Case Study 2

INTRODUCTION
People today tend to disregard the importance of healthy lifestyle, proper diet and exercise. It is
very important to prepare a clean, safe and delectable food in our table. And it is alarming that children of
today prefer to eat process foods and loves to drink cola on which are bad for their health. We must take
an action to these problem for our children who are risk to this disease.
Acute gastroenteritis or diarrhea is one of the top illnesses reimbursed by PhilHealth. Diarrhea
with moderate and severe dehydration requires inpatient care because of the need for rapid intravenous
rehydration and close observation due to risk of developing complications.
Diarrhea disease is the second leading cause of death in children under five years old. It is both
preventable and treatable. Each year diarrhea kills around 525 000 children under five. A significant
proportion of diarrheal disease can be prevented through safe drinking-water and adequate sanitation and
hygiene. Globally, there are nearly 1.7 billion cases of childhood diarrheal disease every year. Diarrhea is
a leading cause of malnutrition in children under five years old. (www.who.int)
In low-income countries, children under three years old experience on average three episodes of
diarrhea every year. Each episode deprives the child of the nutrition necessary for growth. As a result,
diarrhea is a major cause of malnutrition, and malnourished children are more likely to fall ill from
diarrhea.
We choose this case because we want to spread awareness of this disease and to share our
knowledge for everyone, but people now are striving to prevent and control the condition. We want to
provide proper teachings to everyone especially those at risk and children that are susceptible to this
disease. Furthermore, we want to enhance our knowledge regarding this condition thus, we can protect
ourselves from acquiring the said disease in the far future.
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REVIEW OF RELATED LITERATURE
Gastroenteritis is a term used to refer to infections of the gastrointestinal tract caused by bacteria,
viral, or parasitic pathogens. Majority of these infections are food –borne illnesses whose common
manifestations are diarrhea and vomiting which may also be associated with systemic features such as
abdominal pain and fever (Behrman, 2008).
Once inside the intestinal mucosa, Enteropathogenesis either leads to an inflammatory or non-
inflammatory response. Non-inflammatory diarrhea is elicited through enterotoxin production by some
bacteria, destruction of villus (surface) cells by viruses, adherence by parasites, and adherence and / or
translocation by bacteria while inflammatory diarrhea is usually caused by bacteria that directly invade
the intestine or produce cytotoxins with consequent fluid, protein, and cells (erythrocytes, leucocytes) that
enter the intestinal lumen (Behrman, 2008).
Acute gastroenteritis or diarrhea is a decrease in stool consistency loose or liquid) and/or increase
in frequency of evacuation 3 or more times in 24 hours with or without vomiting or fever, usually lasting
for 7 days but not more than 14 days.
Acute diarrheal illness causes significant morbidity among young children and other older adults,
especially in less-industrialized nations of the world. Rapid propulsion of intestinal contents through the
small bowel results in diarrhea and may lead to serious fluid volume deficit. Common causes are
infections, malabsorption syndromes, medications, allergies and systemic diseases. Distention is caused
by excessive gas in the intestines. It may be due to the inability to digest adequately a specific nutrient,
such as lactose or it may result from defect in intestinal motility. Flatus (passing of bowel gas) may be
another clinical manifestation. In intestinal disorders, nausea results from distention of the duodenum.
Vomiting occurs from changes in the integrity of the intestinal wall or from changes in the motility of the
bowel caused by obstruction. Vomitus that contains fecal matter usually indicates a distal obstruction in
the small intestine. (Black Hawks 2004)
(Ref. http://www.doh.gov.ph/notifiable_diseases)
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Dehydration is a common body fluid disturbance encountered in the nursing care of infants and
children; it occurs whenever the total output of fluid exceeds in total intake, regardless of the underlying
cause. When the lost fluid and electrolytes are not replaced adequately, a deficit of water and electrolytes
develops resulting in to dehydration.
Two Types of Diarrhea (Ref. Wong’s Nursing Care of Infants and Children 2010)
1. Acute – a sudden increase inflammatory of stools is often caused by an infectious in the GI tract
cause spread by fecal or oral route.
a. Mild – 5-6% degree of DHN
Increase thirst, slightly dry buccal membrane.
b. Moderate – 7-9% degree of dehydration
Loss skin turgor, dry buccal mucous membranes, sunken eyeball/ fontanel.
c. Severe - more than 9% of dehydration
Rapid thread pulse, cyanosis, rapid breathy, lethargy/coma.
2. Chronic – increase stool frequency, increase water content with duration more than 14 days
caused by malabsorption syndrome, inflammation bowel disease, immune deficiency, food
allergy, lactose intolerance.
Clinical Manifestations of Acute diarrhea

 Fever
 Vomitus
 Watery stools
 Abdominal cramps
 Nausea
 Body malaise
 Bloody diarrhea
 Anorexia
Types of Dehydration
1. Isotonic – loss of water and salt.

2. Hypotonic – loss of salt more than water.
3. Hypertonic – loss of water more than salt.
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Clinical Manifestations of Dehydration (Ref. Wong’s Nursing Care of Infants and Children 2010)
Manifestations Isotonic Hypotonic Hypertonic

Skin
Color Gray Gray Gray
Temperature Cold Cold Cold or Hot
Turgor Poor Very poor Fair
Feed Dry Clammy Thickened, doughy
Mucous Membrane Dry Slightly point Parched
Tearing and Absent Absent Absent
Salivation
Eyeball Sunken Sunken Sunken
Fontanel Sunken Sunken Sunken
Body temperature Subnormal or elevated Subnormal or elevated Subnormal or elevated
Pulse Rapid Very rapid Moderately rapid
Respiration Rapid Rapid Rapid
Behavior Irritable to lethargic Lethargic or comatose, Marked lethargy with
convulsions extreme hyperirritability
on stimulation
Complications
Diarrhea is usually temporary and causes no serious problem. However, it does pose on increased threat
to the very old, the very young and those in poor in health. These individuals are more likely to become
dehydrated and experience electrolyte imbalances and metabolic acidosis. Chronic diarrhea interferes
with absorption of nutrients and can lead to malnutrition and anemia.
Key measures to treat diarrhea include the following:
 Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and
sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine and replaces the
water and electrolytes lost in the feces.
 Zinc supplements: zinc supplements reduce the duration of a diarrhea episode by 25% and are
associated with a 30% reduction in stool volume.
 Rehydration: with intravenous fluids in case of severe dehydration or shock.
 Nutrient-rich foods: the vicious circle of malnutrition and diarrhea can be broken by continuing to
give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious
diet – including exclusive breastfeeding for the first six months of life – to children when they are
well.
Consulting a health professional, for management of persistent diarrhea or when there is blood in stool or
if there are signs of dehydration.
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PATIENT HEALTH HISTORY
BIOGRAPHIC DATA
Name : Patient R
Address : Purok-1, Brgy. Cagtina-Ealim, Mono, Surigao
Age : 2years 1month 23 days
Sex : Female
Civil Status : Child
Date of Birth : August 22, 2015
Birth of Place : Malimono, Surigao
Religion : Roman Catholic
Nationality : Filipino
Health Care Financing & Usual Source of Medical Care: PhilHealth
ADMISSION DATA
Hospital: : Caraga regional Hospital

Case Number: : 00000177159
Hospital Number: : 313878-2017
Room Number: : PED-EX-56
Room Type: : Ward
Date Admitted: : October 15, 2017
Mode of Admission: : Per Stretcher
Admitting Vital Signs: : HR 146, RR 37, Temp 38.30 C
Weight: : 10kg
Chief Complaint: : LBM and Vomiting
Final Diagnosis: : AGE with Moderate Dehydration
Admitting Physician: : Dr. Edna M. Asodisen, MD
Attending Physician: : Dr. Edna M. Asodisen, MD
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BRIEF HISTORY OF PRESENT ILLNESS:
Four days prior to admission, the patient has a hyperthermia and diarrhea
GENERAL SURVEY:
The patient is awake upon admission and has a hyperthermia;
Upon admission Vital Signs:
Heart Rate : 146 bpm
Respiratory Rate : 37cpm
Temperature : 38oC
History Present Illness

Prior to admission, the patient has a hyperthermia and a severe watery stool, the family decided to rush
her at Caraga Regional Hospital.
Past Health History

The patient has a hyperthermia and a severe watery stool. The patient had chicken pox at the age
of one.
Immunizations
She had been immunized including BCG, DPT, Oral Polio Vaccine, and Hepatitis B vaccine.
Medication:
The patient has a maintenance of vitamins such as tiki-tiki and celine
Family Health History
The patient’s grandmother on the mother’s side is anemic and her grandfather has an asthma.
Both grandparents on the father’s side have a hypertension.
Personal Health History
Personal Habits
Before her hospitalization,

She used to play Barbie doll with her cousins and she love to play in her mother’s cellphone.
During her hospitalization,

