A CASE STUDY ON

ACUTE GASTROENTERITIS (AGE)

Submitted by: Arlene Salceda

INTRODUCTION
Acute gastroenteritis (AGE) is an acute infectious process affecting gastrointestinal tract caused by virus, bacteria and parasites. The disease is transmitted by ingestion of contaminated food, water, or by contaminated hands, linens, equipments, and supplies. ost serious complication is dehydration and electrolyte losses which may lead to metabolic acidosis and death. The primary manifestation of gastroenteritis is diarrhea, but it may be accompanied by nausea, vomiting, and abdominal pain. The vomiting usually settles in a day or so. The diarrhea may last for up to !" days, but usually lasts only to # or $ days. %f there is fever, or blood and mucus in the stools it is more li&ely to be contagious. Gastroenteritis is contagious as the organism lives in the gastrointestinal tract, so it is important to wash hands thoroughly after going to the toilet and before preparing food. Acute gastroenteritis is associated with significant morbidity in developed countries and each year is the cause of death of several million children in developing countries. Estimates of the overall incidence of acute gastroenteritis range from !.$ to #.$ episodes of diarrhea per year in children under five years of age. Each year, more than $"" '.(. children die from this illness. %n the 'nited (tates alone, gastroenteritis accounts for more than ##",""" hospital admissions per year in children less than five years of age, or appro)imately !" percent of hospitali*ations in this age group. Acute gastroenteritis is a common and costly clinical problem in children. %t 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 e)amination to uncover other illness with similar presentations. inimal laboratory testing is generally required. Treatment is primary supportive and is directed at preventing or treating dehydration. ,hen positive, an age+supportive diet and fluids should be continued. -ral 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. (evere dehydration requires the prompt restoration of intravascular volume through the intravenous administration of fluids followed by oral rehydration therapy. ,hen 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. -n its mortality and morbidity, AGE is a leading cause of infant mortality throughout the world. 0y age $ years, virtually all children become infected with the most common agents. (evere cases are seen in the elderly, infant and immunosuppressed population including transplant patients. 1ast 2uly "3, #""4, we encountered a patient with such &ind of infection. This patient has caught our attention and has given the opportunity to study his case. The ob5ective 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 e)ercise our duties as student nurses which is to render care. % was given the chance to improve the quality of care % can offer and to pursue our chosen profession as future nurses.

PATIENTS PROFILE
Patients Name: 0udong Age: 6 years 7 4 months Gender: ale

Address: 8arig (ur, Tuguegarao 8ity Date of Birt : 5uly $, #""9 Ci!i" Stat#s: (ingle Re"igion: :oman 8atholic Nationa"it$: ;ilipino Dia"e%t: %locano Date of Admission: <ec 3, #"!# Time Admitted: =>3" A Attending P $si%ian: <ra. ? C ief Com&"aint: 10 7 vomiting

Admitting Diagnosis: AGE with <ehydration Fina" Diagnosis: AGE with <ehydration

NURSING 'ISTOR( OF ILLNESS PRESENT 'EALT' 'ISTOR(

Two days prior to admission (<ec $, #"!# in the evening), the patient had vomiting for $ times associated with abdominal pain and passage of watery stool due to his inta&e of ice+cold co&e and water according to his mother. A day prior to admission (<ec 6, #"!#), the patient still attended his classes but still with vomiting and passage of watery stool. And last 2uly 3, #"!# he was rushed to the @ospital due to wea&ness and severe abdominal pain.

PAST 'EALT' 'ISTOR(

According to the patientAs mother, the patient has his complete immuni*ations. @e is ta&ing his vitamin supplements but still he is very slim and never li&ed vegetables. The patient was first hospitali*ed due to asthma. @is second hospitali*ation was due to bronchopneumonia and the latest was due to AGE.

FA)IL( 'EALT' 'ISTOR(

According to the patientAs mother, their family have history of @ypertension, <iabetes mellitus, 0ronchial Asthma and 8ancer. @ypertension is evident on the patientAs grandfather and uncle, while 8ancer is evident on the patientAs aunt.

GORDONS ** FUNCTIONAL PATTERN 'ea"t Per%e&tion+'ea"t )anagement Pattern

0efore his hospitali*ation, the patient perceives health in a way that he is not suffering from any disease. @e ta&es vitamins for him to improve his health and to protect him from acquiring any disease. <uring his hospitali*ation, the patient feels so unhealthy according to his mother because of his hospitali*ation. @e is obedient in ta&ing his medications and is participative in all the nursesA interventions.

