UPH- DR. JOSE G.

TAMAYO MEDICAL UNIVERSITY

Sto. Nio, Bian, Laguna
COLLEGE OF NURSING
A.Y 2008-2009
Acute Gastroenteritis
(Manuscript)
BS Nursing 3, Section 12
GROUP 48
Berunio, Rowena B.
Custodio, Jazine Monique S.
Postrado, Wilmer R.
Presbitero, Jewel F.
Rebutazo, Michelle Ann D.
Regis, Johnre Johnson L.
Reyes, Joevelyn D.
Sabado, Maybellene S.
Sales, Ramon Oliver B.
Turallo, Joshua D.
Villame, Jill Vivien S.
Ybaez, Rainna Glenn A.

Presented to:
Ms. Cecile Yee, RN
Clinical Instructor

July 17, 2008

INTRODUCTION
Acute gastroenteritis could be more simply called a long, and potentially lethal
bout of stomach flu. The most common symptoms are diarrhea, vomiting and
stomach pain, because whatever causes the condition inflames the
gastrointestinal tract. Acute gastroenteritis is quite common among children,
though it is certainly possible for adults to suffer from it as well. While most cases
of gastroenteritis last a few days, acute gastroenteritis can last for weeks and
months.
Numerous things may cause acute gastroenteritis. Bacterial infection is
frequently a factor, and infection by parasites like giardia can cause acute
gastroenteritis to last for several weeks. Viruses can also cause lengthy stomach
flu, particularly rotaviruses and noroviruses. Accidental poisoning or exposure to
toxins may also instigate acute gastroenteritis as well.
When a person does not recover from stomach flu symptoms within a day or so,
it is usually a good idea to see a doctor. Some types of acute gastroenteritis will
not resolve without antibiotic treatment, especially when bacteria or exposure to
parasites are the cause. Physicians may want to diagnose the cause by
analyzing a stool sample, when stomach symptoms remain problematic.
Another reason to seek medical treatment is that some forms of acute
gastroenteritis mimic appendicitis, which may require emergency treatment. As
well, young children run an especially high risk of becoming dehydrated during a
long course of the stomach flu. One should receive directions regarding how to
help affected kids or adults get more fluids. Sometimes children, those with
compromised immune systems, and the elderly may require hospitalization and
intravenous fluids. Dehydration can actually cause greater nausea, and can
begin to cause organ shut down if not properly addressed.
Even through causes for acute gastroenteritis vary, methods of transmission from
one person to another usually remain the same. Generally, contact with the fecal
matter of a person with the condition and then improperly washing or not washing
the hands causes acute gastroenteritis to be quite contagious. Proper
handwashing for both the ill person, and well people in the family is always
encouraged.
Other methods of transmission of acute gastroenteritis can include eating food or
drinking liquids contaminated with bacteria or parasites. For example, poorly
cooked hamburger might result in a very severe case of acute gastroenteritis due
to exposure to E. coli, a sometimes lethal bacterial infection in young children.
Drinking improperly treated water, or drinking from streams and lakes can expose
one to giardia, which can leave one ill for many weeks, without treatment.

PATIENTS PROFILE
Name: RG
Age: 1yr. 6mos.
Birthday:
Sex: Male
Address: Carmona, Cavite
Religion: Catholic
Civil Status: Child
Admitting Date: July 12, 2008 @ 10:00PM
Admitting Diagnosis: Gastroenteritis with some Dehydration
Chief Complain: Vomiting and Diarrhea
Family History:
(-) mothers side
(-) fathers side
Past Medical History:
First time to be admitted
Nursing Assessment:
Level of consciousness
The patient is generally conscious, but not able to participate well with
the nursing student because he was crying. Seems to be in pain at that time.

Skin
Brown in complexion, not pale looking, with slightly poor skin turgor
with body temp of 37 C (taken 12am).

Head and Neck

The patient has a rounded head with short black straight hair. Nose is
symmetric and straight. Ears are symmetrically aligned with same color as
facial skin. Lips are slightly dried.

Cardiovascular
CR- 142 bpm

Abdomen
Symmetric contour

Extremities
Upper extremities
With IV line at the left arm, good capillary refill. Arms are moving
freely.
Lower extremities
Good capillary refill. Legs are moving freely.