She won’t play with her Barbie doll anymore and always clings to her mother.
Diet
Before hospitalization
The client ate four times a day such as breakfast, lunch, merienda and dinner. According to the
significant others, she always ate rice, noodles, egg, and hotdogs. She drank 4 glasses of water in a day
the source of their water is from spring. She had no eating discomforts.
During Hospitalization
The patient has no appetite to eat and do not like to eat hospital foods.
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Sleep rest and pattern
Before Hospitalization
The patient sleeps about 10 hours a day. From 8pm to 6am.She had no problem to sleep. Her
sleep was always continuous especially when she is tired. She always took her siesta.
The patient has a difficulty in sleeping and always irritable.
Elimination Pattern
The patient defecates every day and her stool was soft but formed and its color is brown and had
a foul odor. She urinates five times a day and is yellowish in color. She had no discomfort to defecate and
to urinate.
The client defecates three-to-four times a day. Her stool is watery, and its color is green. She has
a discomfort to defecate.
Activities of Daily Living

The client had no difficulties in performing ADL’s and other instrumental activities of daily
living. She could eat, eliminate, stand, and walk.
The patient hadn’t sufficient energy for completing her desired required activities.
Recreation and Hobbies

The client’s hobby is watching TV and playing with her cousins or neighbors.
Patient just lies or sits on the bed.
Social data
The patient lives in an extended family house. She is closer to her mother and loves to play with
her cousins.
During hospitalization the family of the patient especially her parents are supportive and more caring to
her.
Environmental Data
The patient resides in Purok-1, Brgy. Cagtina-Ealim, Malimono, Surigao. Their house is made of
wood and accessible transportation. The source of their water is from a spring.
Health Beliefs
Patient significant others believes in “Hilot” and quack doctors’, they seek help whenever their
baby has a cough or fever.
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Psychological Data
Cognitive-Perception Pattern
Before her hospitalization
The patient is fine in terms of her cognitive abilities. She has no problems with her senses. She
can do scribbles, squatting, and can open door knobs.
During her hospitalization
She is very irritated and whenever she wants something she asks by pointing her finger to the
object.
Coping Stress- Tolerance Pattern

The patient’ mother will give her candy when she is in distress. And when patient is scolded by
her parents, her grandmother will come to the rescue.
During her hospitalization, she demonstrates anxiety with people wearing white whom comes near her
and clings to her mother, if there are unfamiliar people to her insight.
Values-Belief Pattern
She is a Roman Catholic. They attend mass regularly. According to her mother, before they
consult the doctors or the hospital, they first consult the quack doctors
Socio-economic status
The patient’s father is a construction worker and the breadwinner of the family but sometimes her
grandparents help them in time of need.
Patterns of Health Care

Health care resources currently used is PhilHealth, dependent to her mother.
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PHYSICAL ASSESSMENT
General Survey
Received lying on bed, awake, conscious, responsive, coherent. Wearing a light clothing top and a diaper
with uncombed hair. She appears irritable. She has IVF of 500 ml PLR infusing well at the right
metacarpal vein at 500- 42gtts/min.
Vital sign upon assessment:
 Temperature: 38.8
 Respiratory Rate: 37 cpm
 Pulse Rate: 146 bpm
Integumentary
Skin
Inspection
 Client has pale complexion.
 No jaundice, birth mark on her left arm Noted
Palpation
 Skin is warm to touch Noted
 Poor skin turgor Noted
 Dry skin
Nails
Inspection
 No lesions Noted
Palpation
 Nail beds are slightly pink with slow capillary refill
Hair
Inspection
 Hair is not evenly distributed on the scalp
 No lice, dandruff, and lesions.
 Not properly combed hair.
Palpation
 No nodules palpated. Noted
Head, Eyes, Ears, Nose, Throat (HEENT)
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Skull and face
Inspection
 No edema
 No scars. Noted
Palpation
 Rounded and normocephalic skull contour. Noted
 Smooth and uniform in consistency of skull.
 No tenderness. Noted
 No lesions.
 No masses. Noted
Eyes and Vision

Inspection
 Sunken eye balls. Noted
 Conjunctiva is clear.
 Sclera is white
 No lesions Noted
 Pupils are equally round and reactive to light and accommodation test (which means the ability of
the eyes to focus on objects that are close and faraway)
Ears and Hearing

Inspection
 Ears are symmetrical and in line with the outer canthus of the eyes
 Ears are brown in color, smooth and can hear normally
 External canals are clear with no redness, swelling, lesions foreign body, and no discharge. Noted
Palpation
 Ear return to position when recoiled
Nose and Sinuses

Inspection
 Nose is symmetrical to the midline of the face
 No lesions or swelling. Noted
 Air moves freely as the patient breathes through the nares.
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Oropharynx (Mouth and Throat)
Inspection
 Mucosa and gingivae is pink
 No masses or lesions in the oropharynx. Noted
 Dry buccal membrane. Noted
 Dry tongue and pink.
 Tongue protrudes in midline with no tremor. Noted.
 Gums are pinkish with no bleeding.
 Client had only 8 lower teeth and 7 upper teeth.
 No plaques on her teeth. Noted
Neck
Inspection
 Head centered on neck
 Same color with facial skin
Palpation
 No tenderness.
 No masses. Noted.
 No lesions.
 Nodules are palpable on her left leg. Noted.
Thorax and Lungs

Posterior
Inspection
 Chest is symmetric
Auscultation
 Equal chest expansion and registers a clear breath sound
Anterior
Inspection
 She has no difficulty of breathing with RR- 37 cpm
Auscultation
 Absence of adventitious sound upon auscultation noted
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Cardiovascular System and Peripheral Vascular System
Palpation
 Palpable peripheral pulses. Noted
Auscultation
 Normal heart sound.
 Has a regular rhythm with 146 beats per minute.
 S1 heart sound heard as well as S2. Noted.
Abdomen
Inspection
 Skin is brown and uniform in color. Noted
 No striae.
 No scars. Noted
 No lesions.
 Abdominal distention. Noted.
Auscultation
 Presence of borborygmic sound
Percussion
 NO tenderness. Noted
Palpation
Musculoskeletal System
Upper extremities
Inspection
 No difficulty in moving. Noted.
 No swelling.
 No deformity.
Palpation
 No tenderness to palpation of joints. Noted
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Lower extremities
Inspection
 No difficulty in moving. Noted.
 No swelling.
 No deformity.
Palpation
 No tenderness to palpation of joints. Noted
Neurologic System
Cranial Nerves Types Function Methods/ Result
I Olfactory Sensory Smell Able to identify different

aromas being introduced to her
(cologne and aromatic foods).
II Optic Sensory Vision and Vision Able to ask object by pointing

Acuity
III Oculomotor Motor Extraocular eye Pupil is constricted upon

movement focused of light, the six ocular
Movement of the movements are present and
sphincter of pupil intact in the patient.
IV Trochlear Motor EOM; specially moves Patient can move her eyeball
eyeball downward and downward and laterally
laterally without difficulty.
V Trigeminal, Sensory Sensation of cornea Patient sensation of skin in
Ophthalmic Branch Motor skin of face and nasal face is present she can
mucosa differentiate what is blunt, dull,
and sharp, patient blinks when
the sclera is touch.
Maxillary branch Sensory Sensation of skin of Able to feel sensation being
pace and anterior oral introduced to her
cavity
Mandibular branch Motor and Muscles of mastication Patient can clench her teeth.
Sensory sensation of skin face.
VI Abducens Motor EOM, moves eyeball Able to move her eyeball
laterally laterally as where the direction
of gauze
VII Facial Motor and Facial expression test Able to smile and puff her
Sensory chicks.
VIII Auditory and Sensory Equilibrium The patient can able to stand
Vestibular branch with assistant of her mother.
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Cranial nerves Types Function Methods/ Result
Cochlear Branch Sensory Hearing Able to hear properly

spoken words
IX Glossopharyngeal Motor and Swallowing ability Able to swallow properly

sensory tongue movement and move her tongue side
taste (posterior to side
tongue)
X Vagus Motor and Sensation of pharynx Patient voice is clear.

sensory and larynx
swallowing, vocal
cord movement
XI Accessory Motor Head movement Able to move her head
shrugging of and can shrug her
shoulders shoulders.
XII Hypoglossal Motor Protrusion of tongue; The patient can protrude

moves tongue up and and move her tongue side
down side to side to side
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NEUROLOGIC TEST
 Oriented to date, time, and place.

