Case Presentation of Patient with Acute Gastroenteritis

Presented by:

BSN 103-A/ Group A2

Flores, Ma. Fe Gabriel, Ivy

Garcia, KesselynGaringo, Jeovina

Gumasing, Mary JanineGutierrez, Sunshine

Hernandez, Baby JaneLamurena, JacquelynLopez, Christine Anne

Lualhati, RichardMapiscay, Ma. RichelMendoza, Rosa Mia

Nicolas, Jean Therese

ASSESSMENT

I. Patient’s Biographical DataNAME : Mrs. Green

ADDRESS : NHV, Tigbe, Norzagaray, Bulacan

DATE OF BIRTH : November 26, 1946

BIRTHPLACE : Leyte

BIRTH HISTORY : Home Birth

AGE : 62 years old

SEX : Female

HEIGHT : 5’1”

WEIGHT : 42 kgs.

FATHER’S NAME : Deceased

MOTHER’S NAME : Deceased

NO. of SIBLINGS : Six (6)

ORDINAL POSITION IN

THE FAMILY : Eldest

CIVIL STATUS : Widowed

NATIONALITY : Filipino

MEDICAL DIAGNOSIS : Acute Gastroenteritis

CHIEF COMPLAINT : Loose watery stool and vomiting

HISTORY OF PRESENT ILLNESS

Prior to admission, the patient complains of loose watery stool and vomiting.

HISTORY OF PAST ILLNESS

The patient reported that she had been hospitalized before with the same medical diagnosis of Acute Gastroenteritis.

II. General Physical AssessmentV/S: temp=36.5˚C, P=62bpm, R=19cpm, BP=120/80

SKIN: The patient’s skin’s moisture is dry due to dehydration. The texture is rough due to aging and signs of dehydration.

HEAD: The patient’s head was round and in proportion w/ the body. Hair color is white and has no dandruff and lice. The patient’s general appearance of face indicates a feeling of weakness.

NECK and SHOULDERS: The veins and clavicle are visible. The shoulders are asymmetrical. The neck muscles are weak.

EYES: The patient’s eyes are symmetrical to the ears. She manifested a blurred vision due to aging. Pale conjunctivae was noted. Sunken eyes was observed. The eyes appeared dry due to dehydration.

EARS: The client’s ear manifested a good hearing balance. There were no discharges noted.

NOSE: The client’s nasal septum is intact and in the midline. There were no discharges noted. Airs move freely as the client breathes through the nose.

MOUTH and THROAT: The client’s mouth has presence of lesions due to frequent vomiting. The lips were dry due to dehydration. The throat was functioning well. No dentures. (+) tartar. There is a black discoloration in the enamel. (+) breath odor.

CHEST: The chest is symmetric. The skin was sagged. The thorax is elliptical.

ABDOMEN: The skin of the abdomen is unblemished and uniform in color. Symmetric abdominal contour flattened and rounded. Audible bowel sounds. Symmetric movements cause by respiration. No tenderness noted.

EXTREMITIES: The fingers in both hands and feet are complete. The shape of the nails is spoon-shape, the consistency is smooth and the color is pinkish white.

SPINE: The spine of the patient is slightly curved. No presence of defects.

III. Significant Health PatternsA. SLEEP

Prior to Hospitalization: Her sleeping pattern before was normal. She was able to consume normal 8-hour sleeping time.During Hospitalization:

During her stay at the hospital she said that she was experiencing difficulty of sleeping.

B. ACTIVITY AND EXERCISEPrior to Hospitalization:

Mrs. Green was a street sweeper and a hog-raiser.During Hospitalization:

During her stay at the hospital, she was not able to perform activities because of restlessness due to her illness.

C. NUTRITIONPrior to Hospitalization:

She has good appetite. During Hospitalization:

During her stay at the hospital, she loses her appetite because of her illness.

IV. Work-ups and InterpretationsA. LABORATORY EXAMINATIONS

URINALYSISColor

Base on the result the color of the urine is yellow. The normal color of the urine must be transparent yellow or amber. Since the color of the urine is yellow it may indicate, food pigments or high-solute concentration.

pH

The pH of the patient’s urine is 8.0. Urinary pH is measured to determine the relative acidity or alkalinity of urine and assess the client’s acid- base status. Urine is normally slightly acidic. Less than 7 (acidic), greater than 7 (alkaline), 7 (neutral).