N#tritiona"+)eta,o"i% Pattern
0efore his hospitali*ation, the patient ta&es his meal three times a day without any restrictions. According to his mother, he has food preferences on fatty and oily foods. @er mother even shared that when they eat adobo, he prefers to eat the fat rather than the muscle because he gets irritated with foods between his teeth. @e has no difficulty in swallowing and he usually eat 5un& foods when its snac& time. @e drin&s 6+3 glasses of water a day and ta&es 8lusivol to improve his appetite. <uring his hospitali*ation, his appetite decreased. @e was restricted from eating dairy products. @is fluid inta&e increased for about 3+4 glasses of water a day.

E"imination Pattern
0efore his hospitali*ation, the patient used to eliminate once a day every morning before going to school with a semi+solid consistency and is brownish in color. @e usually urinates # times a day with the normal light yellow color and aromatic odor. @e also perspires every time he plays. <uring is hospitali*ation, the patientAs stool is watery with a yellowish color. @e urinates #+$ times a day. @e also perspires but itAs due to the hot environment not from any activity since he 5ust stays on bed.

A%ti!it$+E-er%ise Pattern
0efore his hospitali*ation, especially during the wee&end, he used to play outside with his cousins. They usually play toy cars and the usual games of his age. @e stops playing when he feels tired.

 <uring his hospitali*ation, he used his time playing the cell phone of his father. ost of his time was spent for resting and sleeping.

S"ee&+Rest Pattern
0efore his hospitali*ation, he usually sleeps 9+= hours. @e is fond of watching the TB series .(uper Twins/ before going to bed when it was still showing. <uring his hospitali*ation, the patient sleeps early but has sleep disturbances when the nurses ta&e his vital signs, administer medicines and also due to the environment.

Cogniti!e+Per%e&tion Pattern
0efore his hospitali*ation, the patient is normal in terms of his cognitive abilities. @e has no problems with his senses. @is mother even shared to us that he is already capable of writing his name and is capable of reading the alphabet and numbers. <uring his hospitali*ation, he relates to us actively. @e responded to our questions enthusiastically. @e also related to us some of his school activities.

Se"f+Per%e&tion. Se"f+Con%e&t Pattern

According to the patientAs mother, heAs a good son though sometimes he tends to disobey his parents. (he said this is normal for his age. @e is the eldest but according to her mother he acts as if he is the youngest.

Ro"e+Re"ations i& Pattern

The patient has a close relationship with his family, but he is closer to his father. @e has a # year old sister, but according to his mother, he does not play the role of an elder brother. @is mother even added that his sister ie more obedient than he is. 0ut during his confinement, he is more obedient because he wanted to get well immediately.

Se-#a"+Re&rod#%ti!e Pattern
Crior to his age, the patient is not yet oriented with any se)ual matters. According to hid mother, he has not yet undergone circumcision.

Co&ing Stress+ To"eran%e Pattern

According to his mother, when he has problems he always approach his parents. (he even added that when he gets scolded, he 5ust stays in his room. ,hen he is bullied or when his cousins get his toys, he does not quarrel with them but instead he reports it to his parents. <uring his hospitali*ation, he feels unsafe with people when his mother is not with him. @e cries without the sight of his mother.

/a"#e+Be"ief Pattern
@e is a :oman 8atholic. They attend mass regularly. @e afraid to do something bad because he believes that God will punish him. According to his mother, before they consult the doctors or the hospital, they first consult the quac& doctors.

P'(SICAL ASSESS)ENT
Date assessed: 0#"$ 123 4115 Genera" assessment: neat, conscious and coherent Initia" !ita" signs: T6$4.=, ::D#", 0CD9"EF", C:D=3 Area Assessed S8in 8olor Te% ni7#e %nspection Norma" Findings 1ight brown, tanned s&in (vary according to race) 1ighter colored palms, soles, lips and nail beds (&in normally dry Gormally warm (mooth, soft and fle)ible palms and soles (thic&er) (&in snaps bac& immediately Transparent, smooth and conve) Cin&ish ;irm ,hite color of nail bed under pressure should return to pin& within #+$ seconds Evenly distributed 0lac& (mooth Carallel to each other CE::1A+ Cupils equally round react A%t#a" Findings Tanned s&in 1ighter colored palms, soles, lips and nail beds (&in normally dry $4.= o 8 (mooth, soft and fle)ible palms and soles (thic&er) (&in snaps bac& immediately Transparent, smooth and conve) Cin&ish ;irm ,hite color of nail bed under pressure returned to pin& within #+$ seconds Evenly distributed 0lac& (mooth Carallel to each other but sun&en CE::1A+ Cupils equally round react E!a"#ation Gormal

