Documente Academic
Documente Profesional
Documente Cultură
Dedication i
Acknowledgement ii
Introduction 5-6
Treatments/ Medications 34
Past Illness/Hospitalization 34
Allergies 34
Developmental History 34
Elimination Pattern 35
Sleep-Rest Pattern 36
Sensory-Perceptual Pattern 37
Cognitive Pattern 37
1
Self-Perception-Self-Concept Pattern 38
Health History 38
Past History 39
Physical Examination 40
Skin 40
Eyes 41
Neck 42
Anterior Chest 42
Breasts (Male) 43
Heart 43
Abdomen 43
2
Genitalia (Male) 43
Review of System 47
General Survey 47
Integumentary System 47
EENT 47
Gastrointestinal System 48
Musculoskeletal System 48
Neurologic System 48
Urinary System 48
Reproductive System 48
Hematologic 49
Endocrine 49
Psychiatric 49
Laboratory Results 50
Hematology 50-51
Urinalysis 54
Pathophysiology 71-74
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Drug Study 75-84
Appendices 100
CFAC 103
Genogram 104
References 105
4
INTRODUCTION
According to World Health Organization 2005( A manual for Physicians and other
Senior Health Workers by Ellis D. Avner, MD page 40-41 Chapter 3 Vol. 1 15th edition). Acute
diarrhea or gastroenteritis is the passage of loose stools more frequently than what is normal for
that individual. This increased frequency is often associated with stools that are watery or
semisolid, abdominal cramps and bloating. Acute watery diarrhea is an extremely common
problem, and can be fatal due to severe dehydration, in both adults and children, especially in the
very young and the old or in those who have poor immunity such as individuals with HIV
infection or patients who are using certain medications that suppress the immune system.
Gastroenteritis means inflammation of the stomach and small and large intestines. Viral
both. It is often called the "stomach flu," although it is not caused by the influenza viruses.
Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Each
organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of
the large intestine, may also be present. 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. Persons can reduce their chance of getting infected by frequent
hand washing, prompt disinfection of contaminated surfaces with household chlorine bleach-
5
If food or water is thought to be contaminated, it should be avoided. Since most cases
of acute watery diarrhea are infectious, especially in developing countries, the majority of such
illnesses can be prevented by drinking water or eating foods that are not contaminated with
infectious agents. Washing hands frequently with non-contaminated water, when caring for a
patient with diarrhea as also always before eating is important. Proper storage of food and water
is also important to prevent harmful bacteria from contaminating them. Other symptoms include
nausea, vomiting, loss of appetite, belching, and bloating. Occasionally, acute abdominal pain
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.
P. Y. a one year old and eight months child residing in Barangay Rizal, Surigao City,
Surigao del Norte was admitted at Surigao Medical Center last January 24, 2019 at exactly 8:54
am with chief complain of loss bowel movement and vomiting for further management. Patient
The second year students chose the case of Patient P. Y to gain more knowledge and
experience in the field of nursing to establish holistic approach to the S.O and to the patient
promoting for optimal health of the patient’s condition. Enhance critical thinking and skills that
can be useful in the future as to provide appropriate nursing care to our clients. Also this output
will be useful for future purposes related to the case ACUTE GASTROENTERITIS with
Moderate Dehydration.
6
REVIEW OF RELATED LITERATURE
outbreaks in Health Care Settings by Kurt B. Stevenson, MD page 55-58 Chapter 22 volume 1
gastrointestinal tract—the stomach and small intestine. Symptoms may include diarrhea,
vomiting and abdominal pain, lack of energy and dehydration may also occur. This typically lasts
less than two weeks. It is not related to influenza, though it has been called the "stomach flu".
Gastroenteritis is usually caused by viruses. However, bacteria, parasites and fungus can
also cause gastroenteritis. In children, rotavirus is the most common cause of severe disease. In
typically appear comma- or s-shaped, and are motile) are common causes. Eating improperly
prepared food, drinking contaminated water or close contact with a person who is infected can
spread the disease. Treatment is generally the same with or without a definitive diagnosis, so
Prevention includes hand washing with soap, drinking clean water, proper disposal of
human waste and breastfeeding babies instead of using formula. The rotavirus is recommended
as a prevention for children. Treatment involves getting enough fluids. For mild or moderate
cases, this can typically be achieved by drinking oral rehydration solution(a combination of
water, salts and sugar).In those who are breastfed, continued breastfeeding is recommended. For
more severe cases, intravenous fluids may be needed. Antibiotics are recommended for young
children with a fever, diarrhea, vomiting and abdominal pain. Vectors such as cockroaches, flies,
7
In 2015, there were two billion cases of gastroenteritis, resulting in 1.3 million deaths
globally. Children and those in the developing world are affected the most. In 2011, there were
about 1.7 billion cases, resulting in about 700,000 deaths of children under the age of five. In the
developing world, children less than two years of age frequently get six or more infections a
Gastroenteritis may also be a symptom of another infection such as influenza, when the
infecting bacteria may spread to the bowel via the bloodstream. When vomiting and diarrhea
accompany flu symptoms, this is often referred to as “gastric flu”. Gastroenteritis in babies is
most common in bottlefed babies and is usually the result of poor sterilization of feeding
equipment
First, stop all foods and milk and give your child only water in small amounts every 15
minutes. Next, put your child to bed with a bowl by the bed in case he vomits. Lastly, make sure
he washes his hands after going to the toilet to prevent the spread of the infection.( Baby and
Child Health Care by Dr. Miriam Stoppard page 140 volume 1 3rd edition)
gastroenteritis. It could spread with close interaction with infected people, contaminated food,
contaminated water, the sharing of eating utensils, poor hygiene habits, the elderly living in
nursing homes, students living in student halls and even children in nurseries and preschools all
may be at higher risk of developing viral gastroenteritis due to the close proximity in which they
breathe and interact. This virus is truly responsible for the infection and could easily spread
8
through the air or through close contact. Bacterial Gastroenteritis is uncommon and generally
very serious in nature. The infection in bacterial gastroenteritis could spread through poor
hygiene habits, contact with infected people, the sharing of eating utensils, contaminated water
and contaminated food. The reason behind parasitic infections could spread through a contact
with infected human or animal wastes, drinking of contaminated water and ingestion of raw
seafood. Eosinophilic Gastroenteritis is also quite less common. Both adults and young
children could be affected with it. The signs of this gastroenteritis are inclusion of other organs in
the body aside from the gastrointestinal tract, lack of known cause for eosinophilia, and pain in
Cryptosporidium. The reason behind Cryptosporidiosis could be the parasites taken in by mouth
through infected water and food, or from individual to individual or animal to individual. This
disease is mild, but can seriously affect the individuals with weak immune system. Major sources
of cryptosporidiosis could be contaminated water supplies, public swimming pools and child
care centers.
Gastroenteritis usually involves both diarrhea and vomiting. Sometimes, only one or the
other is present .This may be accompanied by abdominal cramps. Signs and symptoms usually
begin 12–72hours after contracting the infectious agent. If due to a virus, the condition usually
resolves within one week. Some viral infections also involve fever, fatigue, headache and muscle
pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial.
Some bacterial infections cause severe abdominal pain and may persist for several weeks.
9
Risk Factors
Close interaction with infected people, Contaminated food, Contaminated water, The
sharing of eating utensils, Poor hygiene habits, the Elderly living in nursing homes, students
living in student halls and even children in nurseries and preschools, contact with infected human
or animal wastes, drinking of contaminated water and ingestion of raw seafood all may be at
higher risk. (The 5-Minute Pediatric Consult by Pramod Kerkar,MD,FFARCSI page 60-64
Complications
Dehydration is an abnormal condition in which the body's cells are deprived of an adequate
amount of water. Dehydration can be the result of conditions that cause the body to lose too
much water, such as excessive heat, sweating, illness, low humidity, medication side effects, and
high elevation, such as in the mountains. Dehydration can also be the result of not drinking
enough water and fluids. Dehydration can be mild, moderate or severe and life-threatening.