Specific Gravity

The specific gravity of the patient’s urine is 1.010. The specific gravity of urine normally ranges from 1.010 to 1.025. If the specific gravity increase urine becomes more concentrated.

BLOOD CHEMISTRYBlood Urea Nitrogen

The BUN of the patient is 48.3 mg/dl, the normal findings is 8-25 mg/dl. There is an increase in BUN that may cause dehydration, BUN measures amount of urea in blood. Directly related to metabolic function of the liver.

Creatinine

The creatinine of the patient is 0.6 mg/dl, the normal finding of the creatinine is 0.5-1.7 mg/dl. Creatinine is exerted entirely in kidney and therefore directly proportional to glomerular filtration rate.

HEMATOLOGY

HemoglobinThe hemoglobin of the patient is 90g/L.

The normal findings of hemoglobin is 115 to 155g/L. There is a decrease in hemoglobin that may possibly cause hemolytic anemia and bone marrow suppression.

HematocritThe hematocrit of the patient is 26%, the

normal finding is 36 to 46%. Hematocrit measures the percentage of red blood cells in the total blood volume. It reported as percentage because it is the proportion of RBC’s to the plasma. There is also a decrease in hematocrit that may possibly cause diet deficiency anemia.

WBC CountThe WBC count of the patient is 5.0 x 10g/L, the

normal findings of WBC is 4 to 11x10g/L. High WBC count are often seen in the presence of bacterial infection; by contrast, WBC count may be low if a viral infection is present.

RBC CountThe RBC count of patient is 3.11 x 10 g/L, the

normal finding of RBC is 4-7 x 10 g/L. Her RBC count decreases and the possible cause of this is Iron Deficiency Anemia.

Differential CountThe result of the patient lymphocyte is 19%, the

normal value is 25-35%. There is a decrease in lymphocyte that may cause severe malnutrition.

The result of patient monocytes is 4%, the normal value is 2-5%.

ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM

The human digestive   system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.

The Digestive Process: 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.

Digestive System Glossary:

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.

PATHOPHYSIOLOGY

Non-modifiable Factor: Age Modifiable Factors: Lifestyle; Diet; Hygiene

Etiology: E. Hystolytica, Salmonella, Shigella, Campylobacter jejuni, E. Coli, Norovirus, Adenovirus

Person to person (hands) Contaminated food and/or water

Ingestion of Pathogens

Direct invasion of the bowel wall Endotoxins are released

Stimulation and destruction of mucosal lining of the bowel wall

Digestive and absorptive malfunction

Excessive Gas Formation

GI Distention

Nausea and Vomiting

F & E Imbalance

Dehydration

Dry lips, dry mouth, fatigue, irritability

Secretion of fluid & electrolytes in the intestinal lumen

Increased Peristaltic Movement

Diarrhea

DRUG STUDY

Drugs Mechanismof action

Indication Contraindication Adverseeffect

Nursingconsideration

Generic name;NIFEDIPINE

Brand name;Nifediac cc

Classification;Calcium channelBlocker

Dosage; 5mg PRN

Variableseffects on AVNodeeffective andFunctionalRefractoryperiod.

Chronic stableangina with outVasospasmincluding anginadue to increaseseffort, especiallyin client, whocannot take betablockers ornitrates whoRemainSymptomaticfollowing clinicaldoses of thisdrugs.Essential tohypertension

Hypersensitivity,lactation

CV;PeripheralAndPulmonaryedema,Hypotensio, palpitation,And tachycardia.

Do not confusenifedipine withNicardipine (theyalso a calciumchannel blocker)

Drugs Mechanism of action

Indication Contraindication Adverse effect

Nursing Consideration

Generic name;Ceftriaxone

Brand name;Rocephin

Classification; Cephalosporin

Dosage; 1ampule=50 mlTIV q12

One-third to two-thirds excreted unchanged in the urine

Lower respiratory tract infection due to streptococcus pneumonia, staphylococcus aureus. Skin and skin structure infections

Increase in serum creatinine presence of casts in the urine.