1ips, nail beds, soles and palms oisture Temperature

%nspection %nspectionE Calpation Calpation Calpation Calpation

Gormal Gormal dEt hyperthermia Gormal Gormal

Te)ture Turgor S8in a&&endages a. Gails Gail beds Gail base

%nspection %nspection %nspection %nspectionE Calpation %nspection %nspection %nspectionE Calpation %nspection %nspection (penlight)

Gormal Gormal Gormal Gormal

8apillary refill b. @air <istribution 8olor Te)ture E$es Eyes Bisual Acuity

Gormal Gormal Gormal dEt dehydration Gormal

Eyebrows

%nspection

Eyelashes Eyelids

%nspection %nspection

to light and accommodation (ymmetrical in si*e, e)tension, hair te)ture and movement <istributed evenly and curved outward (ame color as the s&in

to light and accommodation (ymmetrical in si*e, e)tension, hair te)ture and movement <istributed evenly and curved outward (ame color as the s&in

Gormal

Gormal Gormal

0lin&s involuntarily 0lin&s involuntarily and bilaterally up to and bilaterally up to #" times per minute !F times per minute <o not cover the pupil and the sclera, lids normally close symmetrically Transparent with light pin& color 8olor is white Transparent, shiny 0lac&, constrict bris&ly 8learly visible ;ree of lesions, discharge of inflammation 8anal walls pin& 8lient normally hears words when whispered (mooth, symmetric with same color as the face 8lose to midline, thic&er anteriorly than posteriorly -val, symmetric and without <o not cover the pupil and the sclera, lids normally close symmetrically Transparent with light pin& color 8olor is white Transparent, shiny 0lac&, constrict bris&ly 8learly visible ;ree of lesions, discharge of inflammation 8anal walls pin& 8lient normally hears words when whispered (mooth, symmetric with same color as the face 8lose to midline, thic&er anteriorly than posteriorly -val, symmetric and without

Gormal

Gormal

8on5unctiva (clera 8ornea Cupils %ris Ears Ear canal opening

%nspection %nspection %nspection %nspection %nspection %nspection

Gormal Gormal Gormal Gormal Gormal Gormal

Gormal Gormal

@earing Acuity Nose (hape, si*e and s&in color Gasal septum

%nspection

%nspection %nspection

Gormal Gormal

Gares

%nspection

Gormal

discharge )o#t and P ar$n1ips 0uccal mucosa Gums Tongue

discharge

%nspection %nspection %nspection %nspection

Cin&, moist symmetric Glistening pin& soft moist (lightly pin& color, moist and tightly fit against each tooth oist, slightly rough on dorsal surface medium or dull red ;irmly set, shiny @ard palate+ dome+ shaped (oft Calate+ light pin& Gec& is slightly hyper e)tended, without masses or asymmetry Gec& moves freely, without discomfort :ises freely with swallowing idline 8lear breath sounds (&in same color with the rest of the body

Cin&, moist symmetric Glistening pin& soft moist (lightly pin& color, moist and tightly fit against each tooth oist, slightly rough on dorsal surface medium or dull red ;irmly set, shiny Go tooth decay @ard palate+ dome+ shaped (oft Calate+ light pin& Gec& is slightly hyper e)tended, without masses or asymmetry Gec& moves freely, without discomfort :ises freely with swallowing idline 8lear breath sounds (&in same color with the rest of the body

Gormal Gormal Gormal Gormal Gormal Gormal

Teeth @ard and soft palate Ne%8 (ymmetry of nec& muscles, alignment of trachea Gec& :om Thyroid gland Trachea T ora- and L#ngs A,domen

%nspection %nspection

%nspection %nspection Calpation %nspection Auscultation %nspection

Gormal Gormal Gormal Gormal Gormal Gormal

0owel sounds

Auscultation

8lic&s or gurling 8lic&s or gurling sounds occur sounds occur irregularly and irregularly and range from 3+$3 per range from 3+$3 per minute minute

Gormal

Ne#ro"og$ s$stem

1evel of consciousness

%nspection

;ully conscious, respond to questions quic&ly, perceptive of events

;ully conscious, respond to questions quic&ly perceptive of events

Gormal

0ehavior and appearance

%nspection

a&es eye contact a&es eye contact with e)aminer, with e)aminer, hyperactive hyperactive e)presses feelings e)presses feelings with response to the with response to the situation situation