ANAPHYSIOLOGY OF THE INTESTINES

SMALL INTESTINE
The small intestine plays a key role in the digestion and absorption of
nutrients. 90% of nutrient absorption occurs in the small intestine. The small
intestine is about 6m (20 ft) long and has a diameter ranging from 4cm (1.6 in.) at
the stomach to about 2.5 cm (1 in.) at the junction with the large intestine. It has
three segments: the duodenum, the jejunum, and the ileum.
The duodenum is 25cm (10in.) in length and is the closest segment to the
stomach. From its connection with the stomach, the duodenum curves in a
C that encloses the pancreas.
This segment receives chime
from the stomach and digestive
secretions from the pancreas and
liver.

An abrupt bend marks the

boundary between the duodenum
and the jejunum. The jejunum is
about 2.5m (8ft) long. The bulk of
chemical digestion and nutrient
absorption occurs in the jejunum.

The jejunum leads to the third

segment, the ileum. It is the
longest segment, averaging 3.5m (12ft) in length. The ileum ends at the
ileocecal valve, a sphincter that controls the flow of material from the ileum
into the cecum, the first portion of the large intestines.

The intestinal lining bears a series of transverse folds called plicae circulares.
The lining of the intestine is composed of a multitude of fingerlike projections
called villi. These structures are covered by a simple columnar epithelium
carpeted with microvilli.
The epithelium contains several plicae; each plica supports a frost of villi, and
each villus is covered by epithelial cells blanketed in microvilli. This arrangement
sums up to a total of 2 million cm (more than 2,200ft) as area of absorption.
Each villus contains a network of capillaries that transports respiratory
gases and carries absorbed nutrients to the hepatic portal circulation fro
delivery to the liver.

In addition to capillaries, each villus contains nerve endings and lymphatic

capillary called lacteal. Lacteals transport materials that cannot enter
blood capillaries (i.e. lipids).

Once the chyme (viscous, highly acidic, soupy mixture of partially digested
food) has entered the small intestine, segmentation contractions mix it with
mucous secretions and enzymes. As absorption subsequently occurs, weak
peristaltic contractions slowly move the remaining materials along the length of
the small intestine. These contractions are local reflexes not under CNS control,
and the effects are limited to within a few centimeters of the site of the original
stimulus.
More elaborative reflexes coordinate activities along the entire length of the
small intestine. Distension of the stomach initiates the gastroenteric reflex, which
immediately accelerates glandular secretion and peristaltic activity in all intestinal
segments. The increased peristalsis moves materials along the length of the
small intestine and empties the duodenum. The gastroileal reflex is a response to
the circulating levels of the hormone gastrin produced by endocrine cells of the
stomach (upon mechanical stimuli or neural stimulation) and of the duodenum
(when exposed to chyme containing undigested proteins).
The entry of food into the stomach triggers the release of gastrin which
relaxes the ileocecal valve at the entrance to the large intestine. Because the
valve is relaxed, peristalsis pushes materials from the ileum into the large
intestine. On average, it takes about 5 hours for ingested food to pass from the
duodenum to the end of the ileum.
LARGE INTESTINE
The large intestine begins at the end of the ileum and ends at the anus. The
main functions of the large intestine include the reabsorption of water and
compaction of the intestinal contents into feces, the absorption of important
vitamins freed by bacterial action, and the storage of fecal material prior to
defecation.
The large intestine, also called the large bowel, has an average length of
approximately 1.5m (5ft) and a width of 7.5cm (3 in.). I t can be divided into three
parts: the cecum, the colon, and the rectum.
Material arriving fro the ileum first enters an expanded pouch, the cecum,
where compaction begins. A muscular sphincter, the ileocecal valve,
guards the connection between the ileum and the cecum. The slender,
hollow appendix, or vermiform appendix, which functions primarily as an
organ of the lymphatic system, attaches to the cecum along its
posteromedial surface.

The colon has a larger diameter and a thinner wall than the small
intestine. The most striking
external feature of the colon
is the presence of pouches,
or haustra, that permit
considerable distension and
elongation. The colon can
be
divided
into
four
segments: the ascending
colon, the transverse colon,
the descending colon and
the sigmoid colon.

The rectum forms the end of

the digestive tract and is an
expandable organ for the
temporary storage of feces.
The last portion of the
rectum, the anal canal, contains small longitudinal folds called anal
columns. The distal margins of these columns are joined by transverse
folds that mark the boundary between the columnar epithelium of the
rectum and a stratified squamous epithelium like that found in the oral
cavity. Very close to the anus, which is the exit of the anal canal, the
epidermis becomes keratinized and identical to that on the skin surface.

