CHAPTER 1: INTRODUCTION

A. Objectives

• General Objectives

This case study aims to be able to come up with an understanding of the disease process
and formulate a comprehensive nursing care plan using the specific objectives nursing process,
to enhance our knowledge and skills understanding regarding the diagnosis of our client and to
improve our learning about Acute Gastroenteritis that would be helpful in our nursing profession.

•Specific Objectives

o To determine the client’s health status through analyzing Acute Gastroenteritis and its
deviation from the normal physiologic process

o To trace the health history of the client and his family by taking the past and present
health history

o To define and discuss thoroughly the complete diagnosis of the client

o To discuss the anatomy and physiology of the involved system in the disease

o To trace the pathophysiology of the disease process, by presenting the etiology, factors,
signs and symptoms present in the client

o To know the client’s medications; its therapeutic and adverse effects, and its significance
to the disease of the client

o To formulate nursing care plan to provide adequate nursing intervention

B. Background of the Study

Gastroenteritis, acute infectious syndrome of the stomach lining and the intestine. It is
characterized by diarrhea, vomiting, and abdominal cramps. Other symptoms can include nausea,
fever, and chills. The severity of gastroenteritis varies from a sudden but transient attack of
diarrhea to severe dehydration. Numerous viruses, bacteria, and parasites can cause
gastroenteritis. Microorganisms cause gastroenteritis by secreting toxins that stimulate excessive
water and electrolyte loss, thereby causing watery diarrhea, or by directly invading the walls of
the gut, triggering inflammation that upsets the balance between the absorption of nutrients and
the secretion of wastes. (Encyclopedia Britannica 2019)

The Provincial Health Office (PHO) has recorded a 31-percent increase in acute gastroenteritis
cases in the province of pangasinan to 4,282 from January 1 to May 20 this year from 3,260
during the same period last year. PHO’s data showed that children aged one to four years old are
the most common victims of the illness, with 1,460 cases for males, and 1,026 cases for females.
Of the 24 fatalities, five were recorded in Dagupan City; Binmaley with four deaths; the towns of
Manaoag, San Fabian, Mangaldan, and Malasiqui with two deaths each; and one death each in
Sta. Maria, Umingan, Binalonan, Mapandan, Infanta, Aguilar, and San Carlos City. (Philippine
News Agency, 2019)

Purpose of the Study

• Specific

o Cognitive

- To distinguish the early finding of client’s problems or complications and timely initiate
measures or interventions that reduce client’s negative outcome through inspection of system.

- To create a specific idea of care plan that helps in attending the overall health and well-being of
clients without having to rely entirely on a physician’s order or interventions.

- To apply a responsible supervising and managing quality of health care provided to clients.
• Psychomotor

-To ensure the client are well taken care of through nursing skills and to identify nursing
problems and provide the appropriate nursing care plan.

-To provide and document important interventions to the client and significant others to
boost their knowledge and understanding of client’s health condition.

o Affective

- To develop a trusting relationship between the nurse and the client.

-To provide care and compassion to the client that are essential to nursing practice and
healthy client outcome.

Significance of the Study

The results of the study will be a great benefit to the following:

o Patient

- This case study will help the patient’s significant other to understand the importance of
handwashing. Hand washing is the number one defense against such diseases because most of
the harmful microbes can be removed via washing. This will also help the caregiver understand
the causes of the disease, its health risks and what needs to be done during and after the
treatment.

o Family

- This case study will help the family of the patient to understand the importance of family
support to the client and how could they help in the treatment of the patient from the disease.
This will also encourage the family to practice good personal hygiene to prevent from getting
such disease.
o Student

- This case study will guide the students to have more knowledge about the illness, its
causes, risk factors, and nursing practice that needs to be understood to help in the prevention
and treatment that needs to be rendered to a patient suffering from Acute Gastroenteritis.

o Nurses

- This case study will help the nurses to develop workshop to provide parents, students with
information about the importance of health promotion to engage individuals to choose healthy
behaviors and make lifestyle that can reduce the risk of developing illnesses and enhance
health well-being.

Chapter 2: REVIEW OF RELEVANT PATIENT RECORDS AND HISTORY

I. DEMOGRAPHIC DATA

A. Initials of Client’s Name: Mister O.

B. Address: Kundiman St. Sampaloc Maynila

C. Age: 1 year

D. Birth Date: June 24 2018

E. Birth Place: Ospital ng Sampaloc Maynila

F. Gender: Male

G. Civil Status: Single

H. Religion: Catholic

I. Highest Educational Attainment: N/A

J. Occupation: None
K. Monthly Income/ Budget: N/A

L. Date of Admission: January 10, 2020

M. Date of Interview: January 11, 2020

N. Primary Informant: Mother

O. Secondary Informant: Father

P. Other Data Sources: Patient’s Chart

II. REASON FOR SEEKING HEALTH CARE

The client sough for consultation due to persistent watery stools and found out that the stool had
blood tinged in it and the increased temperature.

III. HISTORY OF PRESENT ILLNESS

In January 10, 2020, the patient was just playing when he suddenly cried and called the attention
of his mother and the mother noticed that the patient was having a high fever and when he
checked the diaper, she found out that the patient stool was watery with blood in it. At first, they
just observe the patient and just gave water and see if there are any changes but the patient’s
fever does not go down and still having watery stool. The parents sought for medical assistance
at a local hospital in Sampaloc manila because they noticed that the he could no longer tolerate
it. During his stay in Sampaloc, Therefore, the attending physician request to do lab examination
which are CBC, urinalysis, fecal examination on the patient and the result found out that the
patient has an amoebiasis. The patient was diagnosed with acute gastroenteritis and moderate
dehydration.

In January 10, 2019. The attending pediatrician ordered to admit the patient for proper treatment
regimen.
IV. PAST MEDICAL HISTORY

Patient had no remarkable past medical history according to the mother. He had BCG
vaccination and other immunizations but still does not have his anti-measles vaccine. He had no
allergy or allergic reaction to foods and drugs. He had no previous hospitalization and any other
illnesses in the past.