Infants, children, athletes and the elderly are particularly prone to dehydration and severe
complications, although dehydration can occur in any age group or population. In an otherwise
healthy person, dehydration can be prevented by drinking about eight eight ounce glasses of
water per day. Shock is a severe condition from reduced blood circulation. Delirium is a severe
state of mental confusion. Metabolic acidosis is a condition that occurs when the body produces
excessive quantities of acid or when the kidneys are not removing enough acid from the body. If
unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to
increased production of hydrogen ions by the body or the inability of the body to form
bicarbonate(HCO3−) in the kidney. Its causes are diverse, and its consequences can be serious,
10
including coma and death. Together with respiratory acidosis, it is one of the two general causes
bodies over 0.5mM, with low and stable levels of insulin and blood glucose. It is almost always
generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood
throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are
depleted (or from metabolizing medium-chain triglycerides. Ketones can also be consumed in
exogenous ketone foods and supplements. Renal failure - is a serious medical condition
affecting the kidneys. When a person suffers from this condition, their kidneys are not
functioning properly or no longer work at all. Renal failure can be a progressive disease or a
Prognosis:
dehydration and difficult rehydration may be an issue in children, old people and those that are
these cases. Prognosis worsens significantly with the inability to compensate for fluid loss
gastroenteritis with high mortality, Nicaragua, 2005. Rev Panam Salud Publica. 2008; 23(4):277-
284.)
11
Prevention:
There are some actions people can do to prevent or reduce the chance of getting
gastroenteritis including wash hands thoroughly, do not eat undercooked foods especially meats,
do not eat or drink raw foods, boil untreated water, do not drink untreated or unpasteurized
fluids, especially milk, thoroughly wash any produce (e.g. fruits, vegetables) before eating, drink
only well-sealed bottled or carbonated water, avoid ice cubes, because they may be made from
contaminated water, use bottled water to brush your teeth, avoid raw food including peeled
fruits, raw vegetables and salads (which has been touched by human hands), and avoid
undercooked meat and fish. (Gastroenteritis Care by Hal B. Jenson, MD page 20 Chapter 1
Diagnosis of AGE is based on the patient's medical history and clinical examination.
Additional diagnostic measures are rarely required but may be carried out in more severe cases
to assess water and electrolyte imbalances. Also, if diarrhea persists for more than four days,
stool samples may be obtained for further analysis as to the cause of the disease. (Chhabra P,
https://www.symptoma.com/en/info/acute-gastroenteritis)
Stool Exam - A stool analysis is a series of tests done on a stool (feces) sample to help diagnose
certain conditions affecting the digestive tract. These conditions can include infection (such as
For a stool analysis, a stool sample is collected in a clean container and then sent to the
12
microbiologic tests. The stool will be checked for color, consistency, amount, shape, odor, and
the presence of mucus. The stool may be examined for hidden (occult) blood, fat, meat fibers,
bile, white blood cells, and sugars called reducing substances. The pH of the stool also may be
measured. A stool culture is done to find out if bacteria may be causing an infection (Bacterial
Infection of the Gastrointestinal tract by Wolters Kluwer Health/Lippincott Williams & Wilkins,
Culture - Cultures can be performed either with fecal or rectal biopsy specimens or with liver
abscess aspirates. Culture has a success rate of 50-70%, but it is technically difficult. Overall,
Xenic cultivation, first introduced in 1925, is defined as the growth of the parasite in the
presence of an undefined flora. This technique is still in use today, using modified Locke-egg
media. Axenic cultivation, first achieved in 1961, involves growing the parasite in the absence of
any other metabolizing cells. Only a few strains of E dispar have been reported to be viable in
axenic cultures.
Medication/Treatment
prescribed by a physician. You probably will be treated with three antibiotics if your infection
the recovery of the intestinal microbial flora altered during the course of microbial disorders of
diverse origin, produces various vitamins, particularly group B vitamins thus contributing to
correction of vitamin disorders caused by antibiotics & chemotherapeutic agents, and promotes
13
normalization of intestinal flora. Acute diarrhea with duration of ≤14 days due to infection, drugs
or poisons.
Chronic or persistent diarrhea with duration of >14 days. Cefexime is a third general
cephalosporin that inhibits cell wall synthesis, promoting osmotic instability usual bactericidal.
vomiting when nasogastric suctioning is undesirable. Ranitidine is for treatment and prevention
of heartburn, acid indigestion, and sour stomach and prophylaxis of GI hemorrhage from stress
ulceration. Children should be given rehydration solutions through oral route such as Rehydrate,
Pedialyte, Resol, and Rice-Lyte. Fruit juice, tea, cola and sports drinks may not be able to replace
fluid or electrolytes lost from vomiting or diarrhea correctly nor will the plain water. Intestines
irritated due to gastroenteritis do not even absorb plain water quite well, also that fact that plain
water will not aid in replacing electrolytes. Following each loose stool, children less than two
years of age should be given one to three ounces of rehydration solution. Older children should
drink as much as three to eight ounces of rehydration solution and adults as much as possible. In
regions where pediatric drinks are not available, a common homemade recipe for rehydration is
being used where two tablespoons of sugar mixed with a quarter teaspoon of table salt and
quarter teaspoon of baking soda or table salt is mixed in 1 liter of clean or already boiled water.
After 24 hours, bland diet should be started with BRAT diet i.e., bananas, rice, applesauce
without sugar, toast, pasta, or potatoes. For adults, initial intake of ice chips and clear, nondairy,
noncaffeinated liquids such as fruit juices, ginger ale, Gatorade, and Kool-Aid or other
commercial drink mixes. A soft bland diet such as the BRAT diet may be started after successful
14
24 hours of fluid diet without vomiting. Medical Treatment: If the patient is not able to take
fluids by mouth because of vomiting, an IV may be inserted to restore fluids back into the body
be required for severe symptoms. Antibiotics are generally not given until a specific bacteria has
been identified as using wrong antibiotics can worsen some of the infections or prolong their life.
Drinking fluids may help to avoid dehydration and relieve the symptoms. Fluid replacement
helps in correcting electrolyte imbalance, which in turn may aid to stop vomiting.
Prevalence:
Rotavirus in children under the age of 5 causes about 110 million cases of gastroenteritis
worldwide every year and nearly half a million deaths. Another significant viral agent which
causes gastroenteritis is adenovirus. Of these, about 82% deaths occur in the world's poorest
countries.
The incidence in the developed countries is about 1 to 2.5 cases per child per year and this has
been a major cause for hospitalization. The most important factors are age, hygiene, living
conditions and cultural habits. Most cases of gastroenteritis occur during summer in the tropics
Prevention by Madeleine Stuart, 2014 page 250 Chapter 8 volume 1 4th edition)
Epidemiology
Acute gastroenteritis diarrhea or vomiting (or both) of more than seven days duration
may be accompanied by abdominal pain , LBM and vomiting . Diarrhea is the passage of
excessively liquid or frequent stools with increased water content. Patterns of stooling vary
widely in young children, and diarrhea represents a change from the norm. Worldwide, 3-5
15
billion cases of acute gastroenteritis and nearly 2 million deaths occur each year in children
under 5 years. In the United States, gastroenteritis accounts for about 10% (220,000) of
admissions to hospital, more than 1.5 million outpatient visits, and around 300 deaths in children
under 5 annually. In the same age group in Australia, about 10, 000 hospital admissions, 22, 000
visits to emergency departments, and 115 000 general practice consultations occur annually for
rotavirus alone. In the United Kingdom, 204 of 1000 consultations with general practitioners in
children under 5 are for gastroenteritis, and the annual hospital admission rate in this group is
about seven per 1000 children. Children in childcare settings are often infected but asymptomatic
Children with poor nutrition are at increased risk of complications. In the north end of Australia,
Aboriginal and Torres Strait Islander children have increased rates of admission for
and a longer hospital stay than their non-indigenous counterparts. The cost of gastroenteritis to
the community is huge but often underestimated if costs to the family, including lost time at
work, are not considered. (Ham EB, Nathan R, Davidson GP, Moore DJ et al Bowel Habits of
Healthy Australian children aged 0-2 years. J Paediatr Child Health 1996; 32:504-7
https://emedicine.medscape.com/article/964131-overview)
Etiology
The two basic types of acute infectious diarrhea are noninflammatory and inflammatory.
