I. READINGS

DEFINITION

Acute gastroenteritis is a general term referring to inflammation or infection of the gastrointestinal tract, primarily the stomach and intestines.

Sometimes it is referred to simply as 'gastro'. It is often called the stomach flu or gastric flu even though it is not related to influenza.

TYPES OF ACUTE GASTROENTERITIS ACCORDING TO CAUSATIVE AGENT:

Viral Gastroenteritis- An infection caused by a variety of viruses that results in vomiting or diarrhea.- Most common cause of gastroenteritis which cannot be cured by antibiotics.- Occurs in people of all ages and backgrounds. Adenoviruses and astroviruses cause

diarrhea mostly in young children, but older children and adults can also be affected.

Bacterial Gastroenteritis- An inflammation of the stomach and intestines caused by bacteria or bacterial toxins.- Can affect one person or a group of people who all ate the same contaminated food. It

more commonly occurs after eating at picnics, school cafeterias, large social functions, or restaurants.

INCIDENCE

Worldwide, gastroenteritis kills 3 million to 5 million children every year, primarily in developing nations where sanitation and health care are poor. Most of these children die from extreme dehydration (abnormally low levels of body water) resulting from a combination of severe diarrhea, vomiting and not drinking enough fluids. Even in the industrialized world, millions of episodes of gastroenteritis occur each year, especially in young children.

This is more likely to happen in infants, children with chronic illnesses and children taking immune-suppressing medications. By age 3 years, virtually all children become infected with the most common agents.

In the Philippines, acute gastroenteritis is one of the ten leading cause of morbidity and mortality. Among Filipino children 1-4 years of age, it is the third most common cause of death with 16.14 deaths per 100,000 population recorded.

According to the Provincial Health Office of Ilocos Norte, as of 2009, it was recorded that gastroenteritis was in the top 10 leading causes of infant morbidity.

There are 3063 patients suffer from this illness in our province.

PHO also confirmed that acute gastroenteritis is a common cause of morbidity among children less than five years of age, and that, it is estimated to 2000 infants, and the rest, is to be credited to the adults.

RISK FACTORS/CAUSES

Consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation.-AGE is basically attributed to food or water contaminated with fecal material containing the virus. And to note, these viruses are potent and aggressive. Evidence suggests that as few as ten viral particles are sufficient to cause AGE.

Overcrowding- overcrowding becomes an avenue to bacteria like the E.coli, because easy transmission can occur

Poverty- with less money, poor people are not able to buy proper sanitized food and water, as well as, they are not able to buy medicines and drug supplements. People who have less in life prioritize buying food than to avail medical assistance. It’s like “isang kahig, isang tuka” system that hat they earn today, is only reserved from their day to day survival for food.

Poor sanitation- the presence of bacteria in the community cannot be lessened since these filthy reservoirs are the best dwelling of disease-causing bacteria. With regards to AGE, bacteria causing it survives for several days in a contaminated environments, thereby making it also to easily spread virus.

Pollution- leads to unhealthy environment which turns to be the reservoir of bacteria. Thus, making the inhabitants of a certain polluted place to be susceptible of getting infected, or say, their food to be contaminated, that leads to food poisoning.

Age-By age 0-5 years, virtually all children become infected with the most common agents since at this age bracket, they are very susceptible to viruses and bacteria causing illnesses. Usually, they are very prone in touching things around them and accidentally places their hands in their mouth, thereby, a point of entry for the pathogens to cause illnesses. At this age, their immune system is still weak that they are easily suppressed by these bacteria and viruses.

CLINICAL MANIFESTATIONS

VIRAL GASTROENTERITIS

Watery diarrhea

Diarrhea refers to the passage of loose or watery stools, and occurs at some point in the life of nearly every child. Diarrhea is not a disease, but is a symptom of a number of illnesses. Diarrhea caused by gastroenteritis is watery and may contain blood if the illness is caused by a type of bacteria.

Vomiting

Vomiting is a forceful action accomplished by a fierce, downward contraction of the diaphragm. At the same time, the abdominal muscles tighten against a relaxed stomach with an open sphincter. The contents of the stomach are propelled up and out.

Headache

Headache or Cephalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck

Chills

Rigor or chills is a shaking occurring during a high fever. It occurs because cytokines and prostaglandins are released as part of an immune response and increase the set point for body temperature in the hypothalamus.

Abdominal pain

Severe abdominal pain can be from mild conditions, such as gas or the cramping of viral gastroenteritis

Loss of appetite

The decreased sensation of appetite.

BACTERIAL GASTROENTERITIS

Diarrhea

Diarrhea refers to the passage of loose or watery stools, and occurs at some point in the life of nearly every child. Diarrhea is not a disease, but is a symptom of a number of illnesses. Diarrhea caused by gastroenteritis is watery and may contain blood if the illness is caused by a type of bacteria.