V. Ortiz-Familial History

A. Genogram
 LEGEND:

FEMALE ALIVE

MALE ALIVE

DECEASED FEMALE

DECEASED MALE

Health Implications:

This here do-familial history shows that the common hereditary diseases that the family may
had inherited is hypertension verbalized according to the patient’s mother. There is no noted
history of infectious disease on his family as reported by the patient’s mother. Therefore, there
are no connection that hypertension can lead to the patient amoebiasis. The only complication
hypertension will result to Heart attack or stroke, aneurysm, Heart failure, weakened and
narrowed blood vessels in your kidneys, thickened, narrowed or torn blood vessels in the eyes,
trouble with memory or understanding, dementia.

B. Family Apgar

APGAR ITEMS ALMOST SOME OF HARDLY

ALWAYS THE EVER
TIME
(2) (0)
(1)

Can you turn to your

family for help when
Adaptation something is troubling
you?
 Are you satisfied with
the way your family
Partnership talk things over with
you and shares
problems with you?

Are you satisfied that

your family accepts
Growth and supports your
wishes to take on new
activities or directions

Are you satisfied with

the way your family
Affection expresses affection
and responds to your
emotions, such as
anger, or love?

Are you satisfied with

the way your family
Resolve share time together
with you?

TOTAL 10

0-3= Low 4-7= moderate 8-10= High

Health Implications:

The result of his family APGAR is 10. This shows that despite of the presence illness to
the patient, this didn’t’ affect her adaptation, growth, affection, and the way he spent time with
his family. On the part of bond and partnership, patients feel support and care for involving on
problem solving maybe because they did not want him to fear what procedure will be done to
him.
VI. SOCIO ECONOMIC HISTORY

Patient O. is the eldest of two children. His civil status is single and was still living with his
family in the father side house in a compound area with their cousins and auntie/uncle and they
only have one room for their own whole family in the Sampaloc Manila. The source of their
water is only tap water with only having a cloth to filter the dirt may in it. The cleanliness in
their environment is maintain due to regular collection of garbage trucks. He and his brother are
still a child which his brother was 4 months old the one who provide their financial need is their
father who earn 7,500 pesos every month (with permissions from the client). His favorite habits
are playing basketballs and play with his cousins outside and going to the park sometimes just to
play.

VII. DEVELOPMENT HISTORY

A. Erick Erikson’s Psychosocial Development

Stage & Functional Age Task Evidences of Milestone

Achievement

Trust vs Mistrust  Close relationships  When the patient

with mother fear something, he
(Ages 0 To 18 months)
always look for his
 Consistency of care. mother.

 When it’s time for

meal he will
eventually go to his
mother to eat.
Health Implication:

This shows that patient mister O. is in the trust side of Erik Erikson’s stage one of
development. Even though that he had strong relationship with mother, he also depends on his
father and grandparents when the mother is not around and according to Erick Erikson’s an
infant is utterly dependent, developing trust is based on the dependability and quality of the
child's caregivers. At this point in development, the child is utterly dependent upon adult
caregivers for everything that he or she needs to survive including food, love, warmth, safety,
and nurturing. Therefore, the trust of the patient mister O. will not be only surround to his
mother but also his father and grandparents who also take care him.

B. L. Kohlberg’s Moral Development

Stage & Functional Age Task Evidences of Milestone

Achievement

Pre- Conventional In stage 1, focuses on the -Patient O. is already

(Obedience-and-
Punishment Orientation)
child’s desire to obey rules behaved when he done
and avoid being punished. something wrong and he
For example, an action is will not repeat the same
perceived as morally mistakes again after being
wrong because the scolded.
perpetrator is punished; the
worse the punishment for
the act is, the more “bad”
the act is perceived to be.

Health Implications:

These shows that patient O. has a strong will to not commit the same mistakes again and
remember what will happen to him when he done something wrong and remembering that it was
for his sake why he was being scolded from it. According to Kohlberg, A child with pre-
conventional morality has not yet adopted or internalized society's conventions regarding what is
right or wrong, but instead focuses largely on external consequences that certain actions may
bring. Therefore, patient mister o. acknowledge the fact that if he do something wrong there will
be a punishment for the time he done it and he obey so there will be no punish that he may get.

VIII. Gordon’s 11 Functional Health Patterns

A. Health Perception – Health Management

Before Hospitalization During Hospitalization Interpretation

• For patient O. he • During the  The patient make’s a

doesn’t even know yet
how to handle his self so
he depends on his mother
for feeding and bathing. all
he done is to play with his
cousins or sometimes
playing ball outside their
house.
interview, Patient O. that careful decision and
to take precautions for any strictly following
contaminated or dirty the precaution
things that he may touch before eating and
while playing. with supervision of
his mother to do
handwashing.

• He also had a skin

asthma in the right arm.

• The patient had a

high fever and water stool
with bright red blood in it.

Health Implications:

Patient O. doesn’t have knowledge yet to understand what does and don’t how to handle
his self it should be supervised by his mother to prevent eating anything or eat with dirty hands
by doing handwashing.
 B. Nutritional – Metabolic

Before Hospitalization During Hospitalization Interpretation

• The patient mister O. • Patient mister O. has  The patient increased

eats soup with rice and also to eat soft, plain foods. The the total amount of
not a picky eater. Also, he eat physician encouraged him to water and stay
3x a day for breakfast, lunch, increase the oral fluid intake. hydrated at all times.
and dinner.

• He always finished up
his whole food and
sometimes, request for 2nd
meal or a snacks.

Health Implications:

This signifies that patient O. become more concern on what he drinks a lot or eat soft
foods after being diagnosed. The patient mother followed what his doctor’s advice to increase
fluid volume and to resolution for having a watery stool that this has a big factor in his health
condition

C. Elimination

Before Hospitalization During Hospitalization Interpretation

• The patient stool is • Patient O. defecates  The patient stool

firm in each day he defecates was watery and have a blood become firm over
2-3 a day tinged in it. time and negative sign
of blood tinged.
Health Implications:

This signified that though his elimination through defecate was not the same as before
being diagnosed, his body is still able to function and eliminates the toxic waste in her body.