invade the intestine directly or produce cytotoxins. Some enteropathogens possess more than one
16
virulence property. Acute diarrhea or diarrhea of short duration may be associated with any of the
recognized bacterial, viral, or parasitic causes of enteritis. Chronic or persistent diarrhea lasting
14 days or more may be due to (1) an infectious agent such as Giardia lamblia, Cryptosporidium
parvum, and enteroaggregative or enteropathogenic Escherichia coli; (2) any enteropathogen that
infects an immunocompromised host; or (3) residual symptoms due to damage to the intestine by
an enteropathogen after an acute infection. There also are many noninfectious cases of diarrhea
and specific enteropathogens may be associated with either clinical form. Generally,
diarrhea may be caused by enteropathogenic E.coli, enterotoxigenic E.coli, Vibrio cholera, and
several of the pathogens associated with inflammatory diarrhea. Viral enteropathogens the main
causes of viral gastroenteritis include rotavirus, enteric adenovirus, astrovirus, Norwalk agent
like virus, and calicivirus. Cytomegalovirus and herpes simplex virus have been associated with
diarrhea and other gastrointestinal tract signs and symptoms, generally in immunocompromised
hosts. Parasitic enteropathogens G. lamblia is the most common parasitic pathogens include
17
Enterocytozoon bieneusi, and Encephalitozoon intestinalis. (Atlas of Infectious Diseases by
Abstract
cause of morbidity and mortality. In fact, there is new shift of numbers of deaths from 7,000 to
17,000 per year according to WHO (2011). Hence incur great attention from all health sector
should be set to prevent direct consequences. This study assessed the maternal knowledge on
design. The study revealed an alarming result that out of 342 mothers who participated in the
study, 52.33% demonstrated “poor knowledge” and 11.40% only have “very good knowledge”
on gastroenteritis. Moreover, the result of this study suggest that there is a significant
relationship between the respondents educational attainment and number of children to their
knowledge on gastroenteritis. Coordinating with DOH and WHO must be set for intensifying
their programs to be more effective in increasing mothers’ knowledge and home care
management on gastroenteritis. Hence, will lessen the number of mortality and morbidity rates of
18
children. Furthermore, extension services focusing on health education regarding prevention and
Introduction
gastrointestinal tract commonly caused by viral pathogens and less frequently by bacterial or
parasitic organisms. Until a study that examined data on the deaths attributed to gastroenteritis,
the disease was considered to be relatively benign (in most developed countries), but deaths have
more than doubled since 1999 through 2007 . In fact, there is new shift of numbers of deaths
from 7000 to 17,000 per year . Despite the fact that gastroenteritis can be prevented, the disease
still affects children, predominantly under the age of five who are not yet capable of managing
their own health. Annually about two billion cases of diarrheal diseases occur among children
under the age of five globally. Though often considered a benign disease, gastroenteritis
represents a major cause of pediatric morbidity and mortality worldwide. Every year about 1.5
million children die from diarrheal diseases, mostly in developing countries. In fact, according to
WHO survey, Gastroenteritis is the second cause of mortality worldwide comprising 18% out of
73% of the 10.6 million yearly deaths in children. In the Philippines, Gastroenteritis continues to
be an important cause of illness and death, having consistently ranked fourth- and second-leading
cause of death for all age groups and for children, respectively. At present time, it is the third
leading cause of regional morbidity in region 8 according to the 2009 Philippine Health
Statistics. While in Samar Provincial Hospital, Gastroenteritis remains to be the number one
reason for children’s admission for 3 consecutive years. In just a span of 19 months (May-
19
November, 2015), Emergency Room records 2,378 cases already of gastroenteritis with signs of
dehydration. Although the burden of gastroenteritis among children under the age of five is
heavy, improved prevention is achievable. Personal and food hygiene, including the use of clean
water sources, are key measures to prevent transmission of these diseases. Breastfeeding,
especially under 6 months of age, also effectively protects infants, and Rotavirus vaccination has
been widely available for children since 2006 and is now recommended
encouraged by the UNICEF, DOH, and WHO. However, Studies show that though most of the
mothers were familiar with the term oral rehydration salt (ORS), there were knowledge gaps as
regards its correct preparation and administration. While improved medical treatment combined
with the programs of DOH to prevent and manage Gastroenteritis at home, many of these
children continuously die endlessly. Many of these children were never seen at a health facility
because services don’t exist, because their families lack access to these services or mothers do
not recognize the warning signs of this life threatening complication like dehydration. Reflecting
on this record, the researchers were then motivated to undertake a study on the existence of such
a record. Saving the lives of millions of children at risk of death from gastroenteritis is possible
with a comprehensive strategy that ensures all children in need to receive critical prevention and
Research Objective
This investigation assessed the maternal knowledge on gastroenteritis and home care
20
Methodology
A Descriptive research design was adopted for this investigation. This design was used
Participants
in Catbalogan City, Philippines. A total of 342 mothers consented to fully participate in the
investigation.
Instrumentation
described the profile of mother respondents. Part II of the questionnaire were questions based on
causes, signs and symptom, prevention and transmission modes. Part III assessed the knowledge
of the respondents about the Home Care Management for Gastroenteritis, Part IV were questions
to gastroenteritis while the last part of the questionnaire were questions about Oral Rehydration
Solution. Part II- IV has possible responses of “yes” and “no”. ‘Yes’ is given a value of 1 point,
and ‘no’ with 0 points; the maximum possible score is 15. The higher the score, the greater the
21
questionnaire was validated for its reliability resulting in statistical value of 0.89 (Cronbach’s
alpha). Meanwhile, The last part of the questionnaire utilized a filtering question in assessing the
Ethical Considerations
The study protocol was approved and reviewed by the Health Ethics Committee of Samar
State University, Philippines. The investigators made sure that the respondents included are
willing to fully participate the study by signing the consent. Furthermore, Confidentiality and
anonymity of the respondents were maintained by only a code number on the questionnaire.
Data Analysis
The data collected were coded and entered into a computerized data base and was
analyzed using the Statistical Package of the Social Science Program (SPPS, version 19).
Descriptive statistics such as the, frequency, percentage, and standard deviation was used to
quantify the profile of the patients. To test for the significance of the coefficient of correlation
between a set of paired variables, Fisher’s T-test and Pearson r were used.
22
Results
As shown in the table, majority of the mother respondents are within the age bracket of
38-45 year old or 74 (21.63%) and Married 147 (42.98), but it is worth noting that 134 mothers
or 39.18% are still single. Findings also suggest that majority of the respondents 130 (38.01%)
23
were not able to reach high school level. When it comes to monthly income, 51.4% of the
mothers are earning less than 5,000 php only and most of them 70(18.4%) have more than 5
children.
24
Table 2 presents the mother respondents answers on the questions about the causes, signs
and symptoms, prevention, and mode of transmission of gastroenteritis. It can be seen in the
table that majority of the participants (n= 203, 59.4%) do not know that viral pathogens can also
cause gastroenteritis but majority of them (n=234, 68.4%) got the correct answer that bacteria or
agreed that diarrhea (26.9%), abdominal pain and cramping (60.2%), and vomiting (57.6%) are
manifestations, majority of the mothers are not knowledgeable of the 5 signs and symptoms.
Moreover, 243 (71.1%) of the mothers agreed that proper hand washing techniques after
defecation and before handling food, and cleanliness and sanitation as well as proper handling,
preparation and storage techniques (n=217 (63.5%) are measures to prevent gastroenteritis. On
the other hand, they need to be corrected that obtaining vaccinations and not to eat food
containing raw eggs and refraining from buying cans or boxes that are damaged can also help in
preventing such medical condition. Finally, it is disturbing that majority of these mothers (n=185,
54.1%) are unaware that gastroenteritis can be transmitted through Fecal-Oral route.
Table 3 Illustrates the distressing result of this study, that majority of the mothers (n=148
05 43.27%) got answers within the score range of 0-5 which is interpreted to have “poor
25
knowledge” on gastroenteritis. This is followed by mothers with “fair knowledge” (n=117 or
34.21%), while only 47 respondents or 13.74% were considered to have “very good knowledge
on gastroenteritis”.
It can be gleaned in the table the information obtained from the respondents regarding their
knowledge on home care management of gastroenteritis. As reflected on the table, most of the
respondents are aware that ORS is one of the management of gastroenteritis at home (n=201,
58.8%) and to increase fluid intake (n=211, 61.69%). However, more than half of the
respondents are not aware that increasing banana (54.1%) and vegetable intake (54.1%), giving
zinc (60.2%), and vitamin A (62.86%) every 6 months are home care management of
gastroenteritis.
26
dehydration
Restless and irritable Yes 124(36.26) 218(37.43)
is a manifestation of
dehydration
Drinks eagerly or Yes 122(35.67) 220(64.33)
thirsty is a
manifestation of
dehydration
Table 5 presents the cumulative scores of the respondents on the question about the
manifestation garnered the highest number of mothers who got the correct answer. While, most
of the mothers did not know that poor skin turgor (n=200, 58.5%), restless and irritable (n=218,
37.43%) and drinks eagerly or thirsty (n=220, 64.33%) are manifestations of dehydration.
Table VI Respondents who have heard about Oral Rehydration Solution (ORS)
Table 5 shows the number of respondents who have heard about oral rehydration
solution. Out of 342 respondents 201 or 58.8% have heard about oral rehydration solution.
