and palms
Inspection
Lighter colored palms, soles, lips and
nail beds
Lighter colored palms, soles, lips and
nail beds Normal
Moisture Inspection/
Palpation
Skin normally dry Skin normally dry Normal
Temperature Palpation Normally warm 36.3 o C Normal
Texture Palpation
Smooth, soft and flexible palms and
soles (thicker)
Smooth, soft and flexible palms and
soles (thicker) Normal
Turgor Palpation Skin snaps back immediately, good
Skin snaps back immediately, good
Normal
Skin appendages
a. Nails
Inspection Transparent, smooth and convex
Transparent, smooth and convex
Normal
Nail beds & folds Inspection Pinkish & intact Pinkish & intact Normal
Nail base & texture
Inspection Firm & soft Firm & soft Normal
Head Inspection Normocephalic Normocephalic Normal
Fontanels Inspection/Palpation
Anterior: Closed (12-18 mos)
Posterior: Closed (2-5 mos)
Anterior: Closed but depressed
Posterior: Closed
d/t dehydration
b. Hair
Distribution Inspection Evenly distributed Evenly distributed Normal
Color Inspection Black Black Normal
Texture Inspection/ Palpation
Smooth Smooth Normal
Eyes
Eyes Inspection Parallel to each other Parallel to each other but sunken
d/t dehydration
Visual Acuity Inspection (penlight)
PERRLA- Pupils equally round react to
light and accommodation
PERRLA- Pupils equally round react to
light and accommodation
Normal
Eyebrows Inspection Symmetrical in size, extension, hair
texture and movement
Symmetrical in size, extension, hair
texture and movement
Normal
Eyelashes Inspection Distributed evenly and curved outward
Distributed evenly and curved outward
Normal
Eyelids Inspection Same color as the skin
Blinks involuntarily
Same color as the skin
Blinks involuntarily
Normal
and bilaterally up to 20 times per minute
Do not cover the pupil and the sclera, lids normally close
symmetrically
and bilaterally up to 16 times per minute
Do not cover the pupil and the sclera, lids normally close
symmetrically
Normal
Normal
Conjunctiva Inspection Transparent with light pink color
Pale d/t AGE with DHN
Sclera Inspection Color is white Color is white Normal
Cornea Inspection Transparent, shiny Transparent, shiny Normal
Pupils Inspection Black, constrict briskly
Black, constrict briskly
Normal
Iris Inspection Clearly visible Clearly visible Normal
Color Inspection Even coloration Even coloration Normal
Ears
Ear canal opening Inspection Free of lesions, discharge of inflammation
Canal walls pink
Free of lesions, discharge of inflammation
Canal walls pink
Normal
Normal
Symmetry Inspection Symmetrical aligned with outer cantus
Symmetrical aligned with outer cantus
Normal
Hearing Acuity Inspection Client normally hears words when whispered
Client normally hears words when whispered Normal
Discharges Inspection Absent Absent Normal
Nose
Shape, size and skin color
Inspection Smooth, symmetric with same color as
Smooth, symmetric with same color as
the face the face Normal
Nasal septum Inspection Close to midline, thicker anteriorly than posteriorly;
deviated
Close to midline, thicker anteriorly than posteriorly;
Gums Inspection Slightly pink color, moist and tightly fit against each tooth
Slightly pink color, moist and tightly fit against each tooth Normal
Tongue Inspection Moist, slightly rough on dorsal surface
medium or dull red / pink
Moist, slightly rough on dorsal surface
medium or dull red / pink
Normal
Teeth Inspection Firmly set, shiny, white
Firmly set, shiny, white
No tooth decay
Normal
Hard and soft palate
Inspection Hard palate- dome-shaped
Soft Palate- light pink
Hard palate- dome-shaped
Soft Palate- light pinkNormal
Uvula Inspection Present Present Normal
Neck
Symmetry of neck muscles,
alignment of trachea
Inspection
Neck is slightly hyper extended,
without masses or asymmetry
Neck is slightly hyper extended, without
masses or asymmetry Normal
Neck Range of Motion
Inspection Neck moves freely, full without discomfort
Neck moves freely, full without discomfort
Normal
Thyroid gland Palpation Rises freely with swallowing
Rises freely with swallowing
Normal
Trachea Inspection Midline Midline Normal
Thorax and Lungs
Auscultation Clear breath sounds Clear breath sounds Normal
Heart
Pulsation
Rhythm
Auscultation Present
Regular
Normal
Normal
Abdomen
Bowel sounds
Inspection
Auscultation
Skin same color with the rest of the body
Clicks or gurling sounds occur
irregularly and range from 5-35 per minute
Skin same color with the rest of the body
Clicks or gurling sounds occur Hyperactive
Normal
d/t AGE
Symmetry Inspection Symmetrical Symmetrical Normal
Contour Inspection Flat Normal
Umbilicus Inspection Midline Midline Normal
Reproductive
MaleTesticles
Palpation Descended Descended Normal
Hernia Palpation Absent Absent Normal
Anus Inspection Perforated Perforated Normal
Neurology system
Level of consciousness Inspection Fully conscious Fully conscious Normal
Behavior and appearance
Inspection Makes eye contact with examiner,
hyperactive expresses feelings with
response to the situation
Makes eye contact with examiner,
hyperactive expresses feelings with
response to the situation
Normal
GROWTH AND DEVELOPMENT
Motor