C. Activity – Exercise

Before Hospitalization During Hospitalization Interpretation

• According to the • As stated by the  The patient have a

patient’s mother, he has
enough energy to play outside
with his cousin and
sometimes to do outdoor play
with the family.
patient mother that the patient limited movement or
had a limited movement with to have exercise end
just only laying, sitting, up to have a bed rest.
standing with the reason of
attached IVF. She has no
exercise routine as prohibited
by the doctor due to body
weakness. Instead, he was
advised to take some walk
sometimes and change
positions over time. His

• only leisure activities

are watching a kid’s movie in
the phone.

Health Implications:

Patient O. was able to move her body but with limitation. Therefore, the patient attached
IVF and weakness is the reason why he wasn’t able to do exercise.
*Katz Index of Independence in Activities of Daily Living during Hospitalization:

Activities Points (1 or 0) Independence = 1 point Dependence = 0 point With

supervision, direction or
No supervision, direction or personal assistance or total
personal assistance needed care

Bathing ✓

Dressing ✓

Toileting ✓

Transferring ✓

Continence ✓

Feeding ✓

TOTAL POINTS 0

Health Implications:

With scoring of Katz Index of Independence in ADL shown above, this simply shows
that the patient needs supervision from his mother and direct assistance of care. He wasn’t able
to perform activities of daily living by his own because of being 1 year old and weakness/limited
movement.
E. Sleep - Rest

Before Hospitalization During Hospitalization Interpretation

• Patient O. reported • Patient O. usually  The patient total

that he has enough sleep.
According to his mother that
he asleep early at night then
waking up at 8:00 am in the
morning then after lunch and
played around 3:00 pm he
will sleep and he eventually
wake up before dinner of 7:00
pm and 10:30 he will sleep all
night. She has an average
sleep of 10-14 hours a day.
• When the symptoms
start the patient had a
difficulty in sleeping he
became irritable and constant
crying because of headache.
sleep at 9 pm and wake up at sleeping hours has
6 (8 hours of sleep per day). decreased because of
He had no difficulty on the disease manifested
sleeping. Then in the and stress to cope up
afternoon after lunch, he in the hospital than
takes a nap for over 30 mins. their house and also
For his mother that the patient the comfort of patient
has enough sleep for entire mister O.
day.
• The patient had a
good quality of sleep because
she sleeps more than 8 hours
and had no disturbances
during the night when
napping he usually sudden
falls asleep.

Health Implication:

This implies that the patient sleeping hours was not the same as before with just only
minimal decreased in hours of sleep during his hospitalization. He also been encouraged to sleep
and rest more often for her faster recovery.
 CHAPTER III

EVALUATION RESULTS INTERPRETATION, ANALYSIS, HEALTH IMPLICATION

& CLINICAL SIGNIFICANCE

I. Comprehensive Physical Examination

A. Vital Signs

T = 39.5 °c

PR = 112 bpm

RR = 29 cpm

B. Anthropometric Data

Height= 31 inches

Weight = 10.2 kg

Body Mass Index (BMI) = 16.46

C. General Appearance

Body build and height-weight proportionality The weight is normal in relation to body and
height of the patient

Posture and Gait Arms are stretched , Legs are externally

rotated

Over-all hygiene and grooming Well groomed and wearing appropriate attire,
no body odor and no necessary breath odor

Obvious signs of distress/illness Overwhelming fear for maybe at strangers

Mental Status Irritable upon physical assessment

Attitude Not Cooperative

Affect/Mood; appropriateness of response Be Irritable might be cause of his illness

Health Implication:

This significant that most of the patient general appearance is normal but the patient is
irritable when starting assessment.

Focused Assessment (January11, 2020)

Body Part Examined Normal Finding Actual Finding Clinical

Significance

INTEGUMENTARY Evenly colored skin Skin tone is light

tones without brown in color and
unusual or prominent even, with no scar or NORMAL

Skin discoloration any lesion.

I: color, uniformity,
edema, lesions

P: moisture, Skin surfaces vary Skin surface is dry, NOT NORMAL

temperature, good moist to dry warm to touch, skin
turgor depending on the is mobile, elastic and The patient has poor
area assess, normally quickly returned to skin turgor and
warm temperature, original shape, with manifested by
skin mobile, with poor skin turgor. moderate
elasticity and returns dehydration
to original shape
quickly

Hair and scalp The color of hair is Hair is black in color NORMAL
determined by the
I: general color and amount of melanin
condition of scalp and present
scalp and hair

P: smoothness Smooth and firm Hair is smooth and NORMAL

somewhat elastic, firm to touch, scalp
scalp is clean and dry is clean and dry
 without any lesions
or scar

Nails Nails are clean and Nails are clean and NORMAL
pink tone should be pink tone
I: grooming and seen
cleanliness, color and
markings, shape

P: Blanch test or Nails are hard and Nails are hard and NORMAL
capillary refill, assess basically immobile, basically immobile,
texture pink tone returns pink tone returns
immediately to immediately to
blanched nail bed blanched nail bed
when pressure is when pressure is
release release

EARS and HEARING Absence of lesions No lesions or pus NORMAL

but seen with dry
cerumen during
inspection

HEAD and FACE Head size and shape Head is NORMAL

vary, especially in Normocephalic and
I: size, shape and accord ethnicity. no lesion seen
configuration of head, Usually the head is
inspect symmetry, symmetric, round,
movement, expression erect, and in midline
and skin condition and appropriate
related to body size
(normocephalic). No
lesion is visible

EYES: Pupils are normally Pupils are equal, NORMAL

equal, round, reactive found and reactive to
I: Pupils assess for to light light accomodation
pupillary using accomodation
PERRLA

Mouth/Oropharynx Lips are smooth and Lips are dry and pale NOT NORMAL
without lesions and in appearance
I: Lips swelling
Observe lip consistency Patient have a sign
and color and symptoms of
dehydration

I: Teeth Twenty pearly Fourteen pearly NORMAL

whitish teeth with whitish teeth with
Note the number of smooth surface and smooth surface and
teeth, color, and edges. No decayed edges. No decayed
condition. areas; no missing areas
teeth.

