Chapter one

Acute gastro enteric is a common cause of morbidity and mobility worldwide. Conservative
estimate put diarrheal in top five causes of death worldwide with most occurring in young
children in non industrialized countries. In industrialized countries, diarrheal disease is
significant cause of morbidity across all age groups. Ecologies include bacteria, viruses,
parasites, toxins and drugs. Viruses are responsible for significant cases affecting patients of
all ages. In the united state, viruses are the leading causes of acute gastroenteritis. According
to (Christina M, Samant H, Diarrheal viral. 2017) viral gastroenteritis ranges from a self
limited watery diarrheal illness (usually> 1 week) associated with symptoms of nausea,
vomiting, anorexia, malaise or fever to severe dehydration resulting in hospitalization.

The clinical encounter acute viral gastroenteritis in three (3) e setting the first is sporadic
gastroenteritis in infants which is frequently causes by rofa virus. The second is epidemic
gastroenteritis, which occurred either in semi closed communities (families, institution, ships,
and vaccination spots) or as result of classis food borne or water borne pathogens (Romani S,
Kang F. Viruses causing childhood diarrheal in the developing world, 22 October 2009).
According to (Scarcella C, Canasi S, Coderia f, et al an outbreak of viral gastroenteritis
linked to municipal water supply Lombardy, Italy, June 2009 Meoline). Most of this infection
is caused by Galici viruses of adults which most likely is caused by caliciviruses, nota
viruses, ostro viruses or adeno viruses.

Objective

 To explore information about gastro enteritis.

 To describe the prevalence and mobility of gastro enteritis from September 2017 to
February 2018.
 To plan and implement nursing care for patient.

Rationale

 In order to better manage the client in the hospital and come out with the case.
 To help know what is happening in the hospital
 To better nursing care and follow up.
Significant

The significant of the study is to gain knowledge on how to diagnose and manage this
pathology (gastro enteritis) and to improve our skills and give quality care to patients
suffering from the disease. In addition to that, also we intend to improve public (community)
awareness with regards to this condition and give them proper health talk and preventive
measures about the condition.

Definition of key terms

Gastroenteritis: an inflammation of the gastro intestinal track that involves the stomach and
the small intestines.

Diarrheal: it is a condition of having three or more loose or liquid stool per day.

Dehydration: an excessive loss of water from the body.

Electrolytes: salts or mineral that produces electrically charged particles (ion) in body fluids.

Vomiting: forcible ejection of content of stomach through the mouth.

Nausea: it is the sensation of being about to vomit.

Inflammation: the body’s attempt to self protection.

Virus: a microorganism that is small than a bacterium that cannot grow or procedure apart
from a living cell.

Parasite: a plant or an organism that lives in or on another and takes its nourishment from
that other organism.

Anorexia: an eating disorder characterised by markedly reduced appetite or total aversion to

food.
 Chapter Two: Literature review.

Definition:

Gastroenteritis is the inflammation of the lining membrane of the stomach and the
intestines characterized especially by nosea, vomiting, diarrhea, and cramps ( Merrian
1828).

Gastro-enteritis is an uncomfortable and inconvenient ailment but is rarely life. Threatening

in the United States and other developed nations. Via, gastro enteritis is frequently referred
to as stomach or intestine flu. Although the intestine virus is not associated with the illness
(Encyclopedia of children Health 2010)

Age: Pre-disposing factors

Young children: Children in child care centers or elementary schools may be especially
vulnerable because it takes time for a child immune systemto be mature.

In addition, older adults’ immune system tends to became:

Less efficient later in life. Older adults in nursing homes are vulnerable because their
immune system weakens and they live in close contact with others who may pass along
germs.

Immune – compromisedpatients: if your resistance to infection is for instance. Immune

system is compromised by HIV/ AIDS, chemotherapy or other medical condition (Liste Mb,
Natera L,et l.2000)

Bold hygiene and sanitation condition

Contaminated food or water.

Drugs: Anti biotic depresses the normal microbes and allows virus and bacteria to thrive.