 Displays normal non-verbal and verbal communication.
 Able to recall word being said a while ago to her
 Upon reviewing the reflexes, the patient can able to flex her arm and rest her forearm without any
difficulty.
 Patient’s response normal upon assessing the patellar reflex.
 Scale for “Grading Reflex Response” +2 indicates normal response
 Level of consciousness, Glasgow Coma Scale.
FACULTY RESPONSE SCORE

MEASURED
Eye Opening 4 Spontaneous 4
3 Speech
2 Pain
1 None
Verbal Response 5 Smiles, oriented to sounds 4
4 Cries but consolable/confused
3 Inconsistently
2 Inconsolable/Inappropriate
1 None
Motor Response 6 Moves spontaneously/obeys 5
5 Withdraws from touch/localizes
4 Withdraws from pain
3 Flexion
2 Extension
1 None
Total 13
Reproductive System
Female Genital and inguinal area.
 During inspection client inguinal part has rashes. Noted
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REVIEW OF SYSTEM
GENERAL DATA
Patient has a sunken eyeball, dry buccal membrane, and distended abdomen. She was lying on her
bed, appears to be irritated and lethargic. Her temperature is 38.40C.
 INTEGUMENTARY SYSTEM:
During the assessment the client had mild rashes on her inguinal part and her skin turgor is
poor. Her skin is pale and dry.
 HEAD, EYES, EARS, NOSE, THROAT (HEENT)

Patient had no history of head injury, eye problem and ear infection. She had no history of
nasal allergies, she had no history of neck lumps, and thyroid problem. There is an absence of tearing
and salivation. She had no history of epistaxis and bleeding gums, sore, lumps, toothaches. She had
no difficulty of swallowing as claimed.
 THORAX AND LUNGS

Patient has a productive cough. There is no presence of signs and symptoms of the disease
such as bronchitis, pneumonia, and asthma.
 CARDIOVASCULAR SYSTEM
Patient’s heart rate was 140 bpm. There was no history of cardiopulmonary disease.
 GASTROINTESTINAL SYSTEM
Patient still likes to drink breastmilk and her favorite food is hotdog and egg. Sometimes the
client had an abdominal cramping and they use an oil liniment to relieve pain.
 GENITOURINARY SYSTEM
Client had no history of urinary frequency, incontinence, and pain or burning upon urination.
She had no history of urinary tract infection. She had no vaginal discharge, swelling, masses, or
lesions. And her mother changes her diaper when she urinates 2-4 times a day.
 MUSCULOSKELETAL SYSTEM
The patient manifested good posture and moved voluntarily; she had symmetrical
musculature on both sides of the body.
 ENDOCRINE SYSTEM
Patient had no history of goiter, or thyroid problem.
 NEUROLOGIC SYSTEM
Patient had no history of difficulty on unconsciousness, seizures and tremors. She is alert,
attentive, and oriented.
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CLINICAL LABORATORY
Requested by: Dr. Edna M. Asodisen, MD Result Date: October 18, 2017
Case Number: 177159 Time: 13:29
EXAM NAME Conventional Unit SI Unit

Result Normal Values Result Normal Values
Sodium 135.9 135-155 mmol/L 135.90 135-155 mmol/L
Potassium 3.73 3.5-5.5 mmol/L 3.73 3.5-5.5 mmol/L
Chloride 106.8 96-109 mmol/L 106.80 96-109 mmol/L
Total Calcium (+) 2.63 2.15-2.90 mmol/L 2.63 2.15-2.90 mmol/L
Ionize (++) 1.35 1.12-1.32 mmol/L 1.35 0-0
FECALYSIS
Result Date: October 15, 2017

Time: 7:20 pm
Case No.: 177159
Normal values Rationale

Color Brown Brown
Consistency Soft Soft and bulky, small
and dry, depending on
the diet.
RBC 1-4 hpf Blood in the stool can
arise from
abnormalities higher in
the colon
WBC 2-5 hpf
OVA parasites No OVA or Parasite Seen

Bacteria Plenty
Amoeba Positive
Cyst 1-2/ hpf
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CLINICAL LABORATORY
Result Date: 10/15/2017

Time: 3:28 pm
Test Result Reference Unit Rationale

WBC 10.05 4.00-12.00 10^9/L
Neu% 35.0 50.0-70.0 % Infections
Lym % 41.3 20.0-60.0 %
Mon % 21.8 3.0-12.0 % Infections
Eos % 1.4 0.5-5.0 %
Bas % 0.5 0.0-1.0 %
RBC 3.93 3.50-5.20 10^12/L
HGB 9.5 12.0-16.0 g/dL Anemic
HCT 28.8 35.0-49.0 % Iron, Vitamin B12, or Folate

Deficiency
MCH 73.3 80.0-100.0 FL Iron deficiency
MCHC 32.9 31.0-37.0 g/dL
RDW-CV 16.1 11.0-16.0 %
RDW-SD 41.8 35.0-56.0 fL
PLT 280 150-400 10^g/L
MPV 8.7 6.5-12.0 fL
DDW 15.6 15.017.0
PCT 0.243 0.108-0.282 %
P-LCC 53 10^9/L
P-LCR 18.8 %
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CFAC OF STOOLS & VOMITUS MONITORING SHEET
Stools Vomitus
Date Shift Remarks Color Frequency Amount Characteristics Frequency
10-15- 3p-12p noted yellow 2x 2tbsp watery stools (-)
17
11p-7a noted brown 2x 1tbsp Watery with (-)
particles as
mucoid
10-16- 7a-3p noted yellow 2x 2tbsp Watery with (-)
17 particles
3p-11p noted yellow 4x 5tbsp Watery with (-)
particles
11p-7a noted yellow 2x 2tbsp Watery with (-)
particles
10-17- 7a-3p noted yellow 5x 2tbsp Watery with (-)
17 particles
3p-11p noted Green/yellow 6x 1tbsp Watery with (-)
particles
11p-7a noted yellow 1x 3tbsp Formed (-)
10-18- 7a-3p noted yellow 4x 1cup Watery with (-)
17 particles
3p-11p noted yellow 3x 1cup Watery with (-)
particles
11p-7a noted yellow 4x ½ cup Watery with (-)
particles
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HUMAN ANATOMY AND PHYSIOLOGY
Digestive System (Essentials of Human Anatomy and Physiology 2008)
The Digestive System takes in food (ingests it), breaks it down physically and chemically into the nutrient
molecules (digests it), and absorbs the nutrients into the bloodstream. Metabolism produces cellular
energy (ATP) and accounts for all constructive and degradative cellular activities. Then it rids the body of
the indigestible remains (defecates).
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The organs of the digestive system can be separated into two main groups:
1. The Alimentary Canal- performs the whole menu of the digestive functions (ingests, digests,
absorbs, and defecates).
2. The Accessory Organs- (teeth, tongue, and several large digestive glands). Assist the process of
digestive breakdown in various ways.
The alimentary canal, also called the gastrointestinal tract is a continuous, coiled, hollow muscular tube
that winds through the ventral body cavity and is open at both ends. Its organs are the mouth, esophagus,
stomach, small intestine, and large intestine. The large intestine leads to the terminal opening or anus.
 Mouth – food enters the digestive tract through the mouth and oral cavity, a mucous-membraned
lined cavity.
 Esophagus – or gullet runs from the pharynx through the diaphragm to the stomach. About 25cm
(10inches long), it essentially a passageway that conducts food (by peristalsis) to the stomach.
 Stomach – the C-shaped stomach is on the left side of the abdominal cavity, nearly hidden by the
liver and diaphragm. The stomach acts as a temporary “storage tank” for food as well as a site for
food breakdown.
 Small intestine – is the body’s major digestive organ. Within its twisted passageways, usable food
is finally prepared for its journey into the cells of the body. The small intestine is a muscular tube
extending from the pyloric sphincter to the large intestine. It is the longest section to the
alimentary tube, with an average length of 2.5 to 7m (8-20 ft.) in a living person.
 Large intestine – is much larger in diameter than the small intestine but shorter in length. About
1.5 m (5ft.) long, it extends from the ileocecal valve to the anus. Its major functions are to dry out
the indigestible food residue by absorbing water and to eliminate these residues from the body as
feces.
Accessory Digestive Organs
 Teeth – the role of the teeth play in food processing needs little introduction. We masticate, or
chew, by opening and closing our jaws and moving them from side to side while continuously
using our tongue to move the food between our teeth. In the process the tear and grind the food,
breaking it down into smaller fragments.
 Tongue – occupies the floor of the mouth. The tongue has several bony attachments two of these
are to the hyoid bone and to the styloid process of the skull.
 Salivary Glands – empty their secretions into the mouth.
 Submandibular Glands and the sublingual glands – empty their secretions into the floor of the
mouth through tiny ducts.
 Liver – is the largest gland in the body. Its digestive function is to produce bile.
 Pancreas – is a soft, pink, triangular, gland that extend across the abdomen from the spleen to
duodenum. Only the pancreas produces enzymes that breakdown all categories of digestible
foods. The pancreas also has an endocrine function, it produces the hormones insulin and
glucagon.
 Gallbladder – is a small, thin-walled green sac that snuggles in a shallow fossa in the inferior
surface of the liver.
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The Essential Activities of the GI Tract:
1. Ingestion – Food must be placed into the mouth before it can be acted on. This is an active and
voluntary process.
2. Propulsion – if foods are to be processed by more than one digestive organ, they must be
propelled from one organ to the next. (e.g. swallowing).
3. Food breakdown: mechanical digestion – mixing of food in the mouth by the tongue, churning of
food in the stomach, and segmentation in the small intestine. Mechanical digestion prepares food
for further degradation by enzymes by physically fragmenting the foods into smaller particles.
4. Food breakdown: chemical digestion – The sequence of steps in which a large food molecule is
broken down to their building blocks by enzymes.
5. Absorption – Transport of the digested end products from the lumen of the GI tract to the blood
or lymph. For absorption to occur, the digested foods must first enter the mucosal cells by active
or passive transport processes. The small intestine is the major absorption site.
Defecation – is the elimination of indigestible residues from the GI tract via the anus in the form
of feces.
22 | P a g e
PATHOPHYSIOLOGY
Predisposing Factor Precipitating Factors