. IM injection should be deep into the body of a large muscles.

. do not mixed drug with other antibiotics.

.stability of solutions for IM or IV use varies depending

on the diluents used. Check package insert carefully.

Drugs Mechanism of action

Indications Contraindications Adverse effect

Nursing consideration

Generic name; Ranitidine

Brand name; zantac

Classifications; histamine H2 receptor blocking drug.

Dosage; 1 ampule TIV q8

Competitively inhibits gastric acid secretion blocking the effect of histamine on histamine H2 receptors. Food increases the bioavailability.

Short-term and maintenance treatment of duodenal ulcer.Short term of treatment of active benign gastric ulcer.

Cirrhosis of the liver, impaired renal or hepatic function.

GI; Constipation, nausea and vomiting, diarrhea, abdominal pain,pancreatitis

. do not confuse

zantac with xanax or zyrtex.

Drugs

Generic name; Paracetamol

Brand name; Acetaminophen

Classification

non-narcotic analgesicDosage; adults; 325-650mg every 4 hour(per orem)Caplets, capsules, oral liquid, or syrup

Mechanism of action

Decrease fever by

Hypothalamic effect

leading to sweating

and vasodilation.

Indications

Control of pain due to headache, Dysmenorrh

ea, muscular pain and

Arthritis To reduce fever in

bacterial or viral

infections.

Contraindications

Renal insufficiency

anemia, clients with cardiac or pulmonary disease are

more susceptible to acetaminophen

toxicity.

AdverseEffect

Few when taken in usual therapeutic

doses. Chronic and even acute toxicity can

develop after long syptom-free usage

Nursing Considerations

. do not exceed dose of 4g/24hour in adults and 75mg/kg/day in children.

.do not take for more than 5 days for pain in children, 10days for pain in adults, or more than 3 days for fever in adults or children without consulting provider.

.take extended relief product with water; do not crush, chew or dissolve before swallowing.

Drugs Mechanism of action

Indications Contraindications Adverseeffect

Nursing considerations

Generic name;Metoclopramide

Brand name;reglan

Classifications; gastrointestinal stimulant

Dosage;10mgIV q8

Dopamine antagonist that acts by increasing sensitivity to Acetylcholine results in increased motility of the upper GI tract and relaxation of the pyloric sphincter and duodenal bulb. Gastric emptying time and GI transit time are shortened.

Parenteral; facilitates small bowel intubation, Stimgastric emptying, and Increase intestinal Transit of barium to aid in radiologic Examination of stomach.

Gastrointestinal hemorrhage, obstruction or perforation; epilepsy.

CNS; restlessness

, drowsiness, fatigue, anxiety, insomnia, headache,dizziness

. inject slowly IV order 1-2mins to prevent transient feelings of anxiety and restlessness.Check packaged insert if drugs is to be admixed.

Drugs Mechanism of action

Indications Contraindications Adverse effect

Nursing consideration

Generic name; Ferrous sulfate

Brand name; feosolClassification; anti anemic iron

Dosage; adults, 150-250mg (1-2 time per day)Per orem

Iron is absorbed from the duodenum and upper jejunum by active mechanism through the mucosal cells where it combines with the protein Transferrin.

.prophylaxis and treatment of iron deficiency and iron deficiency anemias..dietary supplement for iron.

Hemosiderosis, peptic ulcer,

Constipation, gastric irritation, nausea, abdominal cramps, anorexia, vomiting, diarrhea, dark colored stools.

. For infants and young children, administer liquid preparation with a dropper. Deposit liquid well back against the cheek.. Eggs and milk and coffee and tea consumed with a meal or 1hour after may significantly inhibit absorption of dietary iron.. Do not crash or chew sustained release products.

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subj. data:

“ Madalas akong dumumi at nasusuka ako”. As verbalized by the patient.

Obj. data:

-dry skin, lips

-body malaise

-sunken eyes

-paleness

-poor skin turgor

-restlessness

V/S:

T- 36.6˚C

P- 63 bpm

R- 19 cpm

BP- 120/80 mmHg

Deficient Fluid Volume

related to frequent

elimination of loose watery

stool and vomiting

LTG:

After 72 hrs. of nsg. Intervention, the patient will be able to maintain the fluid volume at functional level by:

1.)Health teaching on patient on how to attain normal hydration status.