Gormal

LABORATOR( RESULTS
'E)ATOLOG( RESULTS
9BC 'g, '%t Differentia" Co#nt L$m& o%$tes Segmenters Norma" /a"#e :+*1 - *1 g.L ) *=+*2 g.d" F *4+*2 g.d" ) =>?+:@? F =5?+@<? 41?+@1? 21?+51? Res#"ts 5;< ** ==? =*? 2>? Ana"$sis Norma" De%reased De%reased Norma" Norma"

FECAL(SIS
ethod used> <irect (mear Res#"ts P $si%a" &ro&erties: Co"or Consisten%$ Lig t ,roAn 9ater$ Ana"$sis Norma" d.t &rof#se se%retion of Aater and e"e%tro"$tes

Remar8s: No ora" intestina" &arasite seen

URINAL(SIS
Co"or Trans&aren%$ Rea%tion S&e%ifi% gra!it$ S#gar Protein Res#"ts (e""oA S"ig t"$ t#r,id 2;1 +*;141 Negati!e Tra%e Ana"$sis Norma" d.t in%reased #rine %on%entration Norma" De%reased: d.t de $dration Norma" Norma"

)ICROSCOPIC EBA)
Ro#nd e&it e"ia" %e""s )#%#s t read RBC P#s %e""s Amor& #rates.& os& ates Res#"t O%%asiona" )an$ 1+* *+4 FeA Ana"$sis Norma" Norma" Norma" Norma" Norma"

ANATO)( AND P'(SIOLOG(

T'E DIGESTI/E S(STE)

Every morsel of food we eat has to be bro&en down into nutrients that can be absorbed by the body, which is why it ta&es hours to fully digest food. %n humans, protein must be bro&en down into amino acids, starches into simple sugars, and fats into fatty acids and glycerol. The water in our food and drin& is also absorbed into the bloodstream to provide the body with the fluid it needs. The digestive system is made up of the a"imentar$ %ana" and the other abdominal organs that play a part in digestion, such as the liver and pancreas. The alimentary canal (also called the digesti!e tra%t) is the long tube of organs H including the esophagus, the stomach, and the intestines H that runs from the mouth to the anus. An adultIs digestive tract is about $" feet long. <igestion begins in the mouth, well before food reaches the stomach. ,hen we see, smell, taste, or even imagine a tasty snac&, our sa"i!ar$ g"ands, which are located under the tongue and near the lower 5aw, begin producing saliva. This flow of saliva is set in motion by a brain refle) thatIs triggered when we sense food or even thin& about eating. %n 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, sa"i!a moistens it for easy swallowing. A digestive en*yme called am$"ase, which is found in saliva, starts to brea& down some of the carbohydrates (starches and sugars) in the food even before it leaves the mouth. (wallowing, which is accomplished by muscle movements in the tongue and mouth, moves the food into the throat, or pharyn). The & ar$n- (pronounced> fair+in&s), a passageway for food and air, is about 3 inches long. A fle)ible flap of tissue called the e&ig"ottis refle)ively closes over the windpipe when we swallow to prevent cho&ing. ;rom the throat, food travels down a muscular tube in the chest called the eso& ag#s. ,aves of muscle contractions called &erista"sis force food down through the esophagus to the stomach. A person normally isnIt aware of the movements of the esophagus, stomach, and intestine that ta&e place as food passes through the digestive tract. At the end of the esophagus, a muscular ring called a s& in%ter allows food to enter the stomach and then squee*es shut to &eep food or fluid from flowing bac& up into the esophagus. The stomach muscles churn and mi) the food with acids and en*ymes, brea&ing it into much smaller, more digestible pieces. An acidic environment is needed for the digestion that ta&es place in the stomach. Glands in the stomach lining produce about $ quarts of these digestive 5uices each day. ost substances in the food we eat need further digestion and must travel into the intestine before being absorbed. ,hen itIs empty, an adultIs stomach has a volume of one fifth of a cup, but it can e)pand to hold more than 9 cups of food after a large meal.