Table VII Respondents’ answer on the correct ingredients of Oral Rehydrating Solution
27
Table 8 illustrates the respondents’ answer on the correct ingredients of oral rehydrating
solution. Out of 201 respondents who claimed that they have heard oral rehydrating solution,
only 88 mothers or (43.78%) got the correct answer. Majority of the respondents (n=100,
49.75%) answered the option letter B which is water and salt only.
Discussions
This study highlights the result that mothers from marginalized communities have “poor
knowledge” on gastroenteritis. This result is consistent to the findings of Bachrach & Gardner on
their study in Nepal that mothers demonstrated limited knowledge on gastroenteritis . Though
most of them are aware that bacteria and other parasitic organisms can cause gastroenteritis,
educating them that viral pathogens can also cause gastroenteritis is necessary. In fact, Rotavirus
is the leading cause of severe gastroenteritis in children and it can also infect adults who are
exposed to children with the virus. Meanwhile, aside from diarrhea, abdominal pain and
cramping, and vomiting, it is vital that mothers should be aware of other manifestations of
gastroenteritis such as fever, nausea, weight loss, distention and hyperactive bowel signs. The
researchers believe that if only the mothers are aware of these manifestations, early management
will then be taken, thus, lessen the chances of increasing the mortality rate of children.
children that will be affected by gastroenteritis. The findings of this study may prove that the
programs of World Health organization and Department of Health have been effective in
increasing awareness that proper hand washing techniques after defecation and before handling
food, and cleanliness and sanitation as well as proper handling, preparation, and storage
techniques are important measures to prevent gastroenteritis. However, these mothers should be
28
aware that presently, available vaccines are already existing to prevent children from acquiring
such condition. This vaccine is called the “rotavirus vaccine”. There are two brands of the
rotavirus vaccine, the Rota Teq (RV5) and Rotarix (RV1). Both vaccines are given orally, not as a
shot. The only difference is the number of doses that need to be given. In addition, not to eat
food containing raw eggs and to refrain from buying cans or boxes or jars that are damaged is
also an important measure to the prevention. Lastly, it is very alarming that these mothers do not
know that gastroenteritis can be transmitted through Fecal-Oral-Route. This result suggests that
Mothers and other caregivers play a critical role in the effective management of gastroenteritis
by correctly recognizing its manifestations, and taking appropriate action. The result of this study
depicts that mothers are aware that ORS and increasing the fluid intake are appropriate actions
for managing gastroenteritis at home. These two home care management are helpful in flushing
the toxins and in replacing the fluid and electrolyte lost. On the other hand, mothers should be
adequately educated that increasing banana which contain little fiber but are high in potassium,
an electrolyte that helps with mineral and fluid balance in the body. Furthermore, increasing
vegetable intake, giving of zinc and vitamin A every 6 months can also help in managing this
illness. Caregivers or mothers are the ones who decide if a child's episode of gastroenteritis
warrants a visit to a health facility or if they can manage the episode themselves at home. In this
study, is worrisome that majority of the mothers cannot recognize the signs of dehydration.
When adequately educated, caregivers can start fluid replacement early in the course of a child's
stressed out by health educators to all caregivers and mothers. The findings of this study is quite
confusing that although most mothers had heard of ORS, the vast majority of them did not get
29
the correct ingredients of ORS. Also of concern was that majority of the mothers who claimed to
have heard ORS reported giving their children a mixture of table salt and water, presumably
intending to substitute for oral rehydration salts. This substitution is dangerous because it can
lead to hypernatremic dehydration. There has been much debate about the relative merits of
teaching caregivers to make sugar-salt solution for ORT versus using prepackaged ORS.
Conclusion
It could be inferred from this investigation that the level of knowledge on gastroenteritis,
home care management, and manifestations of dehydration among the study population is
“poor”. The finding also concludes that mothers do not know the correct ingredients and
proportion of ORS that should be given. Therefore, the researchers suggest that the World Health
Organization and Department of Health should strengthen their programs on the proper
Acknowledgement
Investigator would like to express gratitude to all individuals who contributed to the
forecasting and directing of this study. Special thanks to all the mothers who participated in this
study.
Conflict of Interest
30
General Approach to Children with Acute Diarrhea
involvement may include diarrhea, abdominal cramps, and vomiting. Systemic manifestations
are varied and associated with a variety of causes. Extraintestinal infections related to bacterial
enteric pathogens include vulvo vaginitis, urinary tract infection, endocarditis, osteomyelitis,
meningitis, pneumonia, hepatitis, peritonitis, chorioamnionitis, soft tissue infection, and septic
thrombophlebitis. The main objectives in the approach to a child with acute diarrhea are to (1)
assess the degree of dehydration and provide fluid and electrolyte replacement, (2) prevent
spread of enteropathogen, and (3) in select episodes determine the etiologic agent and provide
specific therapy if indicated. (Pediatric Gastrointestinal Disease by Joann L, Ater, MD page 4000
31
NURSING HEALTH HISTORY
Biographic Data:
Sex : Male
DEL NORTE
Occupation : NONE
Height : 79cm
Weight : 10kg
Admission Data:
32
Vital Signs upon admission
33
CLIENT HEALTH HISTORY
Client Profile
Patient Y is a 1 year and 8 months old boy, catholic, Filipino child, born on May
6, 2017. An only child and currently living with his family at Barangay Rizal, Surigao
City, Surigao del Norte,. Major reason for seeking health care is due to vomiting and loss
Treatments/Medications:
Past Illness/Hospitalization
Allergies
DEVELOPMENTAL HISTORY
A developmental task is a task which arises at or about a certain period in the life of an
individual. Havighurst has identified six major age periods: infancy and early childhood
(0-5 years), middle childhood (6-12 years), adolescence (13-18years), early adulthood
(19-29 years), middle adulthood (30-60 years), and later maturity (61+).
Basing on Havighurst’s Theory, our patient belongs in the infancy and early childhood
stage(Autonomy vs. Shame and Doubt according to Erik Erikson's stages of psychosocial
conscience.
34
NUTRITONAL METABOLIC PATTERN
Before hospitalization: The client eats four times a day including breakfast, lunch,
merienda and dinner. According to the significant other, he always eats rice and soup. He
can drink 4 glasses of water in a day. He has no eating discomforts. Develops 8 teeth .
During Hospitalization: The client seldom eats at the hospital. He does not have appetite
ELIMINATION PATTERN
Before Hospitalization:
Bowel habits: The client defecates everyday and his stool is soft, formed and its color is
Bladder habits: He urinates 5-6 times per day and is yellowish in color. Doesn’t have
urinating.
During Hospitalization:
Bowel habits: The client defecates 4 times a day. His stool is watery and yellowish in
color.
35
ACTIVITY EXERCISE PATTERN
television with his father. In early afternoon eats lunch together with his family. Takes
nap in the afternoon. During evening he would have dinner with his family at 6:30 pm.
Hygiene: showers and washes hair everyday in assistance with his mother or father
During Hospitalization: Arises at 6am in the morning. The client seldom eats at the
hospital. He does not have appetite for eating. He does not takes nap in the afternoon.
SEXUALITY-REPRODUCTION PATTERN
Before and during Hospitalization: The client can identify the difference of external
SLEEP-REST PATTERN
Before Hospitalization: The client sleeps about 10 hours a day. From 8pm to 6am. He
has no problem falling asleep and does not take sleep medications. His sleep is always
continuous especially when he is tired. He takes a nap during afternoon. From 12:30pm
to 3pm.
36
During Hospitalization: The client still sleeps 10 hours a day. Continuous. He only
wakes up when his medications are due. He has no problem falling asleep and does not
SENSORY-PERCEPTUAL PATTERN
Smell: Doesn’t have difficulty with smell, pain, postnasal drip, sneezing and nosebleed
COGNITIVE PATTERN
Before Hospitalization: The client does not have difficulty in hearing and has no hearing
aid. According to the significant others, If ever the client get sick, they immediately go
During Hospitalization: The client takes the prescribed medications for recovery.
ROLE-RELATIONSHIP PATTERN
Before Hospitalization: The client lives with his mother and father. His mother and
father is taking care of him and supportive . His parents loves him
During Hospitalization: The family of the patient especially his parents are supportive
37
SELF-PERCEPTION-SELF-CONCEPT PATTERN
Before and during Hospitalization: The mother said that her son is a happy child and
likes playing toys and watching television with his father . He likes to hold utensil while
eating sometimes using hands while eating. He enjoys showers and washes his hair with
COPING-STRESS TOLERANCE
The mother said that her son experiencing adjustment because it was a first time admitted
on the hospital. He copes up with his stress through playing toys and watching television.