Abdominal pain

Severe abdominal pain can be from mild conditions, such as gas or the cramping of viral gastroenteritis

Loss appetite

The decreased sensation of appetite

Vomiting

Vomiting is a forceful action accomplished by a fierce, downward contraction of the diaphragm. At the same time, the abdominal muscles tighten against a relaxed stomach with an open sphincter. The contents of the stomach are propelled up and out.

Fever

The presence of fever (with or without chills) generally suggests that an invasive organism is the cause of diarrhea, although many extra intestinal illnesses can present with both fever and diarrhea, especially in children.

TREATMENT & MANAGEMENT

Give 2-4 ounces of extra fluid every time that he has a large watery diarrhea. BRAT diet Give sips of oral rehydration salt solution or pedialyte

Don't eat solid foods until the diarrhea has passed, and avoid dairy products, which can make diarrhea worse (due to a temporary state of lactose intolerance).

Drink any fluid (except milk or caffeinated beverages) to replace fluids lost by diarrhea and vomiting.

Give children an electrolyte solution sold in drugstores. IV fluid

PREVENTION

To help prevent gastroenteritis in all members of your family, you can take the following steps:

Wash your hands frequently, especially after using the toilet, after changing the diapers and after carrying for a child with diarrhea.

Wash your hands before and after preparing foods, especially after handling raw meat. Wash diarrhea-soiled clothing in detergent and chlorine bleach. If bathroom surfaces are

contaminated with stool, wipe them with a chlorine-based household cleaner Cook all meat thoroughly before you serve it to your family, and refrigerate leftovers

within 2 hours. Make sure you don’t transfer cooked foods on to unwashed plates that held raw meat. Wash kitchen countertops and utensils thoroughly after they have been used to prepare

meat. Never drink unpasteurized milk, unpasteurized apple cider or untreated water. If you travel to an area where sanitation is poor, make sure that your family drinks only

bottled water of soft drinks, and that they don’t eat ice, uncooked vegetables or fruit that they haven’t peeled themselves.

PHARMACOLOGICAL MANAGEMENT

Ondaserton- CLASSIFICATION: AntiemeticMECHANISM OF ACTION : Selective 5-HT3 receptor antagonist, blocking serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone.

DoxycyclineCLASSIFICATION: AntibioticMECHANISM OF ACTION: Inhibits protein synthesis of susceptible, bacteriostatic.

GlucolyteCLASSIFICATION: Fluid and electrolyteMECHANISM OF ACTION: To increase fluid and electrolyte in the body

DicycloverineCLASSIFICATION: Anticholinergic

MECHANISM OF ACTION: Thought to exert direct effect on GI smooth muscle by inhibiting acetylcholine at receptor sites, thereby reducing GI tract motility and tone.

Cotrimoxazole

CLASSIFICATION: Antibacterials (Sulfonamides)

MECHANISM OF ACTION: Sulfamethoxazole component inhibits the formation of dihydrofolic acid from PABA; the trimethoprim component inhibits dehydrofolate reduclase. Both decrease bacterial folic acid synthesis.

Metronidazole

CLASSIFICATION: Gastrointestinal Stimulant (bactericidal)

MECHANISM OF ACTION: May caused bactericidal effect by interacting with bacterial DNA. Active against many anaerobic gram-negative bacilli ,anaerobic gram-positive cocci.

DIAGNOSTIC PROCEDURES

Stool culture

Diseases can be detected with a stool culture. Toxins from bacteria such as Clostridium difficile can also be identified. Viruses such as rotavirus can also be found in stools.

Hematology

Also known as full blood count (FBC) or full blood exam (FBE) or blood panel, is a test requested by a doctor or other medical professional that gives information about the cells in a patient's blood.

This procedure is done to the client to determine general health status and to screen for a variety of disorders and in order to determine whether there are evaluations in the blood components.

Fecalysis

To detect the presence of a specific disease agent

To detect indirectly evidence or malfunction of some portions of the gastro-

intestinal tract.

II. Anatomy and Physiology

Digestive System

The digestive system takes in food, breaks it down physically and chemically into nutrient molecules, and absorbs the nutrients into the bloodstream. Then it rids the body of the indigestible remains.

The alimentary canal performs the whole menu of digestive functions. The accessory organs assist the process of digestive breakdown in various ways.

Mouth The mouth is also called the oral cavity, a mucous membrane-lined cavity. The mouth is

the place where food is taken in and where digestion begins. The mouth is adapted to receive food by ingestion, break it into small particles by mastication, and mix it with saliva.

Pharynx

A fibromuscular passageway, commonly called the throat, that extends from the base of the skull to the level of the sixth cervical vertebra. It serves both the respiratory system and the digestive system by receiving air from the nasal cavity and air, food, and water from the oral cavity.