Causes

Gastro-enteritis is caused by the ingestion of viruses, certain bacteria, or parasites. Food

that has spoiled may also cause illness. Causes may be seen as follows.
Viral infection

Viral infection is the most common cause of gastro-enteritis. Viral gastro- enteritis is highly
contagious and can be spread through close contact with an infected person. Exposure can
also occur through the fecal route. Such as consuming food and beverages that are
contaminated by fecal material related to poor sanitation or by touching contaminated
surfaces. There are four types of virus that causes most viral gastro-enteritis namely: Rata
virus, adeno virus, calici virus and astro virus.

Typically, children ages three – 15 months are more vulnerable to rotavirus. While children
under age two are more susceptible to aderovirus serotypes 40-41.

In addition, calxivirus causes infection in people of all ages. This family of viruses include the
noroviruses (Sapporo virus). And the Astrovirus primarily infects infants, young children and
the elderly.

Bacterial and parasitic infections.

Bacteria gastro-enteritis is frequently as s result of poor sanitation, the lack of safe drinking
water, or contaminated food.

Common types of bacterial gastro enteritis can be linked to salmonella and conpylobacter
bacteria and Escherichia coli. If food becomes contaminated and remains at room
temperature for a period of time, the bacteria multiplies and increase the risk of infection
on those who consume the food.

Parasitic infections that causes gastro enteritis are most commonly caused by frandia

Which is easily spread through contaminated water and human contact. Cryptosporidium is
anther common parasitic organism that causes the symptom of gastroenteritis.

Pathophysiology

Adequate fluid balance in human depends on the secretion and reabsorbtion of fluid and
electrolytes in the intestinal track; diarrheal occurs when intestinal fluid output overwhelms
the absorptive capacity of the gastro intestinal track. The second (2) primary mechanism
responsible for acute gastroenteritis are: (1) damage the villous brush border to the intestinal,
causing malasorphian of the intestinal contents and leading to an esmotic diarrheal and (2) the
release of toxins that binds to specific enterocyte receptors and cause the release of chloride
ion in to the intestinal lumen, leading to secretary diarrheal. (King K, Was R et al, November
21st 2003)

Even in severe diarrheal, however, various sodium coupled solute co-transport mechanisms
remain intact, allowing for the efficient reabsorption of salt and water. By providing a 1:1
proportion of sodium in glucose, classic and rehydration solution (ORS) takes advantages of
specific sodium, glucose transporter (SGLT-1) to increase the reabsorption of water. Rice and
cereal –based ORS may also take advantage of sodium-amino acid transporters to increase
reabsorption of fluid and electrolytes (Randy P, Pricilla 2016).

CLINICAL MANIFESTATIONS

Although it is commonly called stomach flu, gastroenteritis is not the same as influenza. Real
flu (influenza) affects only your respiratory system, your nose, throat and lungs.
Gastroenteritis on the hand attacks your intestines causing the following signs and symptoms.

Water stool, usually none bloody diarrheal- bloody diarrheal usually means you have a more
different severe infection. Abdominal cramps and pains, nausea, vomiting or both, occasional
muscle or headache and low grade fever.

Depending on the cause, viral gastroenteritis symptoms may appear within one to three days
after you are infected and range from mild to severe. Symptoms usually last only for a day or
two, but occasionally they may persist as long as 10 days (Mayo in clinic Health, 1998).

Role of Nursing in Diagnostic Testing

Nurses provide a vital service to patients and other health care providers. They specialized in
patient care, proper patients for testing and evaluate their health progress.

Pre:

The nurse has the responsibility in gathering and preparing equipment. It includes checking
the equipment to assure it is working properly and it ready for use on patients.

Preparing a patient foe diagnostic testing is also a nurse responsibility. Drawing blood or
administering medication prior to testing.
Also responsible in collecting specimens such as stool and sending them to the lab.

Nurses also assist with mentally preparation of patients for testing (counselling) by answering
questions, explaining the procedure or test and possible outcome.

Peri:

Assist both health care provider and patients during testing. They provide patient care which
include administering medicines when needed, proper positioning. Patients are also
monitored by the nurse during the diagnostic testing. Motifor patients’ current medical
condition, checking of vital signs, asses physical conditions

Past:

Patients test result is reported to the patient doctor, specialist and other in need of the
information by the nurse.

It may also be nurses’ responsibility to check for the results of the test as well and also be in
charge of entering the result into the patient medical record.