 Age  Contaminated
 Gender Food & Water
 Immunocompromised  Poor Hygiene
 Lack of Sanitation
 Knowledge Deficit
ACUTE GASTROENTERITIS
Bacterial
Ingested of Contaminated food and water
Pathogens invades GI tract
Stimulation & Destruction of

Abdominal ---------- mucosal lining of the bowel wall
Pain
Stimulation of mucosal lining of intestine
Increase of Peristaltic Movement

------ Presence of
borborygmic sound
Inhibition of Sodium Reabsorption
Increased Protein in the lumen
23 | P a g e
Diarrhea
Watery Stools ----------- ----------------------- Abdominal Distention
Acute
Fluid & Electrolyte Imbalance
Dehydration
-----------------------------------------------------------------------------------------------------------------
Behavior: Sunken Absence of Dry Skin

-Irritability eyeball & Tearing & Turgor
-Lethargic fontanel Isotonic Salivation
Hyperthermia
If untreated:
Serious fluid Volume Deficit
Hypovolemic Shock Hypotension

------
Death
Legend:
------- Clinical Manifestation
Manifested to Patient
If untreated
24 | P a g e
DRUG STUDY NO.1
Generic Name: Cefixime
Brand Name: Suprax
Classification: Therapeutic: anti-infectives
Dosage: 2.5 ml BID
Indication:
Treatment of the following infections caused by susceptible organisms. Otitis Media
Contraindication:
Caution: Hypersensitivity to cephalosporins, Serious hypersensitivity to penicillin.
Use cautiously in renal impairment.
Mechanism of Action:
Bind to the bacterial cell wall membrane, causing cell death.
Therapeutic Effects: Bactericidal against susceptible bacteria.
Spectrum: Like that of second-generation cephalosporins, but activity against staphylococci is less,
whereas activity against gram negative pathogens is greater, even for organisms resistant to first – and
second- generation agents. Notable is increased action against: Enterobacter, Haemophilus influenzae,
Escherichia coli, klebsielaa pnuemoniae, Neisseria gonorrhea, Citrobacter, Morganella, Proteus,
providencia, serratia, Moraganella, Proteus, Providencia, Serratia, Moraxella catarrhalis, Borrelia
burgdorferi. Some agents have activity against Pseudomonas aeruginosa (Ceftazidime, cefoperozone).
Not active against methicillin- resistance staphylococci or enterococci. Some agents have activity against
anaerobes, including Bacteroides fragilis (cefoperazone, cefotaxime, ceftizoxime, ceftriaxone.
Adverse Drug Interaction:

High doses, headache, GI: diarrhea, nausea, vomiting, cholestasis, cramps
Nursing Implications:
 Assess for injection at beginning of and throughout therapy.
 Before initiating therapy, obtain a history to determine previous use of the reactions to
penicillin’s of cephalosporins.
 Obtain specimens for culture the sensitivity before initiating therapy.
 Observe patient for signs and symptoms of anaphylaxis.
 Pedi: assess newborn for jaundice and hyperbilirubinemia before making decision to use
Ceftriaxone.
25 | P a g e
DRUG STUDY NO.2
Generic Name: Metronidazole
Brand Name: Flagyl
Classification: Anti-infectives, anti-protozoal and anti-ulcer agents
Dosage: 4ml TID, for 7days
Indication:
Treatment of the following anaerobic infections: Intra-abdominal infections (may be used with a
cephalosporins), Gynecologic infections, Skin and skin structures infections, CNS infections, Septicemia
Contraindication:
 Hypersensitivity to parabens (topical only): First trimester of pregnancy.
 Use cautiously in history of blood dyspraxias
 History of seizures or neurologic problems. Severe hepatic impairment.
 Pregnancy, lactation patients, receiving corticosteroids or predisposed to edema.
 Disrupts DNA and protein synthesis in susceptible organisms.
 Therapeutic Effects: Bactericidal, trichomonacidal or amoebicidal action.
 Spectrum: Most notable for activity against anaerobic bacteria, including Bacteroides,
Clostridium difficile

 CNS: dizziness, headache
 EENT: tearing,
 GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue glossitis, unpleasant task,
vomiting
 Derma: rashes, burning, mild dryness, skin irritation, transient redness
 Hemat: leukopenia
 Local: phlebitis at IV site
 Neuro; peripheral neuropathy.
 Misc.: superinfection, disulfiram-type reaction with alcohol.
 Assess patients for injection at beginning of and throughout therapy.
 Obtain specimens for culture and sensitivity before initiating therapy.
 Monitor neurologic status during and after IV infusions.
 Monitor intake and output and daily weight especially for patients on sodium restriction.
 Instruct patient to take medication exactly as directed with evenly spaced times between doses,
even if feeling better. Do not skip doses or double up on missed doses. Take missed doses as soon
as remembered if not almost time for next dose.
 May cause dizziness or light headedness. Caution patient to avoid activities requiring alertness
until response to medication is known.
 Inform patient that medication may cause urine to turn dark.
26 | P a g e
DRUG STUDY NO.3
Generic Name: Zinc Sulfate
Brand Name: Zincate
Classification: Mineral and electrolyte replacements/supplements.
Dosage: 5ml OD
Indication:
Replacement and supplementation therapy in patients who are at risk for zinc deficiency
Contraindication:
Hypersensitivity or allergy to any components in the formulation.
Use cautiously in renal failure.
Serves as a cofactor for many enzymatic reactions. Required for normal growth, and tissue repair, wound
healing and sense of taste of smell
Therapeutic Effects: Replacement in deficiency states.

Abdominal pain, dyspepsia, nausea, vomiting, diarrhea, gastric irritation, gastritis. Prolonged use may
cause copper deficiency (e.g. sideroblastic anemia, neutropenia).
 Monitor progression of zinc deficiency symptoms during therapy.
 Encourage patient to comply with diet recommendation. Ask the patients to notify any of the
health care team if the patient feels nausea, vomiting, abdominal pain or tarry stools occur.
 Patient self-medicating with vitamin supplements should be cautioned not to exceed RDA. The
effectiveness of mega doses for treatment of various medical conditions is unproved and may
cause side effects.
 Emphasize the importance follow up exams.
27 | P a g e
DRUG STUDY NO.4
Generic Name: Metoclopramide
Brand Name: Reglan
Classification: Anti-emetics
Dosage: 2mg IVTT every 8hr PRN
Indication:
Prevention of chemotherapy-induced emesis. Treatment of postsurgical and diabetic gastric stasis.
Facilitation of small bowel intubation in radiographic procedures. Management of esophageal reflux.
Treatment and prevention of post-operative nausea and vomiting when nasogastric suctioning is
undesirable.
Contraindication:
 Contraindicated with hypersensitivity to metoclopramide
 Possible GI obstruction or hemorrhage
 History of seizure disorder
 Pheochromocytoma; Parkinson’s Disease
Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI
tract and accelerates gastric emptying.
Therapeutic Effects: Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Each passage
of nasogastric tube into small bowel.