The major functions of the large intestine are reabsorption of water and a
variety of other substances (i.e. electrolytes), and preparation of the fecal
material for elimination.
The gastroileal and gastroenteric reflexes now move material into the cecum
while you eat. Movement from the cecum to the transverse colon is very slow,
allowing hours for the reabsorption of water. Movement from the transverse colon
through the rest of the large intestine results from powerful peristaltic
contractions called mass movements, which occur a few times a day. The normal
stimulus for mass movements is distension of the stomach and duodenum. In
response to commands relayed over the intestinal nerve plexuses, contractions
force fecal material into the rectum, causing the urge to defecate.

Reference:

The Essentials of Anatomy and Physiology, Fourth Edition

PATHOPHYSIOLOGY OF GASTROENTERITIS
Primary Predisposing Factor:
Food and Water contaminated with pathogen Rotavirus

foodborne and waterborne transmission of Rotavirus

via oral route

invasion of Rotaviruses on intestines

destroy mature host epithelial cells

in the middle and upper villi of the small intestine
increase in body temperature
due to viral infection
inflammation of the mucosal linings of intestines
due to loss of epithelial cells
abdominal cramping/pain
and vomiting may occur
due to inflamed linings
decreased reabsorption
of electrolytes and water from bowel lumen
due to inflammation

fluid and electrolyte imbalance

frequent loose,
watery stool
dehydration

References:

Burtons Microbiology For the Health Sciences, Eighth Edition

Robbins Pathologic Basis of Disease, Sixth Edition
Pathophysiology: Concepts of Altered Health States, Sixth Edition

MEDICAL MANAGEMENT
DATE AND TIME
07-12-08

DOCTORS ORDER

RATIONALE

Kindly admit to my
service. (by Dr. Pizzara)
Secure the guardians
consent for admission
and management

-to secure the guardian

that he/she understood the
medical management their
child will undergo

TPR q shift and record

-to monitor any alteration

in V/S

Diet for AGE, include

bananas and apple

-to aide in the self-limiting

process of the healing of
the inflamed intestines

IVF D5 0.3 NaCl 500cc

@ 27-28 mcgtts/min

-this is a hypotonic
solution that will help
attract water into the cells
thus preventing further
dehydration

Labs:
CBC
Fecalysis

Meds:
Aeknil, 0.6 ml q 4 x T
38.5C PRN
Paracetamol, 120mg/5ml
5ml q 4 x T 37.8C
PRN
Hydrite,1 sachet, PRN

-(CBC)to monitor WBC

count that are critical in
knowing whether an
infection still persists or
not; (fecalysis)to detect the
possible pathogen that
caused the disease
condition
-(Aeknil) to decrease body
temperature;(Hydrite) to
replenish lost electrolytes

GENERIC NAME CLASSIFICATION

Oral
Rehydration
Salts

Electrolytes

MECHANISM OF
ACTION
Replaces and maintain
sodium chloride levels
w/c are essential ions
necessary in normal
cellular metabolism

INDICATION

SIDE EFFECTS

Treatment of children
& adults w/
dehydration due to
diarrhea. Replaces
fluid & electrolytes lost
due to diarrhea &
vomiting.

Over dosage
may cause
pulmonary edema
Back pain
Diarrhea
Muscle twitching
Hyperactivity
confusion

CONTRAINDICATION

SPECIAL
PRECAUTION

Hypersensitivity to any
of its components

CHF
Circulatory
insufficiency
Kidney
dysfunction
Hypoproteinemia

BRAND NAME

Hydrite

DOSAGE
1 sachet in
200ml

NURSING
CONSIDERATIONS
monitor other
electrolytes level
assess patient
status
monitor for
possible drug
induced

GENERIC NAME CLASSIFICATION

Paracetamol

Analgesics and
Antipyretics

MECHANISM OF
ACTION
Decreases fever by
inhibiting the effects of
pyrogens on the
hypothalamic heat
regulating center

INDICATION

SIDE EFFECTS

Pyrexia of unknown
origin. Fever and pain
associated w/common
childhood disorders,
tonsillitis upper
respiratory tract
infections past
immunization
reactions.