Hands often open Begins reaching and grasping with palm Transfer objects from one hand to another Picks up objects well with whole hand Reaches for toys Rakes for objects and releases objects Releases hold on cup
Psychosocial
Knows parents Shows emotions of fear and anger Has mood changes Quiets self
Sensory / Cognitive
Notes bright objects if in line of vision Follows an object with eyes Begins to play with objects Recognizes familiar faces Turns head to locate sounds Recognizes parent in other clothes, places Uses hands to learn concepts of in and out Searches for hidden toys Explores boxes, inserts objects in container
Language / Communication
Strong cry Respond to human faces Responds to voices, watches speaker Can say mama, dada Understand and obey simple commands, such as “wave, bye-bye” Responds to “no”
Mobility
Raises head, holds position Moves all extremities, kicking arms and legs when prone Sits alone, using hands for support Begins to pull up Takes first step Walks alone Sits from a standing position
V. ANATOMY and PHYSIOLOGY
THE DIGESTIVE SYSTEM
Every morsel of food we eat has to be broken down into nutrients that can be absorbed by the body, which is why it takes hours to fully digest food. In humans, protein must be broken down into amino acids, starches into simple sugars, and fats into fatty acids and glycerol. The water in our food and drink is also absorbed into the bloodstream to provide the body with the fluid it needs.
The digestive system is made up of the alimentary canal and the other abdominal organs that play a part in digestion, such as the liver and pancreas. The alimentary canal (also called the digestive tract) is the long tube of organs — including the esophagus, the stomach, and the intestines — that runs from the mouth to the anus. An adult's digestive tract is about 30 feet long.
Digestion begins in the mouth, well before food reaches the stomach. When we see, smell, taste, or even imagine a tasty snack, our salivary glands, which are located under the tongue and near the lower jaw, be gin producing saliva. This flow of saliva is set in motion by a brain reflex that's triggered when we sense food or even think about eating. In response to this sensory stimulation, the brain sends impulses through the nerves that control the salivary glands, telling them to prepare for a meal.
As the teeth tear and chop the food, saliva moistens it for easy swallowing. A digestive enzyme called amylase, which is found in saliva, starts to break down some of the carbohydrates (starches and sugars) in the food even before it leaves the mouth.
Swallowing, which is accomplished by muscle movements in the tongue and mouth, moves the food into the throat, or pharynx. The pharynx (pronounced: fair-inks), a passageway for food and air, is about 5 inches long. A flexible flap of tissue called the epiglottis reflexively closes over the windpipe when we swallow to prevent choking.
From the throat, food travels down a muscular tube in the chest called the esophagus. Waves of muscle contractions called peristalsis force food down through the esophagus to the stomach. A person normally isn't aware of the movements of the esophagus, stomach, and intestine that take place as food passes through the digestive tract.
At the end of the esophagus, a muscular ring called a sphincter allows food to enter the stomach and then squeezes shut to keep food or fluid from flowing back up into the esophagus. The stomach muscles churn and mix the food with acids and enzymes, breaking it into much smaller, more digestible pieces. An acidic environment is needed for the digestion that takes place in the stomach. Glands in the stomach lining produce about 3 quarts of these digestive juices each day.
Most substances in the food we eat need further digestion and must travel into the intestine before being absorbed. When it's empty, an adult's stomach has a volume of one fifth of a cup, but it can expand to hold more than 8 cups of food after a large meal.
By the time food is ready to leave the stomach, it has been processed into a thick liquid called chyme. A walnut-sized muscular tube at the outlet of the stomach called the pylorus keeps chyme in the stomach until it reaches the right consistency to pass into the small intestine. Chyme is then squirted down into the small intestine, where digestion of food continues so the body can absorb the nutrients into the bloodstream.
The small intestine is made up of three parts:
1. the duodenum, the C-shaped first part 2. the jejunum, the coiled midsection 3. the ileum, the final section that leads into the large intestine
The inner wall of the small intestine is covered with millions of microscopic, finger-like projections called villi. The villi are the vehicles through which nutrients can be absorbed into the body.
The liver (located under the ribcage in the right upper part of the abdomen), the gallbladder (hidden just below the liver), and the pancreas (beneath the stomach) are not part of the alimentary canal, but these organs are still important for healthy digestion.