Esophagus

The esophagus, or gullet, runs from the pharynx through the diaphragm to the stomach. About 25 cm long, it is essentially a passageway that conducts food to the stomach.

Stomach The stomach is the sac-like portion of the gastrointestinal system that follows, and

receives food from the esophagus. The stomach is located in the upper left quadrant of the abdomen is divided into different regions. The cardiac region surrounds the cardioesophageal sphincter, through which food enters the stomach from the esophagus. The fundus is the expanded part of the stomach lateral to the cardiac region. The body is the midportion, and the funnel-shaped pylorus is the terminal part of the stomach. The stomach is continuous with the small intestine through the pyloric sphincter, or valve. The stomach is approximately 25cm long, but its diameter depends on how much food it contains. When it is full, it can hold about 4 liters of food. When it is empty, it collapses inward on itself, and its mucosa is thrown into large folds called rugae.

Small intestine The small intestine is the body’s major digestive organ. The small intestine is a muscular

tube extending from the pyloric sphincter to the ileocecal valve. It is the longest section of the alimentary tube, with an average length of 2 to 4 m hangs in sausagelike coils in the abdominal cavity, suspended from the posterior abdominal wall by the fan-shaped mesentery. The large intestine encircles and frames it in the abdominal cavity.

The small intestine is divided into the duodenum, jejunum, and ileum. The duodenum, which curves around the head of the pancreas, is about 25cm long. The jejunum is about 2.5m long and extends from the duodenum to the ileum. The ileum, about 3.6m long, is the terminal part of the small intestine. It joins the large intestine at the ileocecal valve.

Large intestine

The large intestine is much larger in diameter than the small intestine, but shorter in length. About 1.5m long, it extends from the ileocecal valve to the anus. Its primary role is the excretion of non-absorbed material passed from the small intestine and water absorption.

Rectum The part of the gastrointestinal tract that continues from the sigmoid colon of the large

intestine to the anal canal and has a thick muscular layer. It follows the curvature of the sacrum and is firmly attached to it by connective tissue.

Anus The terminal opening of the gastrointestinal tract. The last 2 to 3 cm of the GI tract is the

anal canal, which continues from the rectum and opens to the outside at the anus. The mucosa of the rectum is folded to form longitudinal anal columns. The smooth muscle layer is thick and forms the internal anal sphincter at the superior end of the anal canal. This sphincter is under involuntary control. There is an external anal sphincter at the inferior end of the anal canal. This sphincter is composed of skeletal muscle and is under voluntary control.

PERTINENT DATA

NAME: Baby Agee

AGE: 2 years old

GENDER: male

ADDRESS: Brgy. Sumader Batac City

BIRTHDAY: January 28, 2008

BIRTHPLACE: Batac City

RELIGION: Aglipayan

NATIONALITY: Filipino

WEIGHT: 5kgs.

HEIGHT: 2’’7’

HOSPITAL NUMBER: IPS062

ADMITTING DATE AND TIME: July 22,2010 9:15 AM

ADMITTING DIAGNOSIS: Acute Gastroenteritis

ADMITTING PHYSICIAN: Dr. Ramon Gaoat

ADMITTING HOSPITAL: Gaoat General Hospital

DISCHARGE DATE AND TIME: July 25, 2010 3:45PM

III. HEALTH HISTORY

FAMILY BACKGROUND

NAME AGE RELATIONSHIP EDUCATIONAL ATTAINMENT

OCCUPATION DISEASE

Carmelo Foronda

60 Grandfather (mother side)

Elementary graduate

N/A Hypertensionarthritis

Agapita Foronda

60 Grandmother (mother side)

Elementary graduate

Utility worker Hypertensionarthritis

Teodoro Fontanilla

56 Grandfather (father side)

Elementary graduate

Farmer Hypertension

Carmelita Fontanilla

54 Grandmother (father side)

Elementary graduate

N/A Hypertension

Billy Fontanilla

27 Father High school graduate

Tricycle driver Cataract

Loida Fontanilla

38 Mother College graduate Avon franchise dealer

Asthma

Abelord Fontanilla

2 Child N/A N/A AGE

A. FAMILY HEALTH HISTORY

Baby Agee belongs to a nuclear family. He is the only son of Mr. & Mrs. Agee.

His mother lamented that Hypertension has been the prevailing disease of the family especially the old ones. They were diagnosed before and were prescribed a drug maintenance but they did not take it either. Also, arthritis as prominent to the old people, they also suffered from it but are able to manage it by applying Efficacent oil. Baby Agee’s father has been diagnosed to have a cataract and was recommended to be operated. However, due to financial constraint, he was not able to avail for one. On the other hand, Baby Agee’s mother suffers from Asthma and she is able to manage it through herbal medicines like oregano.