0y the time food is ready to leave the stomach, it has been processed into a thic& liquid called % $me. A walnut+si*ed muscular tube at the outlet of the stomach called the &$"or#s &eeps chyme in the stomach until it reaches the right consistency to pass into the small intestine. 8hyme 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> !. the d#oden#m, the 8+shaped first part #. the CeC#n#m3 the coiled midsection $. the i"e#m, the final section that leads into the large intestine The inner wall of the small intestine is covered with millions of microscopic, finger+ li&e pro5ections called !i""i. The villi are the vehicles through which nutrients can be absorbed into the body. The "i!er (located under the ribcage in the right upper part of the abdomen), the ga"","adder (hidden 5ust below the liver), and the &an%reas (beneath the stomach) are not part of the alimentary canal, but these organs are still important for healthy digestion. The pancreas produces en*ymes that help digest proteins, fats, and carbohydrates. %t also ma&es a substance that neutrali*es stomach acid. The liver produces ,i"e, which helps the body absorb fat. 0ile is stored in the gallbladder until it is needed. These en*ymes and bile travel through special channels (called ducts) directly into the small intestine, where they help to brea& down food. The liver also plays a ma5or role in the handling and processing of nutrients. These nutrients are carried to the liver in the blood from the small intestine. ;rom 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. 0y the time food reaches the large intestine, the wor& of absorbing nutrients is nearly finished. The large intestineIs main function is to remove water from the undigested matter and form solid waste that can be e)creted. The large intestine is made up of three parts> !. The %e%#m is a pouch at the beginning of the large intestine that 5oins the small intestine to the large intestine. This transition area allows food to travel from the small intestine to the large intestine. The a&&endi-, a small, hollow, finger+li&e pouch, hangs off the cecum. <octors believe the appendi) is left over from a previous time in human evolution. %t no longer appears to be useful to the digestive process. #. The %o"on e)tends 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. 0acteria in the colon help to digest the remaining food products. $. The re%t#m is where feces are stored until they leave the digestive system through the anus as a bowel movement.

PAT'OP'(SIOLOG( DGASTROENTERITISE

Predis&osing Fa%tors
F Age F En!ironment

Pre%i&itating Fa%tors
F Lifest$"e F Poor '$giene F Diet

Etio"og$: infants.$o#ng % i"dren: 'aemo& i"#s inf"#enGae

Person to &erson D andsE

Contaminated food.Aater

Anima" &ets

Ingestion of Pat ogens

In!asion of t e GIT

Enteroto-in &rod#%tion

Affe%ts t e !omit re%e&tors /omiting %enter in t e ,rain is stim#"ated /omiting /omiting

Destr#%tion of e&it e"ia" %e""s S#&erfi%ia" #"%eration of m#%osa a,domina" s&asm to "imit m#%osa" inC#r$

red#%ed a,sor&tion of f"#id H e"e%tro"$tes

S$stemi% In!asion

Intera%ts Ait m#%osa" "ining

Inf"ammation of "a$er of tiss#e ,eneat e&it e"i#m of m#%osa Ce""#"ar meta,o"ism d.t #nder"$ing inC#r$ to GI '$&ert ermia and edema

A"ters &ermea,i"it$

Prof#sese%retion se%retionof off"#ids Aater Prof#se and e"e%tro"$tes

A,domina" %ram&s A,domina" &ain a,domina" &ain

B"ood3 m#%#s in stoo"

A,domina" %ram&s Diarr ea Genera" Aea8ness F"#id and e"e%tro"$tes "oss Infe%tion in ot er &art of t e ,od$ E-%retion of Interstitia" f"#ids A%%ess to S$stemi% %ir%#"ation

De $dration Deterioration and %o""a&se DEAT' Se&ti%emia )eningitis

NURSING CARE PLANS

ASSESS)ENT S#,Ce%ti!e data: . ainit po ang pa&iramdam &o/ as verbali*e by the patient O,Ce%ti!e data: TD $4.= o 8 (&in is warm to touch RRD #" NURSING DIAGNOSIS '$&ert ermia r.t e-&os#re to ot en!ironment PLANNING At the end of thirty minutes, the patient will maintain a core temperature within normal. NURSING INTER/ENTIONS Crovide proper ventilation. RATIONALE Croper ventilation may reduce the temperature of the patient. <ysrhythmias are common due to electrolyte imbalance, dehydration, and direct effects of hyperthermia on blood and cardiac tissue. @eat loss by convention. E/ALUATION

onitor heart rate and rhythm.

Cromote surface cooling by means of cool environment andEor fans.

 Cromote client safety. Encourage patientAs participation in ways to protect oneself from e)cessive e)posure to hot environment. %nstruct clientE(to increase fluid inta&e. :eview sings and symptoms of hyperthermia.

Ensuring patientAs safety prevents other problems. (elf+care awareness help in the prevention and control of hyperthermia.