CNS: Drowsiness extrapyramidal reactions, restlessness, Neuroleptic Malignant Syndrome, anxiety,
depression, irritability, tardive dyskinesia.
CV: arrhythmias (Super ventricular tachycardia, bradycardia), hypertension, hypotension.
GI: constipation, diarrhea, dry mouth, nausea.
Endo: gynecomastia
Hemat: methemoglobinemia, neutropenia, leukopenia, agranulocytosis.
 Assess patient for nausea, vomiting and abdominal distention and bowel sounds before and after
administration.
 Assess the patient for extrapyramidal side effects (parkinsonian- difficulty speaking or
swallowing, loss of balance control, pill rolling, mask-like face, shuffling gait, rigidity, tremors;
and dystonic- muscle spasms, twisting motions, twitching, inability to moves eyes, weakness of
arms of legs) periodically throughout course of therapy.
 Assess patient for signs of depression periodically throughout therapy.
28 | P a g e
 Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, & extremities;
lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm like
movements of tongue). Usually occurs after a year or more continued therapy. Report
immediately; may be irreversible.
 Pedi: Unintentional overdose has been reported in infants and children with the use of
metoclopramide oral solution. Teach parents how to accurately read labels and administer
medication.
29 | P a g e
DRUG STUDY NO.5
Generic Name: Ampicillin
Brand Name: Albercillin
Classification:
Therapeutic: anti-infectives
Pharmacologic: aminopenicillins / bacterial lactamase inhibitions
Dosage: 250mg IVTT every 6hr ANST
Indication: Treatment of the following infections: Skin and skin structure infections; soft tissue, Otitis
media; Sinusitis, Respiratory infections, Genitourinary infections, Meningitis, Septicemia. Endocarditis
prophylaxis
Contraindication:
Hypersensitivity to penicillin or sulbactams.
Use Cautiously in: Severe renal insufficiency (dosage reduction if CCR< 10ml/min); infectious
mononucleosis, acute lymphocytic leukemia or cytomegalovirus infections (increased incidence of rash);
Patients allergic to cephalosporins; OB: Has been used during pregnancy; Lactation: Is distributed into
breast milk. Can cause rash, diarrhea, and sensitization in the infant.
Binds to bacterial cell wall, resulting in cell wall, resulting in cell death; spectrum is broader than that of
penicillin.
 Assess patient for infection (VS, wound appearance, sputum, urine, stool and WBC) at beginning
and throughout therapy.
 Obtain a history before initiating therapy to determine previous use and reactions to penicillin’s
or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an
allergic response.
 Obtain specimens for culture and sensitivity before therapy. First dose may be given before
receiving results.
 Instruct patient to take medication around the clock and to finish the drug completely as directed,
even if feeling better. Advise patients that sharing of this medication can be dangerous.
Pedi: Instruct parents and caregivers not to save or use this medication for other infections.
 Advise patients to report the signs of superinfection (furry overgrowth on the tongue, vaginal
itching or discharge, loose or foul- smelling stools) and allergy.
 Advice patients taking oral contraceptives to use and alternate or additional nonhormonal method
of contraception while taking ampicillin and until next menstrual period.
 Caution patient to notify health care professional if fever and diarrhea occur, especially is stool
contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care
professional. May occur up to several weeks after discontinuation of medications.
 Instruct the patients to notify health care professionals if symptoms do not improve.
30 | P a g e
DRUG STUDY NO.6
Generic Name: Paracetamol
Brand Name: Tempra
Classification: Therapeutic: antipyretics, nonopioid analgesics
Dosage: 250mg every 4hr PRN for fever
Indication:
 Mild pain
 Fever
Contraindication:
Previous hypersensitivity products containing alcohol, aspartame, saccharin, sugar or tartrazine (FDC
yellow dye HS) should be avoided in patient who have hypersensitivity or intolerance to these
compounds.
Use Cautiously in: Hepatic disease/ renal disease (lower chronic doses recommended); Chronic alcohol
use/ abuse; Malnutrition.
Inhibits the synthesis of prostaglandins that may serve as mediation of pain and fever, primarily in an
CNS, has no significant inflammation properties of GI toxicity

 GI: hepatic failure, hepatotoxicity (overdose)
 GU: renal failure (high doses/chronic use)
 Hemat: neutropenia, pancytopenia, leukopenia
 Derma: rash, urticaria
 Assess overall health status and alcohol usage before administering acetaminophen. Pt. who are
malnourished or chronical abuse alcohol are at higher risk of dendroping hepatotoxicity with
chronic use of visual dose of this drug.
 Assess amount, frequency, and type of drugs taken in patients self-medicating, especially with
OTC drugs. Prolonged use of acetaminophen increases the risk of adverse renal effects. For short-
term use, combined doses of acetaminophen and salicylates should not exceed the recommended
dose of either drug given alone.
 Pain: Assess type, location, and intensity prior to and 30-60 min following administration.
 Fever: Asses fever: note presence of associated signs (diaphoresis, tachycardia and malaise).
31 | P a g e
DRUG STUDY NO.7
Generic name: Bacillus Clausii

Brand Name: Erceflora
Classification: Antidiarrheal
Mechanism Action:
 Contributes to the recovery of the intestinal microbial flora altered during microbial disorders of
diverse origin.
 Produces various vitamin, particularly group B vitamins thus antibiotics and chemotherapeutic
agents.
 Promotes normalization of intestinal flora.
Indication:
 Acute diarrhea with duration at 14days due to 14 days due to infection, drugs or poison.
 Chronic or persistent diarrhea with durations of >14 days.
Nursing implications:
 Shake drug well before administration
 Administer drug orally
 Monitor patients for any unusual infections from drug
 Administer drug within 30min. after expiring container.
32 | P a g e
DRUG STUDY NO.8
Generic Name: Hyoscine

Classification: Antiemetics
Indication: relief of smooth muscle spasm of the gastrointestinal and gastrourinary system.
Mechanism Action: Acts as competitive inhibitor at postganglionic muscranic receptor sites of
parasympathetic nervous system and on smooth muscles that respond to acetylcholine but lack
cholinergic innervation. May block cholinergic transmission from vestibular nuclei to higher CNS center
and from reticular formation to vomiting center.
Contraindications:
 Acute hemorrhage
 Myasthenia gravs
 Reflux esophagitis
 Obstructive uropathy
 Ulcerative Colitis or toxic megacolon
 Be alert for adverse reactions and drug interactions.

 Assess for eye pain
 Assess for urinary
 Assess for constipation
 Monitor urine output
33 | P a g e
DRUG STUDY NO.9
Brand Name: Ceelin

Classification: Vitamin C
Dosage: This medication administered orally for the prevention of deficiency conditions the dose is 25-75
mg / day.
Indication:
prevention and treatment of hypo- and avitaminosis of vitamin C; providing increased need for vitamin C
during growth, pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe
illness; in winter with an increased risk of infectious diseases.
For intravaginal use: chronic or recurrent vaginitis (bacterial vaginosis, nonspecific vaginitis) caused by
the anaerobic flora (due to changes in pH of the vagina) in order to normalize disturbed vaginal
microflora.
Contraindication:
Increased sensitivity to ascorbic acid.
Mechanism of Action: Ascorbic acid (vitamin c) is essential for the formation of intracellular collagen, is
required to strengthen the structure of teeth, bones, and the capillary walls. It participates in redox
reactions, the metabolism of tyrosine, converting folic acid into folinic acid, metabolism of carbohydrates,
the synthesis of lipids and proteins, iron metabolism, processes of cellular respiration. Reduces the need
for vitamins B1, B2, A, E, folic acid, pantothenic acid, enhances the body's resistance to infections;
enhances iron absorption, contributing to its sequestration in reduced form. Has antioxidant properties.
With intravaginal application of ascorbic acid lowers the vaginal pH, inhibiting the growth of bacteria and
helps to restore and maintain normal pH and vaginal flora (Lactobacillus acidophilus, Lactobacillus
gasseri).
Adverse drug interaction:

CNS: headache, fatigue, insomnia.
Digestive system: stomach cramps, nausea and vomiting.
Allergic reaction: describes a few cases of skin reactions and manifestations of the respiratory system.
Urinary system: when used in high doses - hyperoxaluria and the formation of kidney stones of calcium
oxalate.
Local reactions: with intravaginal application - a burning or itching in the vagina, increased mucous
discharge, redness, swelling of the vulva. Listen Read phonetically.
Other: sensation of heat.
Nursing implication:
Used with caution in patients with hyperoxaluria, renal impairment, a history of instructions on
urolithiasis. Because ascorbic acid increases iron absorption, its use in high doses can be dangerous in
patients with hemochromatosis, thalassemia, polycythemia, leukemia, and sideroblastic anemia.
Patients with high content body iron should apply ascorbic acid in minimal doses.
Used with caution in patients with deficiency of glucose-6-phosphate dehydrogenase.
The use of ascorbic acid in high doses can cause exacerbation of sickle cell anemia.
Data on the diabetogenic action of ascorbic acid are contradictory. However, prolonged use of ascorbic
acid should periodically monitor your blood glucose levels.
It is believed that the use of ascorbic acid in patients with rapidly proliferating and widely disseminated
tumors may worsen during the process. It should therefore be used with caution in ascorbic acid in
patients with advanced cancer.
Absorption of ascorbic acid decreased while use of fresh fruit or vegetable juices, alkaline drinking.
34 | P a g e
DRUG STUDY NO.10
Brand Name: Tiki- Tiki