Mrs. Agee also informed us that their family also experiences fever, cough, common colds and stomachache. They often manage it through herbal plants such as oregano and “dangla” for cough, eucalyptus for common colds, extracts of “tawwa-tawwa” for stomachache.For the fever, they often manage it through self-prescription or medication with over-the-counter drugs such as Paracetamol/Biogesic. She also added that sudden change in weather such as a decrease in temperature is a contributory factor for the family members to acquire common colds and cough. Other management for their common illnesses would include increase fluid intake or water therapy for fever, cough and common colds; taking in vitamin C-rich foods and dringking calamansi juice for cough and common colds; TSB for fever; mumps is also experienced by the family members and they usually treat it by applying “akot-akot” and

vinegar topically. Childhood illnesses experienced by the family members would also include chicken pox and measles. They usually manage chicken pox through bed rest and by exposing to the burnt onions when lesions are healing. As for measles, they usually treat it by wearing black long-sleeved shirts.

At times of illnesses like cough or fever, the family tries to manage this on their own by taking some OTC drugs or by herbal plants but when they experience serious illnesses, they usually seek consultation in the RHU. And for other severe cases, the family would go to hospital for further consultation and management.

According to Mrs. Agee, Baby Agee’s relatives were drinking coffee and tea. They do not smoke nor intoxicate themselves with liquor. Their family does not have any kind of allergy to foods, medicines and environment. The client as well as his family likes any type of cooked foods.

B. PAST HEALTH HISTORY

The interview became an avenue to trace several diseases in the family. Mrs. Agee told us that Baby Agee had experienced cough, colds, fever, stomachache and measles. Independent management such as rest and giving in medications are found to be helpful. Medications such as Paracetamol (biogesic). She also added that they are bringing Baby Agee to “ilots”. She also revealed to us that they are using some herbal plants when it comes to cough and common colds and stomachache such as oregano, “dangla” and “tawwa-tawwa” and they found it to be very effective. However, she admits that there were also instances that such kinds if illnesses are not manageable especially when things get worst and could no longer tolerate. As such, that will be the time for them to seek medical advised.

With regards with Baby Agee’s immunization, he had been vaccinated of BCG, OPV and anti measles. Some other immunizations cannot be remembered by the mother. He availed this doses of immunization at the RHU which is located at Brgy. Nalupta, Batac City. He also had his vaccination for AH1N1 correspondingly.

Last November 2008, Baby Agee was hospitalized with a chief complaint of cough and common colds. He was admitted at Gaoat General Hospital with Dr. Ramon Gaoat as the admitting physician.

C. PRESENT HEALTH HISTORY

Three days before his hospitalization, Baby Agee attended a birthday party at their neighborhood. According to Mrs. Agee, Baby Agee ate pancit and shanghai together with a soda.

The next day, Baby Agee began to move his bowel frequently. He defecated six times and began to have fever. Mere touch of the mother shows that Baby Agee is being ill with fever. Mrs. Agee all knew that it was just a fever and LBM that he ate something which is not good for his stomach.

On the second day, the patient experienced body weakness and abdominal pain.

They submitted Baby Agee to Gaoat General Hospital last July 22, 2010 at 9:15 AM and accompanied by his mother and father. He was admitted by Dr. Ramon Gaoat with the admitting diagnosis of acute gastroenteritis.

D. LIFESTYLE AND RECREATION

Baby Agee is a 2 year old boy. He usually eats his breakfast with coffee and pandesal. After having his breakfast he usually plays with his mother because he doesn’t have any playmate in the neighborhood.

Baby Agee usually sleeps at 7 or 8:30 in the evening and wakes up at about 4 or 6 in the morning.

He is having his bowel movement once every morning.

They make use of the well as the source of their water supply.

In instances when the family is invited to attend a party, they usually bring their son with them and part ate also what eve food is being served.

E. PSYCHOLOGICAL DATA

Psychosocial Theory of Erik Erickson

According to Erik Erikson’s Theory of Psychosocial Development, our patient belong to the Early Childhood age bracket (18 months-3 years old), with a central task of Autonomy vs. Shame & Doubt.

Erickson’s envisions life as a sequence of levels of achievement. Each stage signals a task that must be achieved which viewed a series of crises. A successful resolution would indicate a support to the person’s ego while the failure to resolve the crises is damaging to the ego. Erikson believes that the greater the task achievement, the healthier the personality of the person while failure to achieve the task influences the person’s ability to achieve the next tasks.

According to Erikson’s Developmental Theory, the primary developmental task of the stage early childhood is, autonomy, which is the capacity of a rational individual to make an informed, un-coerced decision.

 Infancy Birth – 18 months Trust vs. Mistrust

 Early Childhood 18 months – 3 years Autonomy vs. Shame & Doubt

 Late Childhood 3 – 5 years Initiative vs. Guilt

 School Age 6 – 12 years Industry vs. Inferiority

 Adolescence 12 – 20 years Identity vs. Role Confusion

 Young Adulthood 18 – 25 years Intimacy vs. Isolation

 Adulthood 25 – 65 years Generativity vs. Stagnation

 Maturity 65 years to death Integrity vs. Despair

TASK PROOF ANALYSISToilet training We can say that our patient

met this task because he is able to go to the toilet alone and urinate. He neither wears diapers at daytime nor at nighttime.