I: Gums Gums are pink, moist Gums are pink, NORMAL

and firm with tight moist and firm with
Retract the client’s lips margins to the tooth. tight margins to the
cheeks to check gums No lesion or masses tooth. No lesion or
for color and masses
consistency

I: Tongue Tongue should be Moist, moderate size NORMAL

pink, moist, a with papillae. No
Inspect for color, moderate size with lesion upon
moister, size, and papillae. No lesion inspection
texture should present

NECK Non palpable lymph Occipital lymph NOT NORMAL

nodes, no node is palpable
P: make note of level of enlargement Palpable lymph
any lymph nodes and node indicate
any increase in size infection

THORAX & LUNGS NORMAL

Posterior Thorax

SPINE

I: Inspect for shape and No deformities. No No deformities. No

symmetry tenderness and tenderness and
swelling. swelling.
Smoothness of
P: edema, tenderness movement
Pe: percuss for Excursion is equally Excursion is equally NORMAL
diaphragmatic bilateral and bilateral and
excursion. Percuss the diaphragm is higher diaphragm is higher
intercostal space at the on the right side on the right side
right posterior chest because of the because of the
wall position of the liver position of the liver

A: Auscultate for breath Normal breath sound

sounds may be auscultated
bronchial,
bronchovesicular,
and vesicular

Anterior Thorax The anteroposterior The anteroposterior NORMAL

diameter is less than diameter is less than
I: Inspect for shape and the transverse the transverse
configuration, position diameter. Ratio 1:2 diameter. Ratio 1:2
of sternum Sternum is Sternum is
positioned at midline positioned at midline
and straight and straight

P: Palpate for No Tenderness or No Tenderness or NORMAL

tenderness, sensation pain is palpated over pain is palpated over
and surface masses lung area with lung area with
respirations respirations

A: Anterior breath No Adventitious No adventitious NORMAL

sounds, adventitious sounds, such as sounds, such as
sounds, voice sounds crackles or wheezes crackles or wheezes
heard

ABDOMEN Abdominal skin may Abdominal skin is NORMAL

be paler than general paler than general
I: Observed the skin tone because skin tone of the
coloration of the skin, this skin is no seldom body, no lesion or
inspect for scar, assess exposed to the scar, no rashes seen
for lesion and rashes natural elements
inspect for the
presence of scar
 MUSCULOSKELETAL

Muscles

Knee Knee symmetric, Knee symmetric, NORMAL

hollows present on hollows present on
I: inspect for sizer, both sides of the both sides of the
shape, symmetry, patella, no swelling, patella, no swelling,
swelling, deformities, or deformities or deformities
and alignment

NEUROLOGIC Patient is alert and Irritable upon NOT NORMAL

oriented to what is physical assessment
Mental Status happening at the time and interview Babies and young
of interview and children are often
Observe for client’s reported to feel
level of consciousness physical assessment.
irritable, especially
when they are tired
or sick.

II. Diagnostic Test

HEMATOLOGY RESULT

Complete Blood Reference Jan. 10, 2020 Jan. 12, 2020 Analysis
Count Range

Hemoglobin 14-16 g/dl 12.4 10.8 Patient has fluid

loss which
results to
moderate
dehydration

Hematocrit 0.40-0.57 0.37 0.31

WBC Count 4.8-10.8 × 10 19.3 9.2 Having a lower

or higher number
of WBCs than
normal may
 indicate an
underlying
condition

Segmenters 60-70% 64 39 Indicates

infection inside
the body

Lymphocyte 30-40% 25 56 Having a low

lymphocyte it
cause another
infection and
high lymphocyte
which indicates
the body dealing
with other
inflammatory
condition
Mid Cells 0-15% 11 05 NORMAL

RBC Count 4.5-6.0×10/12 4.13 3.68 Patient has fluid

loss which
results to
moderate
dehydration

Platelet Count 310 348 310 Infection is seen

at the patient

URINALYSIS

Macroscopic Result Interpretation Analysis

Color Yellow Not Normal Yellow urine color is

due to dehydration
Transparency Clear

PH 6.0 Normal N/A

Specific Gravity 1.005

Protein Negative Normal N/A

Glucose Negative Normal N/A

Microscopic Result Interpretation Analysis

Pus Cell 0-2/HPF

Red Cell 0-1/HPF

FECALYSIS

Color Yellow

Consistency Soft

Pus Cell 3-5/HPF

Red Cell 1-2/HPF

Others Positive for E. Histolytica Cyst

III. Review of system

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity,
where food enters the mouth, continuing through the pharynx, esophagus, stomach and intestines
to the rectum and anus, where food is expelled. There are various accessory organs that assist the
tract by secreting enzymes to help break down food into its component nutrients. Thus the
salivary glands, liver, pancreas and gall bladder have important functions in the digestive system.
Food is propelled along the length of the GIT by peristaltic movements of the muscular walls.
The primary purpose of the gastrointestinal tract is to break food down into nutrients, which can
be absorbed into the body to provide energy. First food must be ingested into the mouth to be
mechanically processed and moistened. Secondly, digestion occurs mainly in the stomach and
small intestine where proteins, fats and carbohydrates are chemically broken down into their
basic building blocks. Smaller molecules are then absorbed across the epithelium of the small
intestine and subsequently enter the circulation. The large intestine plays a key role in
reabsorbing excess water. Finally, undigested In material and secreted waste products are
excreted from the body via defecation (passing of feces).the case of gastrointestinal disease or
disorders, these functions of the gastrointestinal tract are not achieved successfully. Patients may
develop symptoms of nausea, vomiting, diarrhea, mal absorption, constipation or obstruction.
Gastrointestinal problems are very common and most people will have experienced some of the
above symptoms several times throughout their lives.

