Acute Gastro Enteritis
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Presented to
Lyceum Northwestern University
Dagupan City, Pangasinan
In Partial Fulfillment
Of The Requirements of RLE III – Pangasinan Provincial Hospital
Submitted to:
Miss Joyce Ferrer
Submitted by:
Pearl Morante
Rutalee Miranda
TABLE OF CONTENTS
ACKNOWLEDGEMENT
I. Objective
II. Introduction
III. Anatomy
IV. Pathophysiology
V. Patient’s Profile
VI. Laboratory Results
VII. Management
A. Nursing Management
- Nursing Care Plan
B. Medical Management
- Drug Study
VIII. Discharge Planning
IX. Significance of the study
X. Definition of Terms
XI. Appendices
A. Actual number of Census
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ACKNOWLEDGEMENT
“The hardest arithmetic to master is that which enables us to
count our blessings.” says Eric Hoffer….
In fulfilling our tasks as student nurses, especially in accomplishing our case study, we had received many blessings. . . Blessings such as meeting great people who helped us by enlightening our mind in doing this case study. . .
Albert Schweitzer said, “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep Gratitude of those who have lighted the flame within us”
To those persons, we call you our angels. . . You helped us accomplish this task Of doing our Case Study and more than that is learning more than we expected.
To our patient, whom we wish to call Child XX for confidentiality,
To his family, for giving us the information we needed,
To our Dean and the Faculty of Nursing who taught us well in preparation to a hospital duty,
To Ms. Joyce Ferrer, whose witt challenged our neurons work to its highest potential, and to her kindness in guiding us to be better student nurses . . . even excellent future professional nurses.
To the staff of Pangasinan Provincial Hospital, who also guided us and helped us adjust and understand our patient,
Without all of you, this case study would not be made possible.
Thank you very much for being our Angels.
And because of all of you, our group has learned to value and to be thankful to each other as we work hand in hand in accomplishing this report.
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I. General Objective
Ø To be able to provide student nurses and other Health Care professionals with an overview of the condition process and the nursing implication of Acute Gastro Enteritis.
Specific Objectives
By the end of this case study, we will be able to:
Ø Identify AGE and its predisposing factors
Ø Identify the history and manifestations of the disease through research and observing a positively identified patient with Typhoid Fever.
Ø Identify the laboratory results undergone by the patient.
Ø Discuss the pathophysiology of AGE.
Ø Discuss ways of managing AGE
Ø Identify means of preventing AGE.
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II. Introduction
Gastroenteritis is also known as gastro, gastric flu, and stomach flu, although unrelated to influenza. It is the 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.
Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year, and is a leading cause of death among infants and children under 5.
At least 50% of cases of gastroenteritis as food borne 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 bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present.
Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers to become infected during times of rain as a result of contaminated runoff water. The incidence is 1 in 1,000 people.
Gastroenteritis can be classified as either viral or bacterial.
Symptoms and signs Gastroenteritis often involves stomach pain or spasms (sometimes to the point of being crippled), diarrhea and/or vomiting, with noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.
It usually is of acute onset, normally lasting 1-6 days (fewer than 10 days) and self-limiting.
Nausea and vomiting
Diarrhea
Loss of appetite
Abdominal pain
Abdominal cramps
Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella, Shigella or some pathogenic strains of Escherichia coli)
Fainting and Weakness
The main contributing factors include poor feeding in infants. Diarrhea is common, and may be (but not always) followed by vomiting. Viral diarrhea usually causes frequent watery stools, whereas blood stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is empty, bile can be vomited up.
A child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs of dehydration (which include dry mucous membranes), tachycardia, reduced skin turgor, skin color discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion and ultimately shock.
Symptoms occur for up to 6 days on average. Given appropriate treatment, bowel movements will return to normal within a week after that.
III. Anatomy and Physiology
The affected system in Acute Gastro Enteritis is the Digestive System.
The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.
In the small intestine - After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.
In the large intestine - After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon.
The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.
------------------------------ PATHOPHYSIOLOGY--------------------
Food/Water/Medication infected with bacteria or Virus
such as:
Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, Etc.
THEN
Taken orally by an individual
THEN
Bacteria/Virus attack the stomach and small intestines
THEN
Inflammation occurs
THEN
Signs and Symptoms:
Nausea and vomiting
Diarrhea/LBM
Loss of appetite
Abdominal pain
Abdominal cramps
Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella, Shigella or some pathogenic strains of Escherichia coli)
Fainting and Weakness
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I. Patient’s Profile
Patient’s Profile
Name: Child XX
Address: Calasiao, Pangasinan
Sex: Female
Civil Status: Single
Birthdate: Novemeber 21 2008
Age: 3 months
Birthplace: Bulacan
Nationality: Filipino
Religion: Roman Catholic
Admission Date: 2/1/2008 Time: 8:35 pm
Type of Admission: New
Chief Complaint:
The patient complained of dyspnea, weakness and loose bowel movements.