Classification: Multivitamins
Dosage:
Pediatric patients 1 to 8 years old 17,500 to 35,000 Units daily for 10 days.
Indication:
Tiki Tiki Star (Vitamin A) injection is effective for the treatment of Tiki Tiki Star (Vitamin A) deficiency.
The parenteral administration is indicated when the oral administration is not feasible as in anorexia,
nausea, vomiting, pre- and postoperative conditions, or it is not available as in the “Malabsorption
Syndrome” with accompanying steatorrhea. Pediatric Use: Tiki Tiki Star (Vitamin A) treatment for
deficiency states has been recognized as an especially effective and important therapy in the pediatric
population.
Contraindication:
Increased sensitivity to ascorbic acid.
Mechanism of Action
For systemic use of Tiki Tiki Star (Vitamin C) Kimia Farma: prevention and treatment of hypo- and
avitaminosis of vitamin C; providing increased need for Tiki Tiki Star (Vitamin C) during growth,
pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe illness; in
winter with an increased risk of infectious diseases. For intravaginal use: chronic or recurrent vaginitis
(bacterial vaginosis, nonspecific vaginitis) caused by the anaerobic flora (due to changes in pH of the
vagina) in order to normalize disturbed vaginal microflora.
Adverse Drug Interaction

CNS: headache, fatigue, insomnia. Digestive system: stomach cramps, nausea and vomiting. Allergic
reaction: describes a few cases of skin reactions and manifestations of the respiratory system. Urinary
system: when used in high doses - hyperoxaluria and the formation of kidney stones of calcium oxalate.
Local reactions: with intravaginal application - a burning or itching in the vagina, increased mucous
discharge, redness, swelling of the vulva. Other: sensation of heat.
Nursing Implication
Tiki Tiki Star (Vitamin C) is used with caution in patients with hyperoxaluria, renal impairment, a history
of instructions on urolithiasis. Because ascorbic acid increases iron absorption, its use in high doses can
be dangerous in patients with hemochromatosis, thalassemia, polycythemia, leukemia, and sideroblastic
anemia. Patients with high content body iron should apply ascorbic acid in minimal doses. Tiki Tiki Star
(Vitamin C) is used with caution in patients with deficiency of glucose-6-phosphate dehydrogenase. The
use of ascorbic acid in high doses can cause exacerbation of sickle cell anemia. Data on the diabetogenic
action of ascorbic acid are contradictory. However, prolonged use of ascorbic acid should periodically
monitor your blood glucose levels. It is believed that the use of ascorbic acid in patients with rapidly
proliferating and widely disseminated tumors may worsen during the process. It should therefore be used
with caution in ascorbic acid in patients with advanced cancer. Absorption of ascorbic acid decreased
while use of fresh fruit or vegetable juices, alkaline drinking.
35 | P a g e
NURSING CARE PLAN #1
ASSESSMENT:
Subjective Cues: “ma’am an ako bata sige magkalibang, basa raba ija tae ma’am”
Objective Cues:
o Frequency- 4x stool a day (noted)
o Consistency- watery with particles (noted)
o Presence of borborygmic sound
o Stool is green in color
NURSING DIAGNOSIS
Diarrhea related to bacterial infection as evidenced by frequent watery stools.
PLANNING
Within 8 hours of rendering nursing interventions patient’s stool will be formed.
NURSING INTERVENTIONS
Implementation Rationale
Independent These assessment findings are commonly
connected with diarrhea. If gastroenteritis involves
1. Assess for abdominal pain, abdominal the large intestine, the colon is not able to absorb
cramping, hyperactive bowel sounds, water and the client’s stool is very watery.
frequency, urgency, and loose stools.
2. Ask the client about a recent history of: Eating contaminated foods or drinking
 Drinking contaminated water. contaminated water may predispose the client to
 Eating food inadequately cooked. intestinal infection.
 Ingestion of unpasteurized dairy
products.
These food items can irritate the lining of
3. Encourage the client to restrict the intake the stomach, hence may worsen diarrhea.
of caffeine, milk and dairy products.
When a client experience diarrhea,

the stomach contents which is high
4. Encourage the client to eat foods rich in potassium get flushed out of the gastrointestinal
in potassium. tract into the stool and out of the body, resulting
in hypokalemia.
Hands that are contaminated may easily spread the

5. Teach the client about the importance bacteria to utensils and surfaces used in food
of hand washing after each bowel preparation hence hand washing after each bowel
movement and before preparing food for movement is the most efficient way to prevent the
others. transmission of infection to others.
6. Educate the client about perianal care The anal area should be gently clean properly after
after each bowel movement. a bowel movement to prevent skin irritation and
36 | P a g e
transmission of microorganism.
Collaborative:
Contributes to the recovery of the intestinal
microbial flora
7. Administer antidiarrheal medications
(Erceflora) as prescribed by the
physician
Evaluation:
Goal partially met, patient’s stool is semi-formed.
37 | P a g e
ASSESSMENT:
Subjective: “nag-sige man kalibanga an ako bata, ma’am” as verbalized by the S.O.
Objective:
 Dry mucus membrane
 Sunken eyeball
 Body malaise
 Poor skin turgor
 Elevated body temp: 38.4oC
NURSING DIAGNOSIS:
Deficient Fluid Volume related to active fluid loss as evidenced by diarrhea.
PLANNING
Within 8 hrs. of rendering nursing intervention patient will exhibit increase of fluid intake.
NURSING INTERVENTIONS:
Independent
1. Assess skin turgor and oral mucous Signs of dehydration are also detected through the
membranes for signs of dehydration. skin. Skin of elderly patient’s losses elasticity,
hence skin turgor should be assessed over the
sternum or on the inner thighs. Longitudinal
furrows may be noted along the tongue.
2. Monitor and document temperature. Febrile states decrease body fluids by perspiration
and increased respiration. This is known as
insensible water loss.
3. Monitor fluid status in relation to dietary Most fluid comes into the body through drinking,
intake. water in food, and water formed by oxidation of
foods. Verifying if the patient is on a fluid
restraint is necessary.
4. Urge the patient to drink prescribed Oral fluid replacement is indicated for mild fluid
amount of fluid. deficit and is a cost-effective method for
replacement treatment. Being creative in selecting
fluid sources (e.g., flavored gelatin, frozen juice
bars, sports drink) can facilitate fluid replacement.
Oral hydrating solutions (e.g., Rehydrate) can be
considered as needed.
5. Provide comfortable environment by Drop situations where patient can experience
covering patient with light sheets. overheating to prevent further fluid loss.
6. Teach family members how to monitor An accurate measure of fluid intake and output is
output in the home. Instruct them to an important indicator of patient’s fluid status.
monitor both intake and output.
7. Identify an emergency plan, including Some complications of deficient fluid volume
when to ask for help. cannot be reversed in the home and are life-
threatening. Patients progressing toward
hypovolemic shock will need emergency care.
38 | P a g e
8. Provide measures to prevent excessive Fluid losses from diarrhea should be
electrolyte loss (e.g., resting the GI tract, concomitantly treated with antidiarrheal
administering antipyretics as ordered by medications, as prescribed. Antipyretics can
the physician). decrease fever and fluid losses from diaphoresis.
Collaborative
9. Administer parenteral fluids as Fluids are necessary to maintain hydration status.
prescribed. Consider the need for an IV Determination of the type and amount of fluid to
fluid challenge with immediate infusion be replaced and infusion rates will vary depending
of fluids for patients with abnormal vital on clinical status.
signs.
10. Monitor laboratory results as indicated: Depending on the avenue of fluid loss, differing
Hb/Hct, electrolytes, total electrolyte/metabolic imbalances may be
protein/albumin, BUN/Cr. present/require correction.
EVALUATION:
Goal Met, patient exhibits increase of fluid intake.
39 | P a g e
NURSING CARE PLAN # 3
ASSESSMENT:
Subjective cue:
“Gihilantan sija maam tas Grabe nija kapaso.” as verbalized by the S.O
Objective cue:
o Body Temperature: 38.3 (noted)
o Skin Warm to Touch (noted)
o Irritability (noted)
o Loss of appetite (noted)
o Dry buccal membrane
o The skin turgor is poor
o Appears to be lethargic.
NURSING DIAGNOSIS:
Hyperthermia related to Dehydration
PLANNING
Within 8 hours of rendering nursing intervention, client Body temperature will decrease from 38.3 0C C to
370C.
NURSING INTERVENTIONS
INTERVENTION RATIONALE
Independent
1. Monitor client temperature. To know the abnormalities of the patient

temperature.
2. Monitor Environmental temperature, Room temperature /number of blankets should be