The gastrointestinal tract is a muscular tube lined by a special layer of cells, called epithelium.
The contents of the tube are considered external to the body and are in continuity with the
outside world at the mouth and the anus. Although each section of the tract has specialized
functions, the entire tract has a similar basic structure with regional variations.
 The wall is divided into four layers as follows:

Mucosa, Sub mucosa, Muscularis external and Serosa.

Individual components of the gastrointestinal system are Oral cavity

Salivary glands, Esophagus, Stomach, Small intestine, Large intestine, Liver, Gall bladder,
Pancreas

II. Case Management

A. Medical Management

Pharmacologic Intervention

DRUGS MECHANI INDICATI CONTRAINDICA ADVERSE INTERACTI NURSING

SM OF ON TION EFFECT ONS CONSIDERATION
ACTION

Drug Name: Inhibits cell- >Respirator >Contraindicated in GI: diarrhea, Drug to Drug: >Monitor sodium
wall y tract patient nausea, level because each
AMPICILLI synthesis infections hypersensitive to pseudomemb Allopurinol: A gram of ampicillin
N during ranous ppears to sodium injection
increase
 bacterial >GI drug or its colitis, occurrence of contains 2.9 mEq of
multiplicatio infections or components. abdominal rash from both sodium.
Dosage/Rout n. GU pain, black drugs. Monitor
e: infections hairy tongue, patient closely. >If large dose are
(excluding enterocolitis, Aminoglycosid given or if therapy is
250 mg/TIV prolonged, bacterial or
q6 parenteral gonorrhea) gastritis, e
glossitis, antibiotics: Ca fungal superinfection
>Uncomplic stomatitis, use synergistic may occur, especially
ated vomiting. bactericidal in elderly, debilitated,
Classificatio gonorrhea or immunosuppressed
effect against
n: HEMATOL patients.
>Bacterial some strains of
OGIC: enterococci
Aminopenici meningitis >Watch for signs and
leukopenia, and group B
llin or symptoms of
thombocytop streptococci.
septicemia enic purpura, hypersensitivity, such
However, as erythematous
>GI anemia, drugs are
Clinical eossinophilia maculopapular rash,
infections physically and urticarial, and
Significance: , hemolytic
and GU chemically anaphylaxix.
tract anemia, incompatible
Used to
infections agranulocyto and are >Use lowest dosage
prevent and
(including sis. inactivated if compatible with
treat a
number of gonorrhea in mixed or given effective treatment in
bacterial females) together. Don’t neonates and infants
infections, mix together. because of
>Respirator incompletely
urinary tract Hormonal
y tract and developed renal
infections, contraceptives:
soft-tissue function in these
meningitis, May decrease
infections patients.
salmonellosis effects of
, and >Urethritis hormonal
>Monitor patients for
endocarditis. in male due contraceptives.
CDAD, which can be
It may also to gonorrhea Advise using
fatal and can occur
be used to alternative
even more than 2
prevent barrier method.
months after therapy
group B Methotrexate:
ends. Antibiotic may
streptococcal Large doses of
need to be stopped
infection in penicillins may
and other treatment.
newborns. interfere with
renal tubular
secretion of
methotrexate,
Date delaying
Ordered: elimination
and elevating
Jan 10, 2020 serum
methotrexate
level. Monitor
patient for
methotrexate
toxicity.
Probenecid: In
hibits renal
tubular
secretion of
ampicillin,
raising its
serum
level. Avoid
use together.

Drug to Food:

Pharmacokinet
ics:
Absorption: Ab
out 42% of
ampicillin is
absorbed the
following
routes of
administration.
Distribution: D
istributed into
pleural,
peritoneal, and
synovial fluids,
lungs, prostate,
liver, and
gallbladder; it
also penetrates
middle ear
effusions,
maxillary sinus
and bronchial
secretions,
tonsils, and
sputum.
Readily
crosses the
placental
barrier;
minimally
protein-bound
(15% to 25%).
Metabolism: O
nly partially
metabolized.
Excretion: Exc
reted in urine
by renal
tubular
secretion and
glomerular
filtration. It
also appears in
breast milk.

Half-life is
about 1 to 11/2
hours; in
patients with
extensive renal
impairment,
half-life is
extended to 10
to 24 hours.
DRUGS MECHANIS INDICATIO CONTRAINDIC ADVERSE INTERACTI NURSING
M OF N ATION EFFECT ON CONSIDERA
ACTION TION