Nutritional Status:
Upon admission the patient was placed on NPO
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Management
Nursing Management
Admitted a dyspneic, feverish patient with LBM to Pedia ICU.
Secured signed consent to care
Placed in bed comfortably - With Linen stretched.
Inserted and fed via OGT aseptically
Vital signs checked and monitored every four hours all through out the confinement in the hospital
Hooked to pulse oximeter and maintain O2 sat >90% as ordered by physician
Medications administered as ordered by the attending physician.
TSB provided
Intake and output monitored to ensure good hydration
Watched for any unusualities
Referred to social worker for assistance and availability of medicines
----------- Place Nursing Care Plans here------------------
Medical Management
A. Rehydration:
IVT hooked – Plain LR
· For rehydration
· As a route for medication
B. Laboratory – as ordered, to check complete status of patient. Results shown above.
-----Place Laboratory Results and Interpretation here! --------------------
C. Diet Therapy – On NPO upon admission. Milk feeding allowed on the second day. Breast feeding was encouraged.
D. Medications ordered such as
Antibiotics:
1. Ceftriaxone 500 mg IVTT now then OD
2. Ampicillin 260 mg IVTT every 6 hours
Fever:
3. Paracetamol 60 mg IVTT every 4 hours, PRN for temp >37.8°C
Seizure:
4. Phenobarbital 104 mg IVTT now as LD then 13 mg IVTT every 12 hours
5. Diazepam 1.5 mg IVTT now the PRN for frank seizures
6. Dopamine @ 2 cc/hr.
------------------------- Place Drug Studies here--------------------
II. Discharge Planning
The patient with ACUTE GASTRO ENTERITIS was instructed to take the following plan of discharge:
M – Medications should be taken regularly as prescribed, on exact dosage, time and frequency, making sure that the purpose of medications is fully disclosed by the health care provider.
E - Exercise should be promoted in a way by stretching hand and feet every morning. Encourage the patient to keep active to adhere to exercise program and to remain as self-sufficient as possible.
T – Treatment after discharge is expected for the patient and watcher to participate in continues medication.
H – Health teachings regarding proper hygiene and hand washing, food and water preparation, intake of adequate vitamins especially vitamin C-rich foods to strengthen the immune response and increasing of oral fluid intake should be conveyed.
O – OPD such as regular follow-up check ups should be greatly encouraged to the patient as ordered by physician to ensure the continuing management and treatment.
D – Diet which is prescribed should be followed. Laxative containing food should be avoided. Laxative foods include most fruits and vegetables, and cereal foods and breads containing the whole of the cereal grain. To include fruits especially banana in the diet is signifant.
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Definition of Terms
anus - the opening at the end of the digestive system from which feces (waste) exits the body.
appendix - a small sac located on the cecum.
ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the small intestine.
cecum - the first part of the large intestine; the appendix is connected to the cecum.
chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for further digestion.
descending colon - the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon.
duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum.
epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in the liver) into the small intestine.
ileum - the last part of the small intestine before the large intestine begins.
jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.
liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks down fats) and some blood proteins.
mouth - the first part of the digestive system, where food enters the body. Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small intestine.
peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is involuntary - you cannot control it. It is also what allows you to eat and drink while upside-down.
rectum - the lower part of the large intestine, where feces are stored before they are excreted.
salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules.
sigmoid colon - the part of the large intestine between the descending colon and the rectum.
stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in a bath of acids and enzymes.
transverse colon - the part of the large intestine that runs horizontally across the abdomen.
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Appendices
Actual number of Census
INFANT MORTALITY
Infant Mortality: Ten (10) Leading Causes
Number & Rate/1000 Livebirths & Percentage Distribution
Philippines, 2004
1. Bacterial sepsis of newborn
2. Respiratory distress of newborn
3. Pneumonia
4. Disorders related to short gestation and low birth weight, not elsewhere classified
5. Congenital Pneumonia
6. Congenital malformation of the heart
7. Neonatal aspiration syndrome
8. Other congenital malformation
9. Intrauterine hypoxia and birth asphyxia
10.Diarrhea and gastro-enterities of presumed infectious origin