VALUE-BELIEF PATTERN
A Roman Catholic child and attended mass every sunday with his family.
HEALTH HISTORY
Prior to admission, the client was vomiting and defecating. His stool was color yellow 4
times defecating and the amount is medium and it was watery . At first, they go to the
Barangay Rizal Health Center and the midwife gave them medication. According to the
midwife, the medication is for LBM, but after taking the medication, the client was still
defecating and vomiting so the family decided to rush the client at Surigao Medical
38
B. Past History
No past history. He had completed all vaccinations including BCG, DPT, Oral Polio
Vaccine, MMR and Hepatitis B vaccine. The patient had never been any of the childhood
disease such as measles, mumps and chicken pox. The patient had no history of accident
39
PHYSICAL EXAMINATION
Properly groomed. Lying comfortably on bed conscious, with sunken eyeballs, appears
fatigue, thin and has dry skin. With an ongoing IVF of D5 IMB 500cc @ 30gtt/min hooked at
right cephalic vein infusing well . Ht: 2’7’’ Wt: 22lbs, Apical pulse: 135, Resp: 35, Temp: 37
Alert and awake with eyes open and looking at examiner; client responds appropriately
Skin
Skin is brown, warm and dry to touch. Poor skin turgor noted. No edema. No scalp
lesions or flaking.
V, pt. identifies light touch and sharp touch to forehead, cheek and chin. Bilateral corneal reflex
40
intact. Masseter muscles contract equally and bilaterally. Function of CN VII pt. smiles, frowns,
Eyes
Eyeballs are sunken. Eyebrows sparse with equal distribution. No scaliness. Lids brown,
without edema, nor lesions. Sclera without increased vascularity nor lesions. Palpebral and
bulbar conjunctiva pale without lesions. Irises uniformly black. Pupils are round and react to
Auricle without deformity, lumps nor lesions. Auricles and mastoid processes non-tender.
Auricle aligned with outer canthus of eye about 10 degree from vertical. Pinna recoils after it is
folded.
Whisper test: Client identifies words clearly. Nose is symmetrical and straight upon palpation.
Nares patent. No tenderness, masses, and displacement of bone cartilages. No redness, swelling,
Lips are pale and dry to touch, cracked lips. Develops 8 teeth and no teeth anomalies
41
Neck
Neck symmetrical without masses and scars. Lymph nodes are non-palpable. Trachea is
Arms are equal in size and symmetry bilaterally; brown; cool and dry to touch without
edema. No lesions and bruising on hands. Three flexion creases present in palm. Fingernails are
Posterior lateral diameter is 1:2 ratio. Respiration rate is 30 cpm. Symmetrical expansion
on posterior thorax.
Anterior Chest
Chest symmetry is equal. Anterior lateral diameter is 1:2 ratio. Shape and position of
sternum is level with ribs. Position of trachea is in midline. No pain nor tenderness in the anterior
42
Breasts (Male)
Skin is the same color as the abdomen/back. No swelling, ulcerations, or nodules noted.
Heart
Apical pulse rate is 130 bpm. No gallops nor murmurs, nor rubs.
Abdomen
Vomits 2 times(projectile) and visceral pain in the umbilical region . Abdomen is uniform
in color upon inspection. No rashes or lesions. No evidence of enlargement of liver and spleen
upon inspection and palpation. Navel is protruding. Hyperactive sounds were heard due to GI
Legs has no abrasion and wound. Skin intact, brown, warm and dry to touch without
edema. Lymph nodes are non-palpable. No edema palpated. Toenails are finely cut, clean and
clear. No clubbing.
Genitalia (Male)
No bulging or masses in inguinal area. No discharge. No pubic hair. Not yet circumcised
43
Musculoskeletal and Neurologic examination
Muscle strength 4/5. No edema noted at both lower extremities. Active resistive range of
motion against some resistance noted. No deviations, inflammations, nor bony deformities.
Moves upper and lower extremities freely against gravity and against resistance. Patient is
conscious; responses in calling the client’s name. Can recall his name. .
The Glasgow Coma Scale (GCS) is scored between 3 and 15, with 3 being the worst and 15 the
best
Obeys command:15
Sensory status: Superficial light- and deep-touch sensation intact on arms, legs, neck, chest, and
44
Cranial Nerve Assessment
each nostril
each pupil
close symmetrically.
in a moderate manner.
both eyes.
45
tone.
46
REVIEW OF SYSTEMS
General Survey
The usual weight of the client is 10.5kg upon hospitalization, the patient’s weight
decreased to 10kg. Sunken eyeballs, appears fatigue, thin and dry skin noted upon assessment.
Integumentary System
Patient has no history of edema, skin allergies, burns, No history of scalp lesions or flaking,
Eyes: Patient has no history of conjunctivitis, visual problems, edema, lesions, scaliness, sore
Ears: Patient has no history of ear infection, draining ears, lumps or lesions. No discharged
Nose: Patient has no history of Nasal Bleeding (epistaxis), nasal stuffiness. No nasal discharge
( Rhinorrhea ), laryngitis
47
Throat: Patient has no history in swelling on uvula, tonsillitis, sore throats bleeding gums
( Gingival Hemorrhage )
Gastrointestinal System
Patient has no history of Nausea, diarrhea, constipation. No history of bright red stools
Musculoskeletal System
Neurologic System
Patient has no history of memory loss, seizure, dizziness, sensation changes such as numbness
and coldness.
Urinary Systems
Patient has no history of any urinary tract infection. No pain in urination. No discharge.
No history of bulging or masses in inguinal area. No discharge. No pubic hair. Not yet
circumcised.
48
Hematologic or Lymphatic
Patient has no history of lymph node enlargement. No history of easy bleeding or bruising.
Endocrine
Psychiatric
49
LABORATORY RESULTS
HEMATOLOGY
VALUES
CELL
COUNT
CELLS
ANALYSIS:
infection
50
HEMATOLOGY
VALUES
CELL
COUNT
BLOOD
CELLS
ANALYSIS:
51
BLOOD CHEMISTRY
VALUES
CALCIUM
Analysis
The result shows decreased sodium counts of 132.4, for the amount of fluid contains is less or
the sodium in the body may be diluted because often the body retains more fluid than sodium,
which means the sodium is diluted. The patient is having diarrhea that causes its potassium level
decreased to 3.35 lost in the digestive tract. Iodized calcium decreased to 0.98 because of
abnormal level in the blood protein malabsorption of calcium, vitamin d, phosphorous and
magnesium deficiency.
52
BLOOD CHEMISTRY
VALUES
CALCIUM
Analysis:
53
URINALYSIS
VALUES
GRAVITY
Analysis
54
STOOL EXAM
Analysis:
Watery with no blood streak is abnormal associated with diarrhea caused by certain intestinal
55
STOOL EXAM
BLOOD STREAK
Analysis:
56
Anatomy and Physiology
The human digestive system is a complex series of organs and glands that processes food. In
order to use the food we eat, our body has to break the food down into smaller molecules that it
can process; it also has to excrete waste. Most of the digestive organs (like the stomach and
intestines) are tube-like and contain the food as it makes its way through the body.
The digestive system is essentially a long, twisting tube that runs from the mouth to the anus,
plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.
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The Normal Digestive Process:
The start of the process - the mouth: The digestive process begins in the mouth. Food is partly
broken down by the process of chewing and by the chemical action of salivary enzymes (these
enzymes are produced by the salivary glands and break down starches into smaller
molecules).
The esophagus - After being chewed and swallowed, the food enters the esophagus. The
esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like
muscle movements (called peristalsis) to force food from the throat into the stomach. This
muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a
very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with
In the small intestine - After being in the stomach, food enters the duodenum, the first part of
the small intestine. It then enters the jejunum and then the ileum (the final part of the small
intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),
pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small
In the large intestine - After passing through the small intestine, food passes into the large
intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are
removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus,
Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part
of the large intestine is called the cecum (the appendix is connected to the cecum). Food then
58
travels upward in the ascending colon. The food travels across the abdomen in the transverse
colon, goes back down the other side of the body in the descending colon, and then through the
sigmoid colon.
The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.
Anus - the opening at the end of the digestive system from which feces (waste) exits the body.
Ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted
Cecum - the first part of the large intestine; the appendix is connected to the cecum.
Chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes
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Descending colon - the part of the large intestine that run downwards after the transverse colon
Duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the
jejunum.
Epiglottis - the flap at the back of the tongue that keeps chewed food from going down the
windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you breathe,
the epiglottis opens so that air can go in and out of the windpipe.
Esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle
movements (called peristalsis) to force food from the throat into the stomach.
Gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a
digestive chemical which is produced in the liver) into the small intestine.
Ileum - the last part of the small intestine before the large intestine begins.
Jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and
the ileum.
Liver - a large organ located above and in front of the stomach. It filters toxins from the blood,
and makes bile (which breaks down fats) and some blood proteins.
Mouth - the first part of the digestive system, where food enters the body. Chewing and salivary
enzymes in the mouth are the beginning of the digestive process (breaking down the food).
Pancreas - an enzyme-producing gland located below the stomach and above the intestines.
Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small
intestine.
60
Peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into
the stomach. Peristalsis is involuntary – you cannot control it. It is also what allows you to eat
Rectum - the lower part of the large intestine, where feces are stored before they are excreted.
Salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that
Sigmoid colon - the part of the large intestine between the descending colon and the rectum.
Stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and
mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in
Transverse colon - the part of the large intestine that runs horizontally across the abdomen.
PHYSIOLOGY
Transverse colon- is the lengthy, upper part of the large intestine, ingested food exits the small
intestine and enters the cecum. As digestion continues, the ingested matter moves up the
ascending colon and into the transverse colon. The transverse colon performs several critical
functions, including moving waste material forward and the absorption of key components for
Stomach- the stomach will provide a place for varied amounts of swallowed food to rest and
digest in. Hence, the stomach is a storage site. The stomach will also introduce our swallowed
food to essential acids. The cells in the stomach’s lining will excrete a strong acidic mixture of
hydrochloric acid, sodium chloride, and potassium chloride. This gastric acid, or colloquially
61
known as gastric “juice,” will work to break down the bonds within the food particles at the
molecular level. Pepsin enzyme will have the unique role of breaking the strong peptide bonds
that hold the proteins in our food together, further preparing the food for the nutrient absorption
that takes place in the small (mainly) and large intestines. This brings us to the third task the
stomach has, which is to send off the churned watery mixture to the small intestine for further
digestion and absorption. It takes about three hours for this to occur once the food is a liquid mix.
Sigmoid colon- Its major function is to transport the fecal matters to rectum and anus. It
eliminates all the solid waste and forms of gaseous waste down the gastrointestinal tract. All the
body waste finds its way to get stored in the sigmoid colon until it the time when it can come out
Salivary glands- As the only secretion of our salivary glands, it is helpful in creating the food
bolus, or the finely packed ball of food that we roll inside our mouths. This shape facilitates its
safe passage through our alimentary canal. Saliva has lubricating properties that are protective,
as well. Saliva protects the inside of our mouths, our teeth, and our throats as we begin to
swallow the bolus. It also cleanses the mouth after a meal and dissolves food into chemicals that
we perceive as taste.
Rectum- The role of the rectum is to temporarily store feces until defecation.
The food that one consumes is first chewed in the mouth and as a part of the digestion process,
has to pass through the stomach, small intestine, and lastly the large intestine. The undigested
food and waste products that are accumulated during the digestion process, move into the rectum
in the form of fecal matter. It is the function of the rectum to receive this fecal matter and hold it
till one defecates. Thus, the rectum stores fecal matter until defecation, during which the feces
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Peristalsis- Peristalsis is a series of wave-like muscle contractions that moves food to different
processing stations in the digestive tract. The process of peristalsis begins in the esophagus when
a bolus of food is swallowed. The strong wave-like motions of the smooth muscle in the
esophagus carry the food to the stomach, where it is churned into a liquid mixture called chime.
Peristalsis concludes in the large intestine where water from the undigested food material is
absorbed into the bloodstream. Finally, the remaining waste products are excreted from the body
Pancreas- The pancreas serves two primary functions, according to Jordan Knowlton, an
advanced registered nurse practitioner at the University of Florida Health Shands Hospital. It
makes "enzymes to digest proteins, fats, and carbs in the intestines" and produces the hormones
Mouth- in the mouth itself, the tongue and teeth help to get the process started by chewing and
chopping the food so it's small enough to be swallowed. Salivary glands secrete saliva, releasing
an enzyme that changes some starches into simple sugars and softens the food for swallowing.
Liver- The liver regulates most chemical levels in the blood and excretes a product called bile.
Bile helps to break down fats, preparing them for further digestion and absorption. All of the
blood leaving the stomach and intestines passes through the liver. The liver processes this blood
and breaks down, balances, and creates nutrients for the body to use. It also metabolized drugs in
the blood into forms that are easier for the body to use.
Jejunum- responsible for absorbing nutrients from digested food into the bloodstream. The
jejunum is able to absorb these nutrients because it is lined with finger-like projections that are
called villi. The villi absorb nutrients in the form of minerals, electrolytes, and carbohydrates,
proteins, and fats that were consumed in the form of food. The nutrients are absorbed into the
63
bloodstream where they can be utilized for energy by the entire body.The jejunum, as well as the
rest of the small intestine, make it possible to change food into energy, powering the body for
daily activities. Without the small intestine, food would pass through the body but we would gain
Ileum- absorb the nutrients from the chyme, or digested food. This is done with the help of villi,
which are finger-like projections found in the inner wall.There are lymph vessels called lacteals
in the villi which absorbs fat in the lymphatic system. This digested fat is then drained into the
bloodstream, which is transported along with other nutrients, to the liver through the hepatic
portal vein. Detoxification takes place and the nutrients are assimilated by the body.
Gall bladder- serves as a reservoir for bile while it’s not being used for digestion. The
gallbladder's absorbent lining concentrates the stored bile. When food enters the small intestine,
a hormone called cholecystokinin is released, signaling the gallbladder to contract and secrete
bile into the small intestine through the common bile duct.The bile helps the digestive process by
breaking up fats. It also drains waste products from the liver into the duodenum, a part of the
small intestine.
Esophagus- The esophagus is an important connection to the digestive system through the
thoracic cavity, which protects the heart and lungs. The esophagus carries food through this
cavity, keeping it separate and moving it through with muscular contractions. Two sphincters on
either side of the esophagus separate food into small units known as a bolus. The size and
Epiglottis- The main function of the epiglottis is to seal off the windpipe during eating, so that
food is not accidentally inhaled. The epiglottis also helps with some aspects of sound production
in certain languages.
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Duodenum- The duodenum is the first and shortest segment of the small intestine. It receives
partially digested food (known as chyme) from the stomach and plays a vital role in the chemical
digestion of chyme in preparation for absorption in the small intestine. Many chemical secretions
from the pancreas, liver and gallbladder mix with the chyme in the duodenum to facilitate
chemical digestion.
Descending colon - primarily serves to absorb water from fecal matter. It also stores food
particles that are to be emptied into the rectum. While working in a downward movement, this
organ continues to push the digested waste products. The wastes move downwards from the
transverse colon to the sigmoid colon. They ultimately enter the rectum to be expelled during
excretion. While moving the waste material, the descending colon also continues to take out any
Chyme - There are two major functions of chyme – the first is to increase the surface area of
food to allow digestive enzymes to complete their work, and the second is to stimulate various
digestive glands to release their secretions.The action of enzymes requires direct contact with the
molecules of the substrate. When food is first ingested, it is in the form of large chunks. Such
particles have a very low surface area for their volume, and therefore, enzymes will only have
access to a small proportion of the molecules in the substrate. Mastication of food, and the
subsequent churning through the muscles of the stomach and small intestine repeatedly break
Cecum- absorb fluids and salts that remain after completion of intestinal digestion and
absorption and to mix its contents with a lubricating substance, mucus. The internal wall of the
cecum is composed of a thick mucous membrane, through which water and salts are absorbed.
65
Bile- lows into the duodenum and mixes with food contents. Bile has two important functions: It
assists in the digestion and absorption of fats, and it is responsible for the elimination of certain
waste products from the body, particularly hemoglobin from destroyed red blood cells and excess
cholesterol.
Ascending colon- The ascending colon carries feces from the cecum superiorly along the right
side of our abdominal cavity to the transverse colon. In the ascending colon, bacteria digest the
transitory fecal matter in order to release vitamins. The intestinal wall absorbs water, nutrients,
and vitamins from the feces and deposits these materials into our bloodstream.