Drug Name: Inhibits >Amebic liver >Contraindicated CNS: Drug- >Always check
nucleic acid abscess in patient headache, drug. Barbitur patient’s apical
Metronidazole synthesis by hypersensitivity to seizures, ates, pulse rate
disrupting >Intestinal drugs or other fever, vertigo, phenytoin: Red before giving
DNA and amebiasis nitroimidazole ataxia, uces drug. If it’s
Dosage/Route: causing (immediate- derivatives. dizziness, antimicrobial slower than 60
breakage; release) syncope, effectiveness beats/minute,
100mg/TIV q8
amebicidal, >Trichomonia incoordinatio of withhold drug
parenteral
bactericidal, sis n, confusion, metronidazole. and call
trichomonacid (immediate- irritability, Patient may prescriber
al. release) depression, need higher immediately.
Classification: weakness, metronidazole
>Bacterial insomnia, dosage. >In diabetic
Nitroimidazole patients,
infection cause peripheral Disulfiram: M
s monitor
by anaerobic neuropathy. ay precipitate
microorganism psychosis and glucose level
CV: flattened confusion. Avo closely because
Clinical >To prevent T wave, drug masks
id use together.
Significance: postoperative edema, common signs
Lithium: May
infection in flushing, and symptoms
Used in increase
contaminated thrombophleb of
treatment lithium
or potentially itis after IV hypoglycemia.
regimens for levels. Monitor
contaminated infusion.
Helicobacterpy serum lithium >Monitor BP
colorectal
lori, a EENT: levels. frequently;
surgery
microaerophili rhinitis, Oral drug masks
c bacterium, >Bacterial sinusitis, anticoagulants common signs
but resistance vaginosis pharyngitis. : Prolongs PT and symptoms
to this drug is (nonpregnant and of shock.
women) GI: nausea, INR. Monitor
frequently
abdominal patient for >Beta blockers
encountered.
>CDAD (mild cramping or increased may mask
to moderate) pain, bruising or tachycardia
stomatitis, bleeding. caused by
Date Ordered: epigastric hyperthyroidis
Drug-
Jan 10, 2020 distress, lifestyle. Alcoh m. In patients
vomiting, ol use: May with suspected
anorexia, cause thyrotoxicosis,
diarrhea, disulfiram-like taper off beta
constipation, reaction blocker to
proctitis, dry (nausea, avoid thyroid
mout, metallic vomiting, storm.
taste. headache,
abdominal >Beta
GU: vaginitis, cramps, and selectivity is
darkened flushing). Disc lost at higher
urine, ourage alcohol doses. Watch
polyuria, use. for peripheral
dysuria, side effects.
cystitis, Pharmacokinet
dyspareunia, ics:
dryness of Absorption: A
vagina and bout 80% of
vulva, vaginal routes
candidiasis, administration
genital is absorbed;
pruritus, UTI, food delays the
dysmenorrhea rate but not the
. extent of
absorption.
Hematologic: Distribution: D
transient istributed into
leukopenia, most body
neutropenia tissues and
Musculoskele fluids,
tal: transient including CSF,
joint pains. bone, bile,
saliva, pleural
Respiratory: and peritoneal
URI fluids, vaginal
secretions,
Skin: rash,
seminal fluids,
genital
middle ear
pruritus.
fluid, and
Other: hepatic and
decreased cerebral
libido; abscesses. CSF
overgrowth of levels
approach
non- serum levels in
susceptible patients with
organisms, inflamed
Candida; meninges; they
flulike reach about
symptoms 50% of serum
levels in
patients with
uninflamed
meninges. Less
than 20% of
metronidazole
is bound to
plasma
proteins. It
readily crosses
the placental
barrier.
Metabolism:
Metabolized to
an active 2-
hydroxymethyl
metabolite and
also to other
metabolites.
Excretion: Abo
ut 60% to 80%
of dose is
excreted as
parent
compound or
its metabolites.
About 20% of
a
metronidazole
dose is
excreted
unchanged in
urine; about
6% to 15% is
 excreted in
feces. Half-life
of drug is 6 to
8 hours in
adults with
normal renal
function; its
half-life may
be prolonged
in patients with
impaired
hepatic
function.

DRUGS MECHANI INDICAT CONTRAINDIC ADVERSE INTERACTION NURSING

SM OF ION ATION EFFECT CONSIDERATIO
ACTION N

Drug Name: Produce >Mild pain >Use of CNS: Drug-Drug >Many OTC and
analgesia by or fever acetaminophen agitation Antacids: Delay prescription
Acetaminophe inhibiting P.O. include (I.V.), and decrease products contain
n prostaglandi hypersensitivity to anxiety, absorption of acetaminophen; be
n and other >Rectal acetaminophen, fatigue, acetaminophen. S aware of this when
Dosage/Route
: substances >Mild to severe hepatic headache, eparate calculating total
that moderate impairment, or insomnia, administration daily dose.
250 mg q4 sensitize pain; mild severe active pyrexia. times.
oral pain hepatic disease. Anticoagulants, >Use caution when
to CV: prescribing,
receptors. moderate thrombolytics: M
Drug may hypertension ay potentiate preparing, and
pain with , administering IV
Classification: relieve fever adjunctive effects of these
through hypotension, drugs. This acetaminophen to
opioid peripheral avoid dosing errors
Tylenol central appears to be
action in the edema, clinically leading to
 hypothalami analgesics; periorbital insignificant. accidental
c heat- fever edema, Anticonvulsants, overdose and
Clinical regulating tachycardia isoniazid: Increas death. Be careful
Significance: center. (I.V.) e risk of not to confuse dose
para- hepatotoxicity. U in milliGRAMS
GI: nausea, se together and dose in
aminophenol vomiting,
derivative. cautiously. milliLITERS. Be
abdominal Phenothiazines: sure to base dose
nonnarcotic pain,
analgesic, May cause on weight for
diarrhea, hypothermia if patients weighing
antipyretic. constipation used with less than 50 kg, to
(I.V.) acetaminophen in properly program
GU: oliguria large doses. Use infusion pump, and
Date Order:
(I.V.) together o ensure that total
Jan. 10 2020 cautiously. daily dose of
Hematologic acetaminophen
: hemolytic Drug-food. Any from all sources
anemia, food: Delays and doesn’t exceed
leukopenia, decreases maximum daily
neutropenia, absorption of limit.
pancytopeni acetaminophen.
a, anemia. Advise taking >Consider
drug on an empty reducing total daily
Hepatic: stomach. dose and
jaundice Caffeine: May increasing dosing
enhance intervals in patients
Metabolic:
therapeutic effect with hepatic or
hypoalbumin
of renal impairment.
emia (I.V.),
acetaminophen.
hypoglycemi
Discourage use
a,
together.
hypokalemia
, Pharmacokinetics
hypomagnes Absorption: Abso
emia, rbed rapidly and
hypervolemi completely via
a, the GI tract.
hypophosph Distribution: 25%
atemia (I.V.) protein-bound.
Plasma levels
don’t correlate
 Musculoskel well with
etal: muscle analgesic effect,
spasm, but they do
extremity correlate with
pain (I.V.) toxicity.
Metabolism: Abo
Respiratory: ut 90% to 95% is
abnormal metabolized in
breath the liver.
sounds, Excretion: Excret
dyspnea, ed in urine.
hypoxia, Average
atelectasis, elimination half-
pleural life ranges from 1
effusion, to 4 hours. In
pulmonary acute overdose,
edema, prolongation of
stridor, elimination half-
wheezing life is correlated
(I.V.) with toxic effects.
Skin: rash, Half-life longer
urticarial; than 4 hours is
infusion-site linked to hepatic
pain (I.V.), necrosis; longer
pruritus. than 12 hours is
linked to coma.