limit/ add bed linens as indicated. altered to maintain near-normal body temperature.
3. Provide cooling blanket as indicated. It helps to reduce fever
4. Provide Tepid Sponge baths. Avoid use of May help reduce fever. Note. Use of ice water
Ice water. may cause chill, elevating temperature.
Dependent
5. Administer antipyretics (paracetamol) as Used to reduce fever by its central action on the
needed by the physician hypothalamus; fever should be controlled in
clients who are neutropenic or asplenic. However,
fever may be beneficial in limiting growth of
organism and enhancing auto destruction of
infected cells.
EVALUATION:
Goal not Met, Client Body temperature 37.9 oC.
40 | P a g e
ASSESSMENT:
Subjective:
“Permi naghilak ako bata ma’am, og gunitan nija permi ija tiyan.” as verbalized by the client
Objective:
 Crying (noted)
 Body malaise (noted)
 Apparent of guarding behavior
 Notice of facial grimace
 Irritability (noted)
 Appears to be restless
NURSING DIAGNOSIS
Acute pain related to prolonged diarrhea as evidenced by apparent abdominal pain.
PLANNING
Within 8 hours of rendering nursing interventions, the patient will display relief of pain.
NURSING INTERVENTION:
INDEPENDENT
1. Note nonverbal cues; e.g., restlessness, Body language/nonverbal cues may be both
reluctance to move, abdominal guarding, physiologic and psychologic and may be used in
withdrawal, and depression. Investigate conjunction with verbal cues to determine
discrepancies between verbal and extent/severity of the problem.
nonverbal cues.
2. Review factors that aggravate or alleviate May pinpoint precipitating or aggravating
pain factors such as stressful events, food
intolerance) or identity developing
complications.
3. Provide comfort measures (e.g., back rub, Promotes relaxation, refocuses attention, and
reposition) and diversional activities. may enhance coping abilities.
4. Provide rest periods to promote relief, One’s experiences of pain may become
sleep, and relaxation. exaggerated because of exhaustion. Pain may
result in fatigue, which may result in
exaggerated pain. A peaceful and quiet
environment may facilitate rest.
5. Get rid of additional stressors or sources Patients may experience an exaggeration in pain
of discomfort whenever possible. or a decreased ability to tolerate painful stimuli
if environmental, intrapersonal, or intrapsychic
factors are further stressing them.
COLLABORATIVE:
6. Implement prescribed dietary Complete bowel rest can reduce pain, cramping.
modifications; e.g., commence with
liquids and increase to solid as tolerated.
EVALUATION:
Goal met, patient displays relief of pain.
41 | P a g e
ASSESSMENT:
Subjective:”naa siyay puya’puya nga nanubo sa bilahan ma’am” as verblized by the s.o.
Objective:
 Destruction of skin layer (noted)
 Rashes. (noted)
 Redness in inguinal area (noted)
 Dry skin (noted)
NURSING DIAGNOSIS:
Impaired skin integrity related to temperature extremes as evidenced by frequent use of diaper.
PLANNING:
Within 8hrs of rendering nursing intervention patient’s/S.O. will demonstrates understanding of plan to
heal tissue and prevent injury.
NURSING INTERVENTION
Intervention Rationale
Independent
1. Monitor status of skin around wound. Individualize plan is necessary according to
Monitor patient’s skin care practices, patient’s skin condition, needs, and preferences.
noting type of soap or other cleansing
agents used, temperature of water, and
frequency of skin cleansing.
2. Monitor patient’s continence status and This is to prevent exposure to chemicals in urine
minimize exposure of skin impairment site and stool that can strip or erode the skin.
and other areas to moisture from
incontinence, perspiration, or wound
drainage.
3. Tell patient to avoid rubbing and Rubbing and scratching can cause further injury
scratching. Provide gloves or clip the nails and delay healing.
if necessary.
4. Encourage a diet that meets nutritional A high-protein, high-calorie diet may be needed
needs. to promote healing.
5. Teach skin and wound assessment and Early assessment and intervention help prevent
ways to monitor for signs and symptoms of the development of serious problems.
infection, complications, and healing.
6. Instruct patient, significant others, and Accurate information increases the patient’s
family in proper care of the wound ability to manage therapy independently and
including hand washing, wound cleansing, reduce risk for infection.
dressing changes, and application of topical
medications).
Collaborative:
7. Administer antibiotics as ordered. Wound infections may be managed well and
more efficiently with topical agents, although
intravenous antibiotics may be indicated.
EVALUATION:
Goal Met, patient’s/S.O. demonstrates understanding of plan to heal tissue and prevent injury.
42 | P a g e
ASSESSEMENT:
SUBJECTIVE:
“Maam sugod to nag kasakit sija ya na sija gana mukaon“ as verbalized by S.O.
OBJECTIVE:
 Noticeable weight loss with adequate food intake
 Food intake less than recommended daily allowance (noted)
 Presence of borborygmic sound
NURSING DIAGNOSIS:
Imbalanced Nutrition: less than body requirements related to decrease intake and inability of body to
absorb fluids
PLANNING:
Within 8hrs rendering nursing interventions patient will show good appetite as evidenced by she eats the
food give to her.
IMPLICATIONS RATIONALE
Independent
1. Plan diet with client, suggesting foods Including client in planning gives a sense of
from home if appropriate. Provide small, control of environment and may enhance intake.
frequent meals/snacks of nutritionally Fulfilling cravings for no institutional food may
dense foods and nonacidic foods and also improve intake. Note: In this population,
beverages, with choice of foods palatable foods with a higher fat content may be
to client. Encourage high- recommended as tolerated to enhance taste and
calorie/nutritious foods, some of which oral intake.
may be considered appetite stimulants.
Note time of day when appetite is best,
and try to serve larger meal at that time.
2. Serve foods that are easy to swallow; e.g., Pain in the mouth or fear of irritating oral lesions
eggs, porridge, cooked vegetables. may cause client to be reluctant to eat. These
measures may be helpful in increasing food
intake.
3. Schedule medications between meals (if Gastric fullness diminishes appetite and food
tolerated) and limit fluid intake with intake.
meals, unless fluid has a nutritional value.
4. Encourage as much physical activity as May improve appetite and general feelings o
possible. well-being
5. Provide rest period before meals. Avoid Minimize fatigue; increases energy available for
stressful procedures close to mealtime. work and eating.
6. Encourage patient to sit up for meals Facilitates swallowing and reduces risk for
aspiration.
Collaborative
 Consult a dietician/nutritional team as  To implement interdisciplinary team
indicated: management.
EVALUATION:
Goal met patient shows good appetite as evidenced by she eats the food give to her.
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ASSESSMENT:
Subjective: “Ma’am nagluja man ako bata sugod nasakit sija” as veralized by the S.O.
Objective:
 Lack of energy
 Decreased performance
 Disinterest in surroundings
 Lethargic or sluggish
 Inability to recover and restore energy, even after sleep
 Result of Hemoglobin on CBC is 9.5 g/dL
Nursing Diagnosis
Fatigue related to Anemia
Planning
Within 8 hours of rendering nursing intervention, patient shows improve sense of energy
Nursing Intervention
Independent
1. Restrict environmental stimuli, especially Vivid lighting, noise, visitors, numerous
during planned times for rest and sleep. distractions, and litter in the patient’s physical
surroundings can limit relaxation, disturb rest or
sleep, and contribute to fatigue.
2. Aid the patient with developing a A plan that balances periods of activity with
schedule for daily activity and rest. periods of rest can aid the patient complete
Emphasize the importance of frequent rest preferred activities without contributing to levels
periods. of fatigue.
3. Promote sufficient nutritional intake. The patient will need properly balanced intake of
fats, carbohydrates, proteins, vitamins, and
minerals to provide energy resources.
4. Encourage verbalization of feelings about Acknowledgement that living with fatigue is both
the impact of fatigue. physically and emotionally challenging helps in
coping.
5. Set practical activity goals with patient. This offers a sense of control and feelings of
achievement.
6. Stay away from topics that annoy or Increased irritability of the CNS can make the
disturb patient. Converse ways to react to patient become easily excited, agitated, and prone
these feelings. to emotional outburst.
7. Educate the patient and family about task Organization and management of time can assist
organization methods and time the patient save energy and avoid fatigue.
organization methods.
8. Aid the patient develop habits to promote Promoting relaxation before sleep and providing
effective rest/sleep patterns. for several hours of uninterrupted sleep can
contribute to energy restoration.
EVALUATION:
Goal met, patient shows improve sense of energy
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ASSESSMENT
Subjective
“kuan lagi ni maam ameoba ug uti” as verbalized by the S.O.
Objective:
 Lack of source of information, (noted)
 Prominent of inaccurate follow-through of instruction
NURSING DIAGNOSIS:
Knowledge deficit related to unfamiliarity with information resources as evidenced by verbalizes
misconceptions or inaccurate information.
PLANNING:
Within 8 hours of rendering nursing interventions significant others will verbalize understanding of
causes of gastroenteritis, mode of transmission, and management of symptoms.
Implications Rationale
1. Assess clients/S.O. knowledge of Clients/ S.O. who experience diarrhea and
gastroenteritis, its mode of transmission, vomiting may not correlate the symptoms with an
and its treatment. acquired intestinal infection. The client may not
realize the risk for transmitting the infection to
others.
2. Assess the client’s/S.O. knowledge on safe The client may not understand the relationship of
food preparation and storage. gastroenteritis to the consumption of inadequately
cooked food, food contaminated with bacteria
during preparation, and foods that are not
maintained at appropriate temperatures.
3. Determine the client’s/S.O. usual methods An effective teaching plan will include methods of
of managing diarrhea or vomiting. symptoms management that the client has found
helpful in the past.
4. Educate the mother about the causes of and Knowledge about the possible cause of this
treatments for gastroenteritis. episode of gastroenteritis will help the client
initiate to prevent future episodes. The client needs
to recognize that the use of antibiotics is
controversial in managing diarrhea. The client
needs to understand the importance of fluid
replacement.
5. Educate the mother about the importance of Good hand washing will prevent the spread of
hand washing after toileting and perianal infectious agents.
hygiene and before preparing food for
others.
6. Educate the mother about food preparation Ground meats are the most common source of
and storage methods to reduce foodborne pathogens. These meats should be
contamination by microorganisms. cooked to an internal temperature of 160°F and
should have no evidence of pink color. Raw meats
should be kept separate from other ready-to-eat
foods. All utensils and surfaces that have been in
45 | P a g e
contact with the raw meat need to be washed with
hot, soapy water. Raw fruits and vegetables must
be washed before eating if they will not be cooked.
Only pasteurized milk, fruit juices, and ciders
should be consumed. Bacteria contamination or
growth is more likely to occur in foods that are not
maintained at appropriate temperatures until eaten.
EVALUATION:
GOALL MET, the mother verbalizes understanding of causes of gastroenteritis, mode of transmission,
and management of symptoms as evidenced by she does all intervention I instructed
46 | P a g e
DISCHARGE PLAN
Name of Patient: Patient R