Appendix- appendix acts as a storehouse for good bacteria, “rebooting” the digestive system
Anus- An aperture for defecation the primary anus function is to serve as an aperture for
defecation. After defecation, the colon and rectum prepare themselves to receive and store the
digestive wastes descending along the alimentary canal .Regulation of excretory process the
internal and external sphincters play a key role in the regulation of excretory process. The
internal involuntary sphincter operates under the command of autonomous nervous system,
voluntary control over feces removal holding feces back for a certain duration is a very important
anus function. Otherwise, you won’t be able to hold the bowels for some time in order to reach
the place of defecation and triggering need for removal of feces sexual arousal.
small intestine- The small intestine is the part of the intestines where 90% of the digestion and
absorption of food occurs, the other 10% taking place in the stomach and large intestine. The
main function of the small intestine is absorption of nutrients and minerals from food.
Digestion involves two distinct parts. The first is mechanical digestion by chewing, grinding,
churning and mixing that takes place in the mouth and the stomach. The second part of digestion
66
is the chemical digestion that uses enzymes, bile acids etc. in order to break down food material
into a form that can then be absorbed, then assimilated into the tissues of the body. Chemical
digestion occurs in the small intestine (and, to a lesser extent, also in some other part of the
gastrointestinal tract.
Large intestine- absorbing water and electrolytes, producing and absorbing vitamins, and
forming and propelling feces toward the rectum for elimination. By the time indigestible
materials have reached the colon, most nutrients and up to 90% of the water has been absorbed
by the small intestine. The role of the ascending colon is to absorb the remaining water and other
key nutrients from the indigestible material, solidifying it to form stool. The descending colon
stores feces that will eventually be emptied into the rectum. The sigmoid colon contracts to
increase the pressure inside the colon, causing the stool to move into the rectum. The rectum
The start of the process - the mouth: The digestive process begins in the mouth. Contaminated
food is partly broken down by the process of chewing and by the chemical action of salivary
enzymes (these enzymes are produced by the salivary glands and break down starches into
smaller
molecules).
On the way to the stomach: the esophagus - After being chewed and swallowed, the
contaminated food enters the esophagus. The esophagus is a long tube that runs from the mouth
to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food
67
from the throat into the stomach. This muscle movement gives us the ability to eat or drink even
In the stomach - Direct invasion and by endotoxin being released by the organism and the
action of the hydrochloric acid of the stomach. As the protective coating of the stomach erodes
the digestive capabilities of the acid helps in destroying the stomach lining
In the small intestine - Stimulation and destruction of mucosal lining of the bowel wall
continues the mucosal lining erodes due to toxin and followed by increasing lymphocytes.
In the large intestine - After passing through the small intestine, food passes into the large
intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are
removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus,
Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. As the bowel
is stimulated by the organism and its toxin, the intestinal tract secretes water and electrolytes in
the intestinal lumen. The body secretes and therefore lost chloride and bicarbonate ions the
bowel as the body try to get rid of the organism by increasing peristalsis and number of
defecation.
The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.
68
Digestive System Glossary:
Anus - the opening at the end of the digestive system from which feces (waste) exits the body.
Ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
Bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted
Cecum - the first part of the large intestine; the appendix is connected to the cecum.
Chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes
Descending colon - the part of the large intestine that run downwards after the transverse colon
Duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the
jejunum.
Epiglottis - the flap at the back of the tongue that keeps chewed food from going down the
windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you breathe,
the epiglottis opens so that air can go in and out of the windpipe.
Esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle
movements (called peristalsis) to force food from the throat into the stomach.
Gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a
digestive chemical which is produced in the liver) into the small intestine.
Ileum - the last part of the small intestine before the large intestine begins.
Jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and
the ileum.
69
Liver - a large organ located above and in front of the stomach. It filters toxins from the blood,
and makes bile (which breaks down fats) and some blood proteins.
Mouth - the first part of the digestive system, where food enters the body. Chewing and salivary
enzymes in the mouth are the beginning of the digestive process (breaking down the food).
Pancreas - an enzyme-producing gland located below the stomach and above the intestines.
Enzymes from the pancreas help in thedigestion of carbohydrates, fats and proteins in the small
intestine.
Peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into
the stomach. Peristalsis is involuntary – you cannot control it. It is also what allows you to eat
Rectum - the lower part of the large intestine, where feces are stored before they are excreted.
Salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that
Sigmoid colon - the part of the large intestine between the descending colon and the rectum.
Stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and
mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in
Transverse colon - the part of the large intestine that runs horizontally across the abdomen.
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PATHOPHYSIOLOGY
Precipitating factors:
Predisposing factors:
Ingestion of contaminated food and drinks
Age: 1 year old & 8 mos.
Unsanitary food handling
Impaired immune system
Poor environmental sanitation
Malnourished
Socioeconomic status
BMI : 10.5kgs
Poor hygiene
Sunken eyes Hyper active-
Dry skin bowel sounds
Dry lips Watery stool
Poor skin turgor
Ingestion of fecally contaminated food and
water
Tergecef
Ranitidine
Metoclopramide
Erceflora
Hydration (IVF D5IMB 500ml)
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If Left Untreated If Left treated
72
LEGEND:
= Disease Process
= Client Manifestation
= Clinical Manifestation
= Treatment/management
= If Left Untreated
= If Left Treated
= Well
= Death
PATHOPHYSIOLOGY:
The predisposing factor of patient P.P are the age, impaired immune system and
malnourished. The precipitating factors are the ingestion of contaminated food and drinks,
unsanitary food handling, poor environmental sanitation and socioeconomic status and poor
hygiene
The pathologic process starts with ingestion of fecally contaminated food and water. The
organisms affects the body through direct invasion and by endotoxin being released by the
organism. Through these two processes the bowel mucosal lining is stimulated and destroyed the
eventually lead to attempted defecation or tenesmus as the body tries to get rid of the foreign
organism in the stomach the client with acute gastroenteritis with mild dehydration may also
report excessive gas formation that may lead to abdominal distention and passing of flatus due to
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digestive and absorptive malfunction in the system . As the destruction of the bowel continues
the mucosal lining erodes due to toxin, direct invasion of the organism and the action of the
hydrochloric acid of the stomach. As the protective coating of the stomach erodes the digestive
capabilities of the acid helps in destroying the stomach lining. Pain or tenderness of the abdomen
is then felt by the patient with a pain scale 4 out of 5 which means it hurts whole lot based from
Wong-Baker FACES. When the burrows or ulceration reaches the blood vessels in the stomach
Feeling of fullness and the increase motility of the gastrointestinal tract may progress to
vomiting. As the bowel is stimulated by the organism and its toxin, the intestinal tract secretes
water and electrolytes in the intestinal lumen. The body secretes and therefore lost chloride and
bicarbonate ions the bowel as the body try to get rid of the organism by increasing peristalsis and
number of defecation. Sodium and water reabsorption in the bowel is inhibited with the lost of
the two electrolytes. Mild diarrhea is characterized by 2-3 stools associated with watery stool and
borborygmi ( hyperactive bowel sounds), fluid and electrolyte imbalance and hypernatremia
associated with sunken eyes, dry skin and lips, and poor skin turgor. Treatment are erceflora and
hydration ( IVF D5IMB 500 ml ). Increase lymphocytes leads to infection treatment is tergecef.
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Drug Study No. 1
Generic name:
Metoclopramide
Brand name:
PLASIL
Dosage:
2mg/ampoule
Route:
IV
Frequency:
q 8hr
Classification
Anti-emetics
Mechanism of action
It blocks dopamine receptors and makes the GI cells more sensitive to acetylcholine, leading to
increased GI activity and rapid movement of food through the upper GI tract.
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Indications
reflux, treatment and prevention of postoperative nausea and vomiting when nasogastric
suctioning is undesirable
Contraindications
Adverse effect
CNS:
dyskinesia
CV:
GI:
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Endo:
Gynecomastia
Nursing Considerations
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Drug Study No. 2
Generic:
Cefixime
Brand:
TERGECEF
Classification:
Cephalosporin
Dosage:
Route:
Oral
Frequency:
2 x a day (BID)
Mechanism of Action:
A third general cephalosporin that inhibits cell wall synthesis, promoting osmotic instability
usual bactericidal
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Indications
Used to treat infections caused by bacteria such as pneumonia, bronchitis, gonorrhea, throat,
pyelonephritis, cystitis, gonococcal urethritis, cholangitis, scarlet fever, otitis media, and
sinusitis. Antibiotics will not work for colds, flu, or other viral infections
Contraindications
Adverse Effect
Nursing Considerations
Obtain urine specimen for culture and sensitivity after first dose. Therapy may begin
pending results.
To prepare oral suspension, add required amount of water to powder into two
portions. Shake well after each addition. After mixing, susp is stable for 14 days. No need
high-risk patients.
Tell patient to take all the medication prescribed, even after he feels better.