DRUGS MECHANI INDICATI CONTRAINDICA ADVER INTERACT NURSING

SM OF ON TION SE ION
ACTION EFFEC CONSIDERATION
TS

Drug Name: Zinc >RDA of Hypersensitivity or CNS: re Drug- Results may not appear for 6 to
reduces zinc. allergy to any stlessnes drug. Certain in zinc-depleted patients.
Zinc Sulfate absorption >Metabolic components in the s. proteins, Zinc decreases absorption of
of ally stable formulation. GI: distr methylcellulo
Ciprofloxaci zinc ess and se tetracyclines and fluoroquinolon

Dosage/Rout n, deficiency. irritation suspensions: Calcium supplements may confe

e Levofloxaci >Stable , nausea, Causes protective effect against zinc
n, and zinc vomitin precipitation
1ml Oral Ofloxacin. deficiency g with of these toxicity.
Absorption with fluid high drugs. Avoid Because of potential for infusion
of both zinc loss from doses, use together.
phlebitis and tissue irritation,
Classificatio salt anf the small gastric Fluoroquinol
n ferrous salts bowel. ulceratio ones, an undiluted direct injection
will reduce n, tetracyclines:
Zincate if used >Zinc diarrhea. Impairs must not be administered into
concomitant deficiency Skin: ras antibiotic
a peripheral vein.
ly >Dietary h. absorption. A
Clinical supplement Other: d void use Don’t exceed prescribed dosag
Significance: ation. ehydrati together.
on. Drug- e of oral zinc; if oral zinc is
trace food. Dairy
element; administered in single 2-g doses
products: Ma
miscellaneou y reduce zinc emesis will occur.
s anti- absorption. D
infective. Monitor patient for severe
iscourage use
nutritional together. vomiting and dehydration, whic
supplement
may indicate overdose.

Date
Ordered:

Jan. 10, 2020

Plans for Nursing Actions

A. COURSE IN THE WARD

Day 1 (January 10, 2020)

A 1 ½ year old male patient was admitted in the emergency room of Ospital ng Sampaloc at
exactly 10 pm last January 10, 2019 accompanied by his mother with a chief complaint of
vomiting and fever. Tbe patient was admitted under the service of DR. G. Initial taking of vital
sign was conducted, with the following result; cardiac rate: 112 bpm, respiratory rate: 29 cpm,
and temperature 39.5 Celsius. History taking as well as physical examination was followed the
following order were given by the admitting physician: IV fluid of DS 0.3 normal saline to be
regulated tat 62-63 gtts per minute. For diagnostic laboratory such as complete blood count with
platelet count,urinalysis and fecalysis; medication such as ampicillin 250mg thru IV every 6
hours after negavitive skin test, metronidazole 100mg thru IV every 8 hours after negative skin
test , zinc drops 1ml once a day, and paracetamol 250mg/5ml every 4 hours as needed for 37.8
celcius; then lastly input and output and vital sign must be taken and recorded every shift. The
Doctor’s orders were carried out by the nurse and afterwards, the patient was ordered by the
doctor to be transferred and admitted in the Pedia Ward.

11 PM

At 11 pm the patient was transferred and endorse to the staff nurse in the pedia ward. The nurse
received the patient awake and active with an IV fluid of 500cc D503 sodium chloride, regulated
at 62-63 drops per minute in his left arm. Routine vital sign taking were started. The patient is
still for urinalysis. Medications were continued and monitoring of the patient continues
throughout the shift.

DAY 2 (January 11, 2020)

6 AM

During the morning shift the nurse received the patient awake and active, still with an IV fluid of
500cc D50.3 Sodium Chloride regulated at 62-63 drops per minute. Vital sign routines were
conducted. The nurse advised the patient’s mother to give the patient adequate fluids and
promote hygienic measures to fasten the recovery period of the patient. Daily medications that
were due were administered as well as routine assessment and monitoring were conducted
throughout the shift.

2-5 PM

In the afternoon shift, the nurse received the patient awake and active still with an IV Fluid of
500cc D50.3 sodium chloride, regulated at 62-63 drops per minute. During vital sign routine the
nurse noted that the temperature of the patient increase to 38.6 Celsius. As needed medicine for
high fever was given and TSB was performed. IV fluid was consumed at 3:30 pm and was
replaced with the same IV fluid, the same total volume and regulation. In addition, DR. G has
made her rounds at around 5pm. During rounds the following findings were confirmed: (+)
loose stool for 6 times, febrile, dry lips, clear breath sound. After the doctor had her rounds, the
patient had an increase temperature. A gain of 38.9 Celsius at 10 pm. As needed medication
more given and tepid sponge bath was performed at around 11:30 pm, the temperature of the
patient goes down to 36.5 celcius after series of nursing intervention and finally monitoring of
patient continued through the entire shift.

DAY 3 (January 12, 2020)

During the morning shift the nurse received the patient active and awake, still with IV fluid of
500cc D50.5 Sodium chloride, regulated at 42-43 drops per minute. Routine vital sign taking
were started. Seen and examine by DR. E and during the following rounds, findings were
confirmed: (+) loose stools for 6 times, (-) sign of vomiting and patient have good oral intake.
Doctor noted to consume management.