2.)Maintain normal fluid volume and replace fluid loss.

-Giving advice on the

patient to increase

fluid intake.

-Encourage

increase oral fluid

intake

-To promote

understanding

and avoid

rercurrence of

Illness

-To reduce risk

of skin

breakdown

Goal was met.

After 72 hrs. of

nsg. Intervention

the patient was

able to maintain

her fluid volume

in functional

level as

evidenced by:

-The patient

demonstrated

proper

understanding

on the

health teaching

-Fluid volume

was normalized

STG:

After 8 hrs. of

nsg.

Intervention, the

patient will be

able to

improve her

body fluid

Volume at

functional level:

1.)Note the

cause of fluid

volume deficit.

2.)Note physical

signs associated

with dehydration.

.

-Determine the

effects of age.

-Compare usual

and current

weight

-Elderly

individuals are at

high risk

because of

decreasing

response/

effectiveness of

compensatory

Mechanism

-Indicator of

overall fluid

nutritional status

STG:

After 8hrs. of

nsg.

Intervertion

the patient

improved her

body fluid

volume,

evidenced by:

-The cause of

fluid volume

deficit was

determined

-Physical signs

associated with

dehydration is

noted and

Examined

3.)Establish 24

hrs. fluid

replacement,

needs, and

routes, as

ordered.

4.)Evaluate the

degree of fluid

deficit

5.)Promote

comfort and

safety of the

patient

6.)Promote

wellness

-Advice intake

of foods with

high fluid

content

-Measure

client’s output

-Encourage

change in

position

frequently

-Provide optimal

skin care

-Provide

frequent

oral and eye care

-To provide

hydration

-To ensure

accurate data of

fluid status

-To prevent

stasis and

reduce risk of

tissue injury

-To prevent

injury from

Dryness

-To prevent

injury from

dryness

-Establish 24

hrs. fluid

replacement,

needs, as

ordered

-The degree of

fluid is

evaluated

-Comfort and

safety of the

patient was

Promoted

-Wellness

promoted

-Discuss factors

and ways to

prevent

dehydration

-Assist client to

measure her

own intake and

output

-Recommend

restriction of

caffeine and

Alcohol

DEPENDENT

-Administer IV

fluids as

Indicated

-To educate the

patient

-Help determine

baseline

symptoms

-To prevent

frequent

Urination

-Fluids may be

given in this

manner, if client

is unable to take

oral fluid, or

when rapid

fluid

resuscitation is

required.

-Administer

medications as

ordered

-Review

laboratory data

Antiemetics or

antidiarrheals

limit gastric/intestinal

losses

-To evaluate degree

of fluid and

electrolyte

imbalance and

response to

therapist

DISCHARGE PLAN

Patients with Acute Gastroenteritis, watchers are instructed to take the following plan for discharge:

M- 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.

- Home medication : Ranitidine tablet (Zantac)E- Exercise should be promoted in a way by stretching hand and

feet every morning and exercise burping every after meal.T- Treatment after discharge is expected for patients and watcher

with Acute Gastroenteritis to fully participate in continuous treatment.- Usually supportive, treatment consists of nutritional

support and increase fluid intake.H- Hygiene must be maintained for patients with Acute Gastroenteritis. Promotion of personal hygiene should be encouraged such as, daily bathing and always wash hands w/ warm water and soap handling foods, esp. after using the bathroom

O- OPD such as regular follow-up check-ups should be greatly encouraged to clients watcher with Acute Gastroenteritis as ordered by physician to ensure the continuing management and treatment.

D- Diet should be promoted, such as soft and bland diet that cannot irritate the GI tract.

S- Signs and Symptoms.-Clinical manifestations vary depending on the pathologic organism and the level of GI tract involved. AGE produces symptoms such as: diarrhea, abdominal discomfort, nausea and vomiting, fever, body malaise-In children and elderly and debilitated people, AGE produces the same symptoms, but the inability of the patient to tolerate electrolyte losses leads to a higher mortality.

-THE END-