Date of Discharge: October 19, 2017
MEDICATION:
Instruct the patient to take all the prescribed medication at the proper time and dosage for the
specific duration as the doctor has ordered.
Medication Dosage Recommendations

Metronidazole 4ml Take the medication after meals for 7days
Zinc Sulfate 5 ml Take the medication once a day
Cefexime 2.5 ml Take the medication twice a day for 5 days
Ceelin 2 ml Take the medication once a day
Tiki- Tiki 2ml Take the medication once a day
ENVIRONMENT
 Walking exercise is the most basic and best exercise for the children to help get fresh air and to
maintain body regularly.
 Instruct patients significant others to have a well-ventilated room and polluted free environment.
 Instruct the significant others to maintain safety measures at home.
TREATMENT
 Increase oral fluid intake to helps prevent dehydration.
 Instruct the patient to continue his medication for the entire length of prescribed period.
 Encouraged patient to have adequate sleep and relaxation.
HEALTH TEACHINGS
 Explain the dehydration to the significant others.

 Instruct the significant others to avoid food rich in oily, fatty, and gas forming foods.
 Instruct the significant others about the proper tepid sponge bath.
 Encouraged patient to have enough rest and sleep.
OUT PATIENT (FOLLOW UP CHECK-UP)

 Instruct the significant others to go at Rural Health Unit for check-up.
 Remind the significant others to report any unusual experiences related to her health.
47 | P a g e
DIET
 Diet as tolerated
 Increase oral fluid intake; To prevent the dehydration.
 Advised the significant others to do not let the patient drink juices and coffee, to prevent
abdominal pain.
 Advised the significant others fed their baby with a nutritious food and high in fiber (banana,
corn, potato, cereals, avocado, carrots).
 Avoid fatty and oily foods.
 Instruct the significant others to feed their baby regularly and properly.
SPIRITUAL
 Encourage the patient and the significant others to have faith in God and always ask guidance for
the improvement of her health
 Advice patient to give thanks to God’s grace even in the time of difficulties
 Encourage patient to think positively and always believed in God
 Encourage patient and her family to attend mass every Sunday and ask God’s protection,
blessings and especially good health and thank the creator for such
48 | P a g e
GENOGRAM
Legend:
49 | P a g e
Hospital : Caraga Regional Hospital
Ward : Pedia-Gastro
Date of Assessment : October 19, 2017
Vital Signs Assessment:

Time: 8:00 a.m.
Temperature 37.30C
Heart Rate 127 bpm
Respiratory Rate 34 cpm
Type of IV PLR
Recommendations 500ml; 42gtts/min
IVF level 250ml
Time: 12:00pm
Temperature 38.40C
Heart Rate 130 bpm
Respiratory Rate 34 cpm
CFAC
Color Yellow
Frequency 4x
Amount 1cup
Consistency Watery with particles
50 | P a g e
DEFINITION OF TERMS:
 Borborygmic Sound- Pertaining to the audible bowel sounds that are a normal part of the
digestive process the borborygmic noise which can be heard is caused by the movements of
air and fluid through the intestines
 Electrolyte- The minerals in your body that have an electric charge.
 Hyperthermia- The term fever describes a body temperature that is higher than normal
 Hypotension- Low blood pressure, can stem from many causes.
 Hypovolemic Shock- Refers to a medical or surgical condition in which rapid fluid loss
results in multiple organ failure
 Immunocompromised - Having an impaired immune system.
 Isotonic – Loss of water and salt.
 Pathogens - Infectious agent is a biological agent that causes disease or illness to its host.
The term is most often used for agents that disrupt the normal physiology of a multicellular
animal or plant.
 Peristalsis- Involuntary movements of the longitudinal and circular muscles, primarily in the
digestive tract but occasionally in other hollow tubes of the body, that occur in progressive
wavelike contractions. Peristaltic waves occur in the esophagus, stomach, and intestines.
51 | P a g e
REFERENCES:
Book References
 Black J, & Hawks J 2004, Medical-Surgical Nursing 7th Edition, Elsevier, Missouri
 Doenges, M, Moorhouse M, & Murr A 2006, Nursing Care Plans 7th edition, F.A. Davis Comp.,
Pennsylvania
 Hockenberry M, & Wilson D 2011, Wong’s Nursing Care of Infants and Children 9th edition,
Mosby Inc. Missouri
 Ignatavicious D, & Workaman L 2005, Medical Surgical Nursing 5th edition, Elsevier, Missouri
 Linton, A 2016, Introduction to Medical-Surgical Nursing 6th edition, Elsevier, Missouri
 Marieb, E 2008, Essentials of Human Anatomy and Physiology 9th edition, Pearson, Philippines
Electronic References
https://www.philhealth.gov.ph/circulars/2016/circ2016-001.pdf
https://nurseslabs.com/gastroenteritis-nursing-care-plans/
http://www.who.int/mediacentre/factsheets/fs330/en/
http://www.doh.gov.ph/notifiable_diseases
52 | P a g e

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INTRODUCTION

Clinical Manifestations of Acute diarrhea

1. Isotonic – loss of water and salt.

Manifestations Isotonic Hypotonic Hypertonic

Key measures to treat diarrhea include the following:

Hospital: : Caraga regional Hospital

History Present Illness

Past Health History

Family Health History

Personal Health History

Before her hospitalization,

During her hospitalization,

Activities of Daily Living

Recreation and Hobbies

Coping Stress- Tolerance Pattern

Patterns of Health Care

Head, Eyes, Ears, Nose, Throat (HEENT)

Eyes and Vision

Ears and Hearing

Nose and Sinuses

Thorax and Lungs

Cranial Nerves Types Function Methods/ Result

I Olfactory Sensory Smell Able to identify different

II Optic Sensory Vision and Vision Able to ask object by pointing

III Oculomotor Motor Extraocular eye Pupil is constricted upon

Cochlear Branch Sensory Hearing Able to hear properly

IX Glossopharyngeal Motor and Swallowing ability Able to swallow properly

X Vagus Motor and Sensation of pharynx Patient voice is clear.

XII Hypoglossal Motor Protrusion of tongue; The patient can protrude

 Oriented to date, time, and place.

FACULTY RESPONSE SCORE

 HEAD, EYES, EARS, NOSE, THROAT (HEENT)

 THORAX AND LUNGS

EXAM NAME Conventional Unit SI Unit

Result Date: October 15, 2017

Normal values Rationale

OVA parasites No OVA or Parasite Seen

Result Date: 10/15/2017

Test Result Reference Unit Rationale

HGB 9.5 12.0-16.0 g/dL Anemic

HCT 28.8 35.0-49.0 % Iron, Vitamin B12, or Folate

MCHC 32.9 31.0-37.0 g/dL

RDW-CV 16.1 11.0-16.0 %

RDW-SD 41.8 35.0-56.0 fL

PLT 280 150-400 10^g/L

MPV 8.7 6.5-12.0 fL

DDW 15.6 15.017.0

PCT 0.243 0.108-0.282 %

Digestive System (Essentials of Human Anatomy and Physiology 2008)

Accessory Digestive Organs

Predisposing Factor Precipitating Factors

Ingested of Contaminated food and water

Pathogens invades GI tract

Stimulation & Destruction of

Stimulation of mucosal lining of intestine

Increase of Peristaltic Movement

Inhibition of Sodium Reabsorption

Increased Protein in the lumen

Fluid & Electrolyte Imbalance

Behavior: Sunken Absence of Dry Skin

Hypovolemic Shock Hypotension

------- Clinical Manifestation