2PM

In the afternoon shift the nurse received the patient active and awake. Still with an IV fluid of
500cc D50.3 Sodium Chloride regulated at 42-43 drops per minute. During vital sign routine the
nurse noted that the patient temperature increase to 36.6 Celsius. Seen and examined by DR. M
around 2:50 pm. During the following rounds, findings were confirmed Active (-) LBM, (-)
dehydration, and fix loose stool. Doctor noted diet as tolerated, emphasize proper hand washing,
and hand hygiene. The doctor also ordered to repeat the laboratory exam such as complete blood
count with platelet count and urinalysis.

DAY 4 (January 13, 2020)

6AM

The patient is still with IV Fluid of 500cc D5IMB sodium chloride regulated at 42-43 drops per
minute. Seen and examined by DR. M. During the following rounds, findings were confirmed
active(-) dehydration, loose stool for once, soft bowel movement for 2 times. Doctor’s noted to
promote hand washing, proper hygiene, and to continue present management.

2 PM

In the afternoon shift the patient s still with IV Fluid of 500cc D5IMB sodium chloride to run for
12 hours and regulated at 42-43 drops per minute. Seen and examined by DR. G. during the
following rounds, the doctor noted active afebrile, (-) dehydration and to continue present
management.

10 PM
 At the night shift the patient is still with an IV Fluid of 500cc D5IMB Sodium Chloride to run
for 12 hours and regulated at 42-43 drops per minute. The nurse’s notes for active (-) LBM and
loose stool for one time. The nurse also noted to emphasize proper hand washing and advice
proper hygiene. The doctor noted active afebrile, diet as tolerated and to continue present
management.

DAY 5 (January 14, 2020)

In the morning shift the nurse receive the patient awake and active. Seen and examine by DR. A.
During the following rounds, findings were confirmed (-) LBM, and (-) vomiting. Doctor’s note
patient with good appetite and diet as tolerated. Lastly 7 am in the morning order made may go
home with advice. IV fluid consumed and terminated at 8 am. The doctor ordered Metronidazole
100ml was given to the patient every 8 hours by 4 more days. Amoxicilin 250ml was given oral
every 8 hours by 4 more days. Zinc Sulfate drop 1ml by 14 days. Doctor advised proper hand
washing and body hygiene. Home instruction was given and noted for the OPD follow up on
January 21, 2020.

B. NURSING CARE PLAN

Name of the Patient: J.M.R.O Date: January 10, 2020 Medical diagnosis: Amebiasis with
moderate dehydration Nursing diagnosis: deficient fluid volume related to watery stool

ASSESSMEN DIAGNOSI PLANNIN INTERVENTIO RATIONALE EVALUATION

T S G N

SUBJECTIV INDEPENDENT INDEPENDE

E: : NT:
Deficient Within 8 After the nursing
“niilalagnat fluid volume hours of 1. Weight 1. Change intervention the
ang anak ko 5 related to nursing patient s in goals are met as
beses na sya vomiting intervention daily. weight evident by the
tumae ng and the client can client have
matubig na diarrhea will be able provide formed stool.
may dugo at to have informa
nagsuka” as adequate tion in
verbalized by hydration as fluid
the mother of evidence by balance
the patient. stable vital and the
signs and adequa
adequate cy of
fluid
 intake of volume
water. replace
OBJECTIVE: 2. Assess ment.
peripheral
pulses, 2. Indicati
T: 39.5 celcius capillary on of
refill, skin hydrati
RR: 29cpm turgor and on
mucous level.
HR: 112bp
membrane Circulat
s. ing
volume
- On 3. Assess .
admissi patient’s
on condition.

- Decreas 3. To
ed fluid monitor
intake for
other
signs
4. Encourage and
increase sympto
fluid ms.
intake
providing
appealing 4. For
liquids. hydrati
5. on.
Encourage
eating
smashed
banana,
white rice,
and
cooked
eggs. 5. To
prevent
diarrhe
a, for
DEPENDENT:
stool
 6. Give formati
antidiarrhe on.
al drugs as
ordered by
the doctor. DEPENDENT
:

6. Most
antidiar
rheal
drugs
suppres
s
gastroin
testinal
motility
, thus
allowin
g for
more
fluid
absorpti
on.
Supple
ments
COLLABORAT of
IVE: benefici
al
7. Refer to bacteria
the (probiot
dietician ics) or
for the yogurt
fiber diet. may
reduce
sympto
ms by
reestabl
ishing
normal
flora in
 the
intestin
e.

COLLABOR
ATIVE:

7. To
prevent
diarrhe
a and
for the
stool
formati
on.

C. DISCHARGE PLAN

Client with amoebiasis with moderate dehydration is instructed to take the following plan for
discharge.

M-edications should be taken regularly as prescribed like metronidazole, amoxicillin, and zinc
sulfur drops. Make sure that the purpose of medications is fully disclosed by the health care
provider.

E-xercise should be promoted in a way by stretching hand and feet every morning. Encourage
the patient to keep active to adhere to exercise program and to remain as self sufficient as
possible. Advised the family to avoid, if possible, exposing the patient in doing heavy work or
activity. Make sure that the patient will have a safe and comfortable bed to take a rest. Instruct
the guardian to provide clean surroundings for the client. Rehabilitation therapy is encouraged.

T-reatment after discharge is expected. Instruct the patient to take her prescribed medicine at
right dosage and at the right time. Inform the patient to have a follow-up check-up.
H-ealth teaching about the importance of proper hygiene and hand washing to prevent infection
should be emphasized. Encourage the patient to have a plenty of rest for recovery.

O-ut patient consultation such as regular follow-up check-ups should be greatly encouraged to
clients with amoebiasis as ordered by the physician to ensure the containing management and
treatment.

D- iet for amoebiasis with acute gastro enteritis patient includes soda crackers, toast, plain
noodles or rice, cooked cereal, applesauce , and bananas. Encourage the patient to avoid hard
digesting or may irritate their stomach such as foods with acid (like tomatoes or oranges), spicy
or fatty food, meats, and raw vegetables.

S-piritual activity like praying and attending to church activity can help improve the patient’s
condition. Encourage the patient to enjoy company with family, friends and relatives.