The pancreas produces enzymes that help digest proteins, fats, and carbohydrates. It also makes a substance that neutralizes stomach acid. The liver produces bile, which helps the body absorb fat. Bile is stored in the gallbladder until it is needed. These enzymes and bile travel through special channels (called ducts) directly into the small intestine, where they help to break down food.
The liver also plays a major role in the handling and processing of nutrients. These nutrients are carried to the liver in the blood from the small intestine.
From the small intestine, food that has not been digested (and some water) travels to the large intestine through a valve that prevents food from returning to the small intestine. By the time food reaches the large intestine, the work of absorbing nutrients is nearly finished. The large intestine's main function is to remove water from the undigested matter and form solid waste that can be excreted. The large intestine is made up of three parts:
1. The cecum is a pouch at the beginning of the large intestine that joins the small intestine to the large intestine. This transition area allows food to travel from the small intestine to the large intestine. The appendix, a small, hollow, finger-like pouch, hangs off the cecum. Doctors believe the appendix is left over from a previous time in human evolution. It no longer appears to be useful to the digestive process.
2. The colon extends from the cecum up the right side of the abdomen, across the upper abdomen, and then down the left side of the abdomen, finally connecting to the rectum.
The colon has three parts: the ascending colon and transverse colon, which absorb water and salts, and the descending colon, which holds the resulting waste. Bacteria in the colon help to digest the remaining food products.
3. The rectum is where feces are stored until they leave the digestive system through the anus as a bowel movement.
The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity, where food enters the mouth, continuing through the pharynx, oesophagus, stomach and intestines to the rectum and anus, where food is expelled. There are various accessory organs that assist the tract by secreting enzymes to help break down food into its component nutrients. Thus the salivary glands, liver, pancreas and gall bladder have important functions in the digestive system. Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.
The primary purpose of the gastrointestinal tract is to break down food into nutrients, which can be absorbed into the body to provide energy. First food must be ingested into the mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and small intestine where proteins, fats and carbohydrates are chemically broken down into their basic building blocks. Smaller molecules are then absorbed across the epithelium of the small intestine and subsequently enter the circulation. The large intestine plays a key role in reabsorbing excess water. Finally, undigested material and secreted waste products are excreted from the body via defecation (passing of faeces). In the case of gastrointestinal disease or disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may develop symptoms of nausea, vomiting, diarrhoea, malabsorption, constipation or obstruction. Gastrointestinal problems are very common and most people will have experienced some of the above symptoms several times throughout their lives.
VII. DIAGNOSTIC PROCEDURES and LABORATORY RESULTS
Name: Basibasi, Jerome Neil G. Lab Number: 118318 Age: 1Y 4M 12D Ward: Pedia Bed Number: 27 Sex: Male Run Date: 01/02/10 09:21AM Physician: Dr. Gregorio / Dr. Ballesteros Print Date: 01/02/10 09:26AM
Clients with Acute Gastroenteritis, watchers are instructed to take the following plan for discharge:
Medications - Medications should be taken regularly as prescribed, on exact dosage, time, & frequency, making sure that the purpose of medications is fully disclosed by the health care provider.
Exercise - Exercise should be promoted in a way by stretching hand and feet every morning and exercise burping every after bottle feeding.
Treatment - Treatment after discharge is expected for patients and watcher with Acute Gastroenteritis to fully participate in continuous treatment.
Hygiene - Hygiene must be maintained for patients with Acute Gastroenteritis. Promotion of personal hygiene should be encouraged such as, daily bathing and changing of diapers when soiled.
OPD - OPD such as regular follow-up check-ups should be greatly encouraged to client’s watcher with Acute Gastroenteritis as ordered by physician to ensure the continuing management and treatment.
Diet - Diet should be promoted, since, during admission, the patient was on NPO. Proper selection of milk that is suitable for babies will help enhance immunity.
Also:
Bed rest Fluids - to avoid dehydration Salt solutions Symptomatic treatment Diet changes
o Clear fluids o Bland foods - e.g. cereals, rice, soup, crackers, applesauce etc. o Avoid fried foods o Avoid spicy foods o Avoid fruits and vegetables
o Gradual addition of solid foods o Gradual return to usual diet
XI. EVALUATION
Within the span of 3 days of rendering care to Jerome Basibasi, we were able to identify potential problems and specific nursing interventions were provided. With the help of health teachings and other interventions, mother of Jerome Niel Basibasi was able to learn how to recognize signs and symptoms and other risk factors of the condition of her son. The parent of Jerome Niel Basibasi was able to verbalize the importance of giving medications and how to take care of her son. They had also recognized the importance of compliance to treatment regimen in order to manage the condition of their son, Jerome Niel Basibasi. The patient’s mother was advised by the physician that his son can go home for full health restoration.