MET

Motor skills We can say that our patient had exemplified to develop his motor skill like walking and climbing during his play time. He is able to show his motor skills like playing even he feels such illness.

MET

ANALYSIS:

Our patient builds rapport with his family. He gets along with us and he seems to be friendly, thereby, he displays autonomy within him.

PHYSICAL ASSESSMENT:

The physical assessment was done last July 23, 2010 at 6:30 AM at Gaoat General Hospital, pediatric ward.

GENERAL APPEARNCE:

Baby Agee was seen lying on bed with white sando and blue printed short. He has an IV fluid of D5 W 500 cc @ 200 cc level regulated to 63 gtts/min infusing well at his right arm, weak in appearance. He has trimmed hair and short, clean fingernails. His skin is light brown. He has white sclera.

VITAL SIGNS:

Vital Signs July 23, 2010Body temp. 37.80CCardiac rate 126bpmRespiratory rate

20bpm

HEAD TO TOE ASSESSMENT

1. Hair

COLOR Black

TEXTURE AND MOISTURE Soft

DISTRIBUTION Equally distributed

THICKNESS AND THINNESS Fine

CONDITION OF THE SCALP No lice and dandruff noted

2. Head

CONDITION No mass palpated

CONFIGURATION Normocephalic

3. Eyes

CONDITION OF THE EYES With coordinated eye movement

COLOR OF THE SCLERA White in color

CONDITON OF THE CONJUNCTIVA Pale palpebral conjunctiva

REACTION TO LIGHT PERRLA (Pupil are Equally Round and Reactive to Light Accomodation)

VISUAL ABILITY With good visual ability can follow hand direction.

4. Ears

APPEARANCE Symmetrical in size and shape

ALLIGNMENT Both eyes are aligned to the outer canthus of the eyes

CONDITION OF THE EAR No cerumen impacted and no lesions noted

5. Nose

PATENCY OF THE NOSE No secretions

SYMMETRY With intact nasal septum and in midline position

CONDITION No flaring of the nose

6. Mouth

LIPS

MOISTURE Upper and lower lips are dry

COLOR Pinkish in color

CONDITION No lesions noted

TONGUE

MOISTURE Moist

COLOR Pinkish in color

TEETH

NUMBER OF TEETH with complete set of milk teeth(20)

CONDITION no dental carries noted

GUMS

COLOR Pinkish in color

CONDITION No swollen gums or bleeding

MUCOUS MEMBRANE

COLOR Pinkish in color

CONDITION Moist, intact mucous membrane

7. Neck

RANGE OF MOTION Able to move without difficulty

CONDITION No mass palpated

8. Chest

CONDITION No rales, wheezing sounds upon auscultation

9. AbdomenSHAPE globular

BOWEL SOUND Hyperactive bowel sound (35)

CONDITION soft upon palpation and dull upon percussion

Upper Extremities

RANGE OF MOTION Both arms has a good ROM (360º) able to extend and flex on normal ROM

CONDITION OF THE SKIN good skin turgor

APPEARANCE with scar on the right deltoid

CONDITION OF THE FINGERNAILS Short and clean

COLOR OF NAILBED Pinkish

CAPILLIARY REFILL With normal capillary refill, at 2 seconds

Lower Extremities

RANGE OF MOTION Both leg has a good ROM able to extend and flex on normal ROM

CONDITION OF THE TOENAILS Slightly long and slightly dirty

COLOR OF THE NAILBED Pinkish

CAPILLIARY REFILL With normal capillary refill, at 2 seconds

10. Skin

COLOR Light brown

TEMPERATURE Warm to touch

TEXTURE smooth

APPEARANCE flushed skin

ON-GOING APPRAISAL

JULY 23, 2010

On the first day of our appraisal, we has seen Baby Agee on bed lying with an IV fluid of D5 W 500 cc @ 200 cc level regulated to 63 mgtts/min, infusing well. He is weak in appearance, with a complaint of stomach pain and febrile. He was in soft diet.

Vital Signs:

Body temp.-37.8 degrees Celsius

CR-126bpm

RR-20bpm

JULY 24, 2010

We had seen our patient sitting on bed with an IV fluid of D5 IMB 500 cc @ 100 cc level regulated at 63 gtts/min, infusing well. He still weak in appearance with stomach pain and afebrile. He was still in soft diet.

Vital Signs:

Body temp.-36 degrees Celsius

CR-138bpm

RR-22bpm

JULY 25,2010

We had seen our patient on bed awake and he is fair in appearance. The doctor’s order is MGH.