Nurses most also notify the patients physician when abnormal or critical result that require no
immediate response.(Career Trend Rachel Dennis; July 05 2017, Massachusetts Avenue, NE
Washington).

Definition

Gastroenteritis is an inflammation of the stomach and the intestinal area caused by various
bacterial, viral and parasitic pathogens.

According to (Sweden et al. 1995), he defines gastro enteritis as an inflammation of the

stomach or the intestine that give the symptoms of diarrheal with or without vomiting.

Nursing Management

A) Assessment:
Systemic assessment include data collection, data analysis and problem determination
collection of data obtained by means of observation, physical assessment, (by Cynda Smirth
freenberg 1992)

 Identify of patient. (client)

 Main complaint, more liquid feaces, vomit, ,body weight decreased. In infant Sunken
fontanel large, tone and reduce skin tugar, dry lips.
 Past medical history: of illness, and immunization history.
 Nutritional pattern: beginning with nausea, vomiting anorexia causing weight loss.
 The pattern of sleep and rest will be disturbed because of abdominal distension that
causes discomfort.
 Pattern hygiene: bathing habit every day.
 Activities will be disturbed because the body is very -----and pain due to abdominal
distension.
 Physical examination: general condition seemed weak, high body temperature, rapid
and weak pulse, breathing rather quickly.

Systemic examination

 Inspection: sunken eyes, fontanel, mucous membranes, mouth and dry lips, weight
loss and anal redness.
 Percussion: presence of abdominal distension.
 Auscultation: bowel sounds hearing.
 Palpalan: less elastic skin tugar.

Nurses Diagnosis

 Volume of fluid and electrolyte deficit is less than body requirements related to
excessive fluid output.
 Impaired nutritional needs less than the body needs related to nausea and vomiting.
 Impaired sense of comfort pains associated with abdominal distension.
 Lack of knowledge related to the lack of information about illness, prognosis and
treatment.
Planning

Plan for care according to patient data

Implementation:

Observation of vital signs, signs of dehydration. Measures fluid input and output of fluid.

Provide and encourage families to provide drinking a lot less than 2000-2500cc per day.

2) Assess client nutritional patterns and changes that occurred, weight loss client.

Assess the factors causing the fulfilment of nutritional disorder.

Give a warm condition and diet in small proportion------frequently.

3) Assess the level of pain. Set a comfortable position for the client.

Give a warm compress on abdomen.

4) Assess the client level of family education and level of family knowledge about the
disease. Explain about the disease.

Evaluation

 The volume of fluid and electrolyte returned to normal as needed.

 Nutritional need is met in accordance.
 Sense of comfort is met.
 Knowledge ancestry increase.

Complication of gastro enteritis

The main complication of viral gastroenteritis is dehydration: a severe loss of water and
essential salts and minerals.

Infants, older adults and people with suppress immune system may become severely
dehydrated when they loss more fluid than they can replace. (Mayo Clinic 1998).

Some complication may also include:

Swollen or painful abdomen, fever higher than Λ0Λo little urine production, bloody bowel
movements.

Patients teaching

Advice the patient on proper hand washing techniques, regular hand washing with soap and
warm water to reduce risk of contacting germs or passing on germs especially after using the
toilet, playing with pets, gardening before buching food.

Keeping the kitchen and toilet clean will equally reduce the risk of diarrheal spacemen.

When handling raw meats, wash hands before buching. Other things such as other foods and
working surfaces or cutleries (Copola and Rafani 2011.)

Reference

1) Cortese M M, et al. Effectiveness of monovolent and pentavolent rofa-virus vaccine

pediatric 2013. Accessed October 2014.
2) Longo D L, et al, New York, the McGraw Hill Companies 2012. Accessed October
20th 2014.
3) Hoa T N et al. Moderular epidemrology of noro viruses associated with sporadic
gastroenteritis in children. Journal of clinician virology 2013.
4) Ryan M.J, Ramsay PM, Brown et al. Hospital admission attribute to Rotavirus
infedtionin England and Wales. Infection diseases 1996.
5) Gill A. Carrasco P. Jimenez R, et al. Burden of hodpitalization attribute to rofa virus
infection in children Spain 1999-2000.
6) Sethi D. Cumberland P, Hudson M.J. et al. A study of infectious intestinal disease in
England.