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Drug Study No. 3
Generic Name:
Bacillus Clausii
Brand Name:
ERCEFLORA
Dosage
1 vial
Route:
Oral
Frequency:
3 x a day
Classification:
Antidiarrheals
Mechanism of Action
Contributes to the recovery of the intestinal microbial flora altered during the course of
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Produces various vitamins, particularly group B vitamins thus contributing to correction
Indication:
Acute diarrhea with duration of ≤14 days due to infection, drugs or poisons.
Contraindication
Not for use in immune compromised patients (cancer patients on chemotherapy, patients taking
Side/Adverse Effect
Nursing Consideration
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BEFORE:
DURING:
Monitoring allows detection of possible side effects of the drug since there
AFTER:
possible complications
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Drug Study No. 4
Generic:
Ranitidine
Brand:
ZANTAC
Classification:
Anti-ulcer
Dosage:
14mg/ampoule
Route:
IVTT
Frequency:
q 8 hours
Mechanism of Action:
Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells,
resulting in inhibition of gastric acid secretion has some antibacterial action against H. pylori
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Indications
Contraindications
Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be
Nursing Intervention
Assess patient for epigastric or abdominal pain and frank or occult blood in the stool,
Nurse should know that it may cause false-positive results for urine protein; test with
sulfosalicylic acid
Inform patient that increased fluid and fiber intake may minimize constipation
Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness;
Inform patient that medication may temporarily cause stools and tongue to appear gray
black
Instruct patients to monitor for and report occurrence of drug-induced adverse reaction
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NURSING CARE PLAN #1
Assessment
Objective:
Diaphoresis
Diarrhea
Vomiting
Irritable
Nursing Diagnosis: Acute pain related to biological injury agent ( e.g., Infection )
Planning: Within 2 hours of nursing intervention the patient will manifest pain is relieve or
controlled.
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Nursing Intervention Rationale
relieving factors.
Evaluated pain characteristics and intensity Use pain rating scale appropriately for age and
Performed pain assessment each time pain occurs. To demonstrate improvement in status or to
Established collaborative approach for pain To assist client to explore methods for
Acknowledged the pain experience and convey Reduces defensive responses, promotes trust, and
Encouraged adequate rest periods To prevent fatigue that can impair ability to
Identified specific signs/symptoms and changes in Provides opportunity to modify pain management
pain characteristics requiring medical follow-up. regimen and allows for timely intervention for
developing complications.
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DEPENDENT To eliminate the pain
( Ranitidine 14 mg ampule)
Evaluation: Goal met within 2 hours of rendering my nursing intervention the patient
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NURSING CARE PLAN #2
Assessment
Objective:
Planning: After 1 day of thorough nursing intervention, the client will be able to:
for eating
Provide frequent oral and skin care To prevent injury from dryness.
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Changed position frequently. To promote proper circulation of blood, thus,
DEPENDENT
Administered fluids and electrolytes(D5IMB 500 To gradually correct the deficient in fluid
Evaluation: Goals are met after 1 day of thorough nursing intervention, the client was able to
maintain body fluid levels, completely eliminate the occurrence of vomiting, increase serum Na+
level from 132.4 to 135 and improve skin turgor of the patient from poor to fair.
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NURSING CAREPLAN #3
Assessment
Objective:
Lack of energy
Weakness
Planning: Within 4-6 hours of rendering my nursing intervention, the client will be able to
perform ADLs and participate activities at the patient’s level of ability and will report an
INDEPENDENT
response to activity
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Encouraged patient to do whatever possible such To manage patients limit of ability
Instructed methods to conserve energy such as To conserve and maximize patient’s energy
Assessed patient in self-care needs and with To protect client from injury
ambulation as needed
Evaluation:
Goal met within 4-6 of rendering my nursing intervention, the client was able to perform ADLs
and participate in activities at the patient’s level of ability and will report an improved sense of
energy.
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NURSING CARE PLAN #4
Assessment
Vomiting
Diarrhea
Dehyration
Planning: Within 6-8 of rendering my nursing intervention patient will be free of complication
Monitored fluid intake and output chronic kidney failure, trauma and surgery, affect
excretion.
Noted the client’s age and developmental level It includes the very young or the premature infant,
which may increase the risk electrolyte imbalance the elderly, or individuals unable to meet their
92
the clients who are unconscious for an unknown
on.
cc), as ordered.
Evaluation: Goal met within 6-8 hours of rendering my nursing intervention the patient was
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NURSING CARE PLAN #5
Assessment
Subjective: “wala man siya’y gana mukaon tapos kung mukaon kay musuka man dayon” as
verbalized by the SO
Vomiting
Decreased appetite
Nursing Diagnosis: Imbalanced Nutrition: less than body requirements related to inability to
Planning: Within 2 hours of rendering my nursing intervention the patient will be able to: a)
Verbalize food preference which is not contraindicated to his underlying disease to promote good
appetite. b) Improve appetite from poor to fair by eating ½ share from ¼ share and reduce the
occurrence of vomiting.
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Nursing Intervention Rationale
INDEPENDENT
stimulate appetite
vomiting.
Dependent
1. Collaborative
Referred to dietician for modification of diet To gradually stimulate appetite for fast
Evaluation: Goal met within 2 hours of rendering nursing intervention the patient was able to
verbalize food preference which are not contraindicated to hr underlying disease to promote
good appetite. b) Improve appetite from poor to fair by eating ½ share from ¼ share and reduce
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Nursing Care Plan # 6
Assessment
Objective:
Irritable
Fatigue
Itching
Anxiety
Nursing diagnosis: Self-Care Deficit related to in ability to perform activities of daily living
Planing: Within 2 hours of rendering my nursing intervention the patient will be able to perform
Bathed or assessed client in bathing, providing for Type and purpose of bath is determined by
Obtained hygiene supplies for specific activity to To provide visual cues and facilitate completion of
Provided for adequate warmth. elderly, and very thin or debilitated persons are
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Determined that client can perceive water To prevent chilling and burns.
Assessed client in and out of shower or tub as To promote safety of the patient
indicated
Use adaptive clothing as indicated ( e.g., clothing These may be helpful for client with limited arm
with front closure, wide sleeves and pant legs. or leg movement or impaired fine motor skills.
Evaluation: Within 2 hours of rendering my nursing intervention the patient was be able to
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DISCHARGE PLAN
MEDICATIONS:
Instruct the SO of the patient to take all the prescribed medications at the proper time and
Inform the S.O about the possible side effects of the medications.
Inform the S.O about the importance of compliance to prescribed medications and
consequences.
ENVIRONMENT
Wash hands with soap after going to the toilet and before eating or preparing food.
TREATMENT
Treat AGE with moderate dehydration with ERCEFLORA 2 billion/5ml one respule three times
a day and Cefixime ( Tergecef )3 ml 2 times a day for 7 days it kills bacterial infection in
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HEALTH TEACHINGS.
Hygiene
Take care of drinking water - either option for mineral water or water boiled for 20
minutes.
OPD- FOLLOW-UP:
Instruct the SO of the patient together with his son to return to the Attending Physician
DIET
Diet as Tolerated
Light soups, toast, rice and eggs are good foods; eat foods high in fiber and
carbohydrates.
SPIRITUAL
Advise the patient to encourage praying to God as the Family does every day and to
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APPENDICES
IVF CHART
Volume
DAILY WEIGHT
Date Weight
1/24/19 10.2kg
1/25/19 10kg
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Vital Signs
1/24/19 8 am - 135 35 37
12 nn - 130 32 36.5
4 pm - 136 35 36.6
8 pm - 131 36 37
12 am - 134 33 36.5
4 am - 136 37 37
1/25/19 8 am - 132 32 37
12 nn - 130 35 37
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I AND O SHEET
taken
unweight vomitus+1xBM
Diaper
740 450+2xBM+2xVomitus
102
CFAC
(12PM)
(12AM)
(12PM)
103
GENOGRAM
80 y/o 80 y/o
78 y/o HTN
Deceased 70 y/o
Deceased 80 y/o
Deceased
A&W
37 y/o
35 y/o
A&W
A&W
1 yr and 8mos
AGE w/
Moderate
Dehydration
LEGENDS:
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References:
1. World Health Organization 2005( A manual for Physicians and other Senior Health Workers by
Ellis D. Avner, MD page 40-41 Chapter 3 Vol. 1 15th edition)
2. Centers for Disease Control and Prevention or CDC(Gastroenteritis outbreaks in Health Care
Settings by Kurt B. Stevenson, MD page 55-58 Chapter 22 volume 1 7th Edition)
3. Baby and Child Health Care by Dr. Miriam Stoppard page 140 volume 1 3rd edition
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