Adequate fluid inta&e prevents dehydration. These may indicate prompt interventions.

O,Ce%ti!e data: <ecreased immunity

Ris8 for infe%tion r.t I/ t era&$

At the end of $" minutes, the client will verbali*e understanding of individual causative and ris&

Gote ris& factors for the occurrence of infection.

%dentifying the possible causative factors helps preventEcontrol the occurrence of infection.

factors. -bserve for locali*ed sings for infection at insertion sites. Assess s&in conditions around insertion sites of pins, wires, and tongs, noting inflammation and drainage. (tress proper hand washing techniques by all caregivers and (-As of the patient. %nstruct clientE(in techniques to protect the integrity of the s&in. Bisible sings of infection enable the management of more severe infections. The s&in is our primary defense against infectious diseases.

@and washing technique is a first+ line defense against nosocomial infections. 8are for the s&in integrity prevents the occurrence of infection.

S#,Ce%ti!e data: .Gagsu&a siya at nagtae/, as verbali*ed by her mother O,Ce%ti!e data: <ry mucous membranes and lips (un&en eyeballs

F"#id !o"#me defi%it re"ated to in%rease meta,o"i% demand and insensi,"e f"#id "oss t ro#g !omiting and in%reased ,od$ tem&erat#re

At the end of the shift, the patient will be able to> + Achieve adequate hydration as evidenced by good s&in turgor, moist mucous membranes and lips, no alteration in mentation

Assessed vital signs and degree of hydration and level of consciousness

Crovides baseline data and informationJ this is also important in the evaluating clients condition an success of intervention Adequate fluids will replace fluid lost through insensible water loss due to hyper metabolic state and vomiting

Encouraged adequate fluid inta&e as tolerated by the patient. %nstructed (to provide fluids in the bedside :egulated %B; according to specified flow rates basing on the physicianAs order

:egulation of fluid is critical in maintaining adequate circulating fluids to recover for the amount of water loss through fever and vomiting

onitored frequency of urination and amount of e)creted urine

'rine output serves as an important parameter in assessing clientAs ability to conserve fluids

DRUG STUD(
)ETRONIDAIOLE
Generi% name: etronida*ole

Brand name: ;lagyl C"assifi%ation: Trichomonacide, amebicide A%tion: Effective against anaerobic bacteria and proto*oa. (pecifically inhibits growth by binding to <GA, resulting in loss of helical structure, strand brea&age, inhibition of nucleic acid synthesis and cell death. Side Effe%ts: GI: nausea, dry mouth, metallic taste, vomiting, abdominal discomfort, andominal pain CNS: headache, di**iness N#rsing Res&onsi,i"ities: onitor stool number and character. ,ith %B therapy, assess for sodium retention.

)ETOCLOPRA)IDE
Generi% name: etoclopramide

Brand name: :eglan C"assifi%ation: gastrointestinal stimulant A%tion: <opamine antagonist that acts by increasing sensitivity to acetylcholineJ results in increased motility of the upper G% tract and rela)ation of the pyloric sphincter and duodenal bulb. Side Effe%ts: GI: nausea, bowel disturbances CNS: restlessness, drowsiness, fatigue, headache, di**iness N#rsing Res&onsi,i"ities: %n5ect slowly %B to prevent transient feelings of an)iety and restlessness. Assess abdomen for bowel sounds and distention.

A)PICILLIN Generi% name: Ampicillin Brand name: 'nasyn C"assifi%ation: Antiboitic, penicillin A%tion: (ynthetic, broad+spectrum antibiotic suitable for gram+negative bacteria. Side Effe%ts: GI: diarrhea, abdominal distention CNS: fatigue, headache GU: dysuria, urinary retention At t e site of infe%tion: pain and thrombo+phlebities N#rsing Res&onsi,i"ities: Gote history of sensitivityEreactions to these or related drugs. onitor 808, liver, and renal function onitor urinary output and serum potassium levels RANITIDINE Generi% name: :anitidine Brand name: ?antac C"assifi%ation: histamine @# receptor bloc&ing drug A%tion: 8ompetitively inhibits gastric acid secretion by bloc&ing the effect of histamine on histamine @# receptors. Side Effe%ts: GI: constipation, diarrhea, abdominal pain CNS: di**iness, headache, insomnia, an)iety N#rsing Res&onsi,i"ities: Assess patient G% condition before starting therapy and regularly thereafter to monitor the doing effectiveness. 0e alert for adverse reaction and drug interaction. Assess patientAs and family &nowledge of the drug therapy.