Vital Signs:

Body temp.- 36.6 degrees Celsius

CR-139bpm

RR-23bpm

JULY 26, 2010 (home visit)

We visited our patient and he is playing in front of their house. Still continuing all the medication.

Vital Signs:

Body temp.- 36 degrees Celsius

CR- 136bpm

RR-21

JULY 27,2010 (home visit)

We had seen our patient playing with his toy inside their house together with his mother, no complaints of stomach pain.

Vital Signs:

Body temp.- 36.4 degrees Celsius

CR-136bpm

RR- 23bpm

DATE July 23 July 24 July 25 July 26 July 27IVF D5 W D5 IMB DIET Soft Soft DAT DAT DATWEAK IN APPEARANCE

X X X

STOMACH PAIN

X

BODY TEMP. 37.80C 360C 36.60C 360C 36.40CCARDIAC RATE

126bpm 138bpm 139bpm 136bpm 136bpm

RESPIRAORY RATE

20bpm 22bpm 23bpm 21bpm 23bpm

NURSING CARE PLAN

1)

Nursing Diagnosis

Acute pain related to irritation of mucosal lining secondary to release of enterotoxin of microorganism as evidenced by facial grimacing, guarding behavior, expressive behavior (crying) and verbalization “mama nagsakit buksit ko”.

Nursing Inference

One of the manifestations of gastroenteritis is abdominal pain. During the course of inflammation, the body’s immune response, causing the release of cytokine and prostaglandin causing an increase in vascular permeability and causes pain, which felt by the patient in the abdomen.

Nursing Goal

After 1-2 hours of rendering effective and appropriate nursing intervention the pain felt by the patient will be minimize or reduce. As will be manifested by absence of guarding behavior, absence of facial grimacing, absence of expressive behavior (crying) and verbalization “haan unay nasakiten”.

Nursing Intervention

1. Reassess for PQRST ( provokes, quality, radiates, severity, time) of pain

Rationale: To validate data.

2. Provide comfort measures such as changing position and backrub.

Rationale: to provide relaxation (non-pharmacological pain management)

3. Provide quiet environment

Rationale: to relax the client and away from pain and lessen the perception.

4. Suggest significant others (parents) should always be present.

Rationale: to comfort child

5. Give pain medication as prescribed.

Rationale: to decrease or eliminate pain.

Nursing Evaluation:

After 1-2 hours of rendering effective and appropriate nursing intervention the pain felt by the patient was minimized or reduced. As manifested by absence of guarding behavior, absence of facial grimacing, and absence of expressive behavior (crying) and verbalization “haan unay nasakiten”.

2)

Nursing Diagnosis:

Hyperthermia related to release of pathogens as manifested by elevated body temperature above normal range (body temp. of 37.80C) skin warm to touch, flush and WBC increase skin and verbalization of “napudot nak.”

Nursing Inference: The entry of foreign substance detected by the body. The immune system sense signals to the hypothalamus which regulates the body temperature. The hypothalamus increases the body temperature to compensate with the foreign substance that attack the body.

Nursing goal:

After 30mins-1 hour of rendering effective nursing interventions, the patient will be able to maintain normal range of body temperature 37.5 0C as will be manifested by decrease body temperature in normal range (36.50C-37.50C ) absence of warm skin, flushed skin and verbalization of “haan nak napuduten.”

Nursing Interventions:

1. Monitor body temperature

Rationale: To obtain data base

2. Render Tepid Sponge Bathing

Rationale: To decrease heat loss through conduction

3. Provide adequate fluid intake

Rationale: To replace fluid loss and to flush microorganisms

4. Administer anti-pyretic drugs as ordered like paracetamol

Rationale: To help reduce body temperature and maintain normal range of temperature.

Nursing Evaluation:

After 1 hour of rendering effective nursing interventions, the patient was able to maintain normal range of body temperature 360C as manifested absence of warm skin, flushed skin and verbalization of “haan nasakit ulo kun”

3)

Nursing Diagnosis:

Nutritional imbalance less than body requirements related to intestinal pain after eating, decreased transit through bowel as manifested by bowel sounds and manifested by abdominal pain and cramping.

Nursing Inference:

Insufficient intake of nutrients causes the body to body to fail to meet its metabolic needs.Nursing Goal:

After 30 minutes-1 hour of rendering therapeutic interventions, the patient will be able to have a normal bowel sound and relieve pain.

Nursing Interventions:

1. Ascertain understanding of individual nutritional needs.

Rationale: To determine what information will going to provide with the patient.

2. Discuss eating habits, including food preferences and intolerance.

Rationale: to appeal to the patient his/her likes/dislikes.

3. Instruct the mother to restrict solid food intake in the diet of the patient

Rationale: To allow for bowel rest/decrease intestinal workload

4. Assess weight, age, body built, strength, activities/rest level and so forth.

Rationale: To have comparative baseline.