Hematological
skin and other
allergic reactions

CONTRAINDICATION

SPECIAL
PRECAUTION

BRAND NAME

Aeknil

DOSAGE
10 yr = 2-3 ml
>10 yr = 1-2 ml

Date: July 14, 2008

Hypersensitivity
Intolerance to
tartrazine
Alcohol
Table sugar
saccharia

Renal and
Hepatic Failure

NURSING
CONSIDERATIONS
Assess patient
fever or pain
Assess allergic
reactions
Monitor liver and
renal functions
Check input and
output ratio

Name of Patient: RG
Age: 1 year and 6 months
Medical Diagnosis: Acute gastroenteritis with moderate dehydration
Nursing Diagnosis: impaired skin integrity related to dehydration as evidenced by slightly poor skin turgor disruption of skin surface.
Short term goal: At the end of the eight-hour shift, patient will be able to maintain a good skin quality.
Long term goal: At the end of patients hospitalization, patient will be able to have a good condition of skin.
CUES

PROBLEM

SCIENTIFIC REASON

Subjective:
Medyo dry
pa rin ang
skin niya. As
verbalized by
the patients
mother

Dehydration

Skin is a particularly
important avenue of
communication fro
these people and,
when compromised,
may affect responses.

Objectives:
-weak looking
-with slight
dehydration
-sunken
eyeballs

Reference: NANDA
book, p. 489
Date: July 14, 2008

INTERVENTION

RATIONALE

EVALUATION

-monitor intake and

output

-provides ongoing estimates

of fluid replacement

-monitor vital signs

-hypovolemia may be
manifested by hypotension,
tachycardia and tachypnea

Goal partially
met, patients
skin became
slightly fair and
normal.

-encourage to increase
fluid intake

-to prevent dehydration

-keep area clean and

dry

-to assist bodys natural

process of repair

-avoid use of plastic

material

-moisture potentiates skin

breakdown

-provide optimum
nutrition and increased
protein intake

-to provide a positive

nitrogen balance to aid in
healing and to maintain
general good health

-provide adequate
clothing

-to prevent vasoconstriction

Name of Patient: RG
Age: 1 year and 6 months
Medical Diagnosis: Acute gastroenteritis with moderate dehydration
Nursing Diagnosis: Risk for deficient fluid volume related to excessive losses through GI tract and altered intake.
Short term goal: At the end of the eight-hour shift, patient will be able to maintain good bowel movement.
Long term goal: At the end of patients hospitalization, patient will be able to promote return of normal bowel movement.
CUES

PROBLEM

Subjective:
Nagsusuka at
nagtatae siya this
morning, as
verbalized by the
patients mother.

Diarrhea

SCIENTIFIC REASON

INTERVENTION

Passage of loose,
unformed stools.

-restrict solid
food intake, as
indicated

-to allow for bowel rest and

reduces intestinal workload

-discuss possible
change in infant
formula

-diarrhea may result from

aggravated by intolerance to
specific formula

-administer
medications, as
ordered

-to treat infectious process,

decrease motility and /or
absorb water

-emphasize
importance of
handwashing

-to prevent spread of

infectious causes of diarrhea
such as Clostridium defficile
or Streptococcus aureus.

-administer
enteral and IV
fluids, as
indicated

-replace electrolytes lost

-review results of
lab testing

-(example parasites,
cultures for bacteria, toxins,
fat, blood) for acute diarrhea

Objectives:
-hyperactive
bowel sounds
-at least five
loose watery
stools per day

Reference: NANDA
book, p. 259
Date: July 14, 2008

RATIONALE

EVALUATION
Goal partially met
since the baby has
passed out a semiformed stool.

Name of Patient: RG
Age: 1 year and 6 months
Medical Diagnosis: Acute gastroenteritis with moderate dehydration
Nursing Diagnosis: Hyperthermia related to inflammatory process as evidenced by increase in body temperature.
Short term goal: At the end of the eight-hour shift, patient will be normal.
Long term goal: At the end of patients hospitalization, patient will no longer exhibit hyperthermia.
CUES
Subjective:
Mainit po and
katawan ng bata, as
verbalized by the
patients mother

PROBLEM

SCIENTIFIC REASON

INTERVENTION

Fever

It is an increase in internal body

temperature to levels above
normal.

-promote surface
cooling by means
of undressing

-for heat loss by

radiation and
conduction

-provision of cool
environment
and/or fans

-heat loss by
convection

-cool tepid
sponge baths or
immersion

-heat loss by
evaporation and
conduction

-local ice packs,

especially in groin
and axillae

-these are areas

with high blood
flow

Objectives:
-body temperature:
38.5C
-cardiac rate: 145
beats per minute
-respiration rate: 40
breaths per minute

Reference:
-administer
http://en.wikipedia.org/wiki/Fever antipyretics, as
ordered

Research Paper help

https://www.homeworkping.com/

RATIONALE

-to lower body

temperature

EVALUATION
Goal met, as
evidenced by normal
body temperature of
37C.