Nursing Evaluation:

After 30 minutes-1 hour of rendering therapeutic interventions, the patient was able to have normal bowel sound and relieved pain.

LABORATORIES AND DIAGNOSTIC PROCEDURE

Hematology and CBC (Complete Blood Count)

Date Ordered: July 22, 2010

A complete blood count (CBC), also known as full blood count (FBC) or full blood exam (FBE) or blood panel, is a test requested by a doctor or other medical professional that gives information about the cells in a patient's blood. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC.

The cells that circulate in the bloodstream are generally divided into three types: white blood cells (leukocytes), red blood cells (erythrocytes), and platelets (thrombocytes). Abnormally high or low counts may indicate the presence of many forms of disease, and hence blood counts are amongst the most commonly performed blood tests in medicine, as they can provide an overview of a patient's general health status. A CBC is routinely performed during annual physical examinations in some jurisdictions.

PURPOSE:

This Procedure was done to the client to determine general health status and to screen for a variety of disorders and in order to determine whether there are evaluations in the blood components. And this will use for physical examination and evaluation of acute disease or symptoms of anemia or infection. CBC is also done asses blood loss, renal function, muscle breakdown and risk for excessive bleeding or clotting and reveal of blood cell destruction. This test is used to evaluate plate production.

Nursing Responsibilities:

Check doctor’s order.

Inform the patient about the procedure to gain cooperation.

Explain that a tingling sensation maybe felt when collecting the specimen.

Follow-up result and refer it to the physician once available.

RESULT

Results Normal values Interpretation

RBC count 4.83 g/L 4.5-5.1 g/l Normal

WBC count 18.1 g/L 5.00-10.00 Increased

Hematocrit 0.35 g/L 0.35-0.44 Normal

Platelet 300 150-450 Normal

Differential count Results Normal Values Interpretation

Neutrophils 0.75 0.50-0.70 Increased

Lymphocytes 0.15 0.20-0.10 Normal

Monocytes 0.10 0.00-0.07 Normal

Eosinophils 0.02 0.00-0.07 Normal

ANALYSIS:

A serious bacterial infection causes the body to produce an increased number of neutrophils, resulting in a higher than normal white blood cell count (WBC).

FECALYSIS

Date ordered: July 23, 2010

Fecalysis is also known as stool analysis. It refers to a series of laboratory tests done on

fecal samples to analyze the condition of a person's digestive tract in general. Among other

things, a fecalysis is performed to check for the presence of any reducing substances such as

white blood cells (WBCs), sugars, or bile and signs of poor absorption as well as screen for

colon cancer.

To properly check for inadequate absorption, a fecal fat test may be required. This is a

diagnostic procedure used to recognize problems with fat absorption. A quantitative fecal fat test

is usually completed in three days and able to verify the amount of fat within a person's body.

PURPOSES:

To detect the presence of a specific disease agent

To detect indirectly evidence or malfunction of some portions of the gastro-

intestinal tract.

Used as a clue in several medical and surgical diagnosis.

Diagnostic Normal Value Result SignificanceColor Yellow Yellow NormalConsistency Soft Watery Presence of infectionCellular FindingsRBC None Not seen NormalPus Cells 0-2 0-1/Hpf NormalBacteria None Many Infection is presentYeast None None Normal

ANALYSIS:

The color of the stool is not normal, because normally the color is yellow. The presence of pathologic

bacteria signifies the presence of infection. The consistency of the stool shows that there is presence of

infecton. The consistency of the stool shows that the body attempts to overcome the disease by flushing

the microorganism out of the gastrointestinal tract.

DRUG STUDY

Date ordered: July 22, 2010

Generic name: Dicycloverine

Brand name: Dicyloveine Hcl

Dosage, Route, Frequency: 1 tsp Oral TID

Classification: Anti- cholinergic

Mechanism of action:

Thought to exert direct effect on GI smooth muscle by inhibiting acetylcholine at receptor sites, thereby reducing GI tract motility and tone.

Desired effect:

Treatment of functional disturbances of GI motility.

Nursing Responsibilities:

1. Check for the Doctor’s order.

2. Check for allergies and contraindication.

Rationale: to prevent further complication

3. Take prescribed dose 1 hour before meal.

Rationale: for optimal absorption

4. Discuss the side effects of the drugs to the watcher such as:Constipation-ensure adequate fluid intake ,proper diet.Difficulty in urination-empty bladder immediately before taking drug

5. Emphasize to the watcher to report rash and flushing skin.

Rationale :to prevent further complication

Date Ordered: July 22, 2010

Generic name: Cotrimoxazole

Brand name: Kathrex

Dosage, Route, Frequency: 1 tsp Oral TID

Classification: Antibacterials (Sulfonamides)

Mechanism of action:

Sulfamethoxazole component inhibits the formation of dihydrofolic acid from PABA; the trimethoprim component inhibits dehydrofolate reduclase. Both decrease bacterial folic acid synthesis.

Desired effect:

It is to treat infection.

Nursing Responsibilities:

1. Chek for the Doctor’s order

2. Check for allergies and contraindication.

Rationale: to prevent further complication

3. Advise the mother to give the patient on regular schedule as prescribed.

Rationale: adherence to antibiotic treatment should be strictly followed to avoid resistance.

4. Teach significant others to recognize and immediately report signs and symptoms of hypersensitivity, especially rash.

Rationale: to prevent further complication

5. Discuss the side effect of the drug to the watcher such as: headache

- emphasize bed rest to prevent from falling, injury or accident.

Nausea and vomiting - frequent, small meals.

Date ordered: July 24, 2010

Generic name: Metronidazole

Brand name: Flagex

Dosage, Route, Frequency: 1 tsp Oral TID

Classification: Gastrointestinal Stimulant (bactericidal)

Mechanism of action:

May caused bactericidal effect by interacting with bacterial DNA. Active against many anaerobic gram-negative bacilli ,anaerobic gram-positive cocci.

Desired effect:

To treat infection.

Nursing Responsibilities:

1. Check for the Doctor’s order

2. Check for allergies and contraindication.

Rationale: to prevent further complication

3. Take with food or milk

Rationale: to reduce GI upset that may cause metallic taste

4. discuss the side effect of the drug to the watcher such as: dry mouth with strange metallic taste

- frequency mouth care, sucking sugarless candies. nausea, vomiting

- frequent, small meals. diarrhea

-add bulk to diet darker the color of urine

-discuss to significant other so that they will not be alarm.5. Encourage the patient to take full course of drug therapy.

Rationale: adherence to antibiotic treatment should be strictly followed to avoid resistance

Date ordered: July 24, 2010

Generic name: Paracetamol

Brand name: Myrenol

Dosage, Route Frequency: 1 tsp Oral QID

Classification: Antipyretic

Mechanism of action:

It is thought to relieve fever by central action in the hypothalamic heat-regulating center.

Desired effect:

It is given to our patient to lower down fever.

Nursing Responsibilities:

1. Check for the Doctor’s order

2. Check for allergies and contraindication.

Rationale: to prevent further complication

3. Take extended relief product with water

Rationale: to mask the unpleasant taste of the drug

4. Review with parents the difference between the concentrated dropper dose formulation and teaspoon dose formulation

Rationale: to prevent overdose/toxicity

5. discuss the side effect of the drug to the watcher such as: headache

- emphasize bed rest to prevent from falling, injury or accident. Drowsiness

- emphasize bed rest to prevent from falling, injury or accident.

GENERAL EVALUATION

Two days prior to admission our patient experienced abdominal pain and diarrhea.On the first day of onset, he move his bowel 6 times with watery , yellowish and foul odor stool. They went to a ‘manghihilot’ and his mother applies acete de manzanilla to relieve the pain but then the said pain was not minimized. On the second day managed it by giving glucolyte but the diarrhea worsen. So they rushed at Gaoat General Hospital with a chief complaint of fever and lbm. He was diagnosed by Dr. Ramon Gaoat and the final diagnosis was AGE.

When he was confined at Gaoat General Hospital, he underwent diagnostic procedure such as Hematology ( complete blood count) to confirm any abnormal findings inside the body ; (fecalysis) to determine the cause of infection. The patient was put under soft diet to allow for bowel rest. He was hooked with D5 W 500cc regulated to 63 microgtts/min.

Medication were given Paracetamol, Antipyretic, 1tsp PO QID; Co- trimoxazole, Anti infective, 1 tsp PO TID; Dicycloveine Hcl, 1 tsp PO TID; Metronidazole, Gastrointestinal stimulant ( Bactericidal), 1 tsp PO TID.

As shown in the fecalysis result, there is the presence of pathologic bacteria in our patien’s stomach.

Our client was discharged July 25, 2010 with Co- trimoxazole 1 tsp PO TID, Dicycloveine Hcl, 1tsp PO TID, Metronidazole, 1tsp PO TID as take home medications.

As we student nurses, who monitored Baby Agee’s case, he has regained strength since he went home July 25, 2010.

NORTHWESTERN UNIVERSITYCOLLEGE OF ALLIED HEALTH AND SCIENCES

DEPARTMENT OF NURSINGLAOAG CITY

ACUTE GASTROENTERITIS

SUBMITTED BY:

AQUINO, PRINCESSARQUILLO, CHEERSCOLOBONG, THEACORPUZ, CHERRY

GANOTISI, SNANETTENICOLAS, ZEILSTRA HANNA

PADILLA, CHERRYRUBIO, RALPH

RABAGO, IRINEOTAGATAC, MA. BENELYN SUERTE

BSN III-F GROUP IV

August 3, 2010