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Acute Gastroenteritis (also called Stomach Flu)

• Acute gastroenteritis is a sudden condition that causes irritation and inflammation of the stomac

h and intestines or the gastrointestinal tract.

• Viral infection is the most common cause of gastroenteritis but bacteria, parasites, and food-borne illness
(such as shellfish) can also cause acute gastroenteritis.
• Fifty to seventy percent of cases of gastroenteritis in adults are caused by the noroviruses while rotavirus is the
leading cause of infection in children. Staphylococcus aureus can form a toxin that cause food poisoning while
the resident Escherichia coli can also cause significant problems.
• Many people who experience symptoms of vomiting and diarrhea, which develop from these types of
infections or irritations believe they have food poisoning, and they indeed have a food-borne illness.
• The severity of gastroenteritis depends on the immune system’s ability to resist and fight the infection.
Electrolytes, especially sodium and potassium may be lost if the client continue to vomit and experience
diarrhea.
• Most people recover easily from a short course of vomiting and diarrhea by drinking lots of fluids and
resuming a typical diet. But for some, especially the young and the old, loss of body fluids with gastroenteritis
can cause dehydration, which is a life-threatening condition unless it is treated and fluids are replaced.

Pathophysiology:
The mechanisms potentially responsible for viral diarrhea include lysis of enterocytes, interference with the brush
border function that leads to malabsorption of electrolytes, stimulation of cyclic adenosine monophosphate (cAMP),
and carbohydrate malabsorption. For bacterial gastroenteritis, the pathophysiology involves the elaboration of toxin
by enterotoxigenic pathogens and the invasion and inflammation of mucosa by invasive pathogens. Parasitic
organisms invade epithelial cells and cause villus atrophy and eventual malabsorption.
Clinical Manifestations:
 • Low grade fever to 100°F (37.8°C)
• Nausea with or without vomiting
• Mild to moderate diarrhea
• Crampy and painful abdominal bloating

More serious symptoms include:

• Blood in vomit or stool

• Vomiting more than 48 hours
• Fever higher than 101°F (40°C)
• Swollen abdomen or abdominal pain
• Dehydration that is manifested by weakness, lightheadedness, decreased and concentrated urination, dry skin
and poor turgor, and dry lips and mouth

Diagnostic Tests:

• Blood test
• Analysis of stool samples
• Electrolyte tests
• Physical examination to rule other existing conditions such as appendicitis

Medical Management:
Home care:

• Clear fluids are appropriate for the first 24 hours to maintain adequate hydration.
• They should be given oral rehydration solutions such as Pedialyte for pediatric patients or commercially
prepared oral rehydration solution. For homemade ORS, mix 2 tablespoons of sugar (or honey) with ¼
teaspoon of table salt in 1 liter (1 qt) of clean or previously boiled water.
• After 24 hours without vomiting , begin to offer soft bland foods such as the BRAT diet, which includes
bananas, rice, applesauce without sugar, toast, pasta, and potatoes.

Hospitalization:

• Hydration through intravenous line.

• Replacement of fluid losses volume per volume.
• Encourage small, frequent feedings.

Prevention:

• Always wash your hands before eating and after using the comfort room.
• Eat only properly cooked and stored food.
• Bleach soiled linens used.
• Have vaccinations for salmonella typhi, vibrio cholerae, and rotavirus.
I.
INTRODUCTION
Acute Gastroenteritis (AGE)

Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the
stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the
influenza virus is not associated with this illness. Major symptoms include nausea and
vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied
by fever and overall weakness. Gastroenteritis typically lasts about three days. Adults usually
recover without problem, but children, the elderly, and anyone with an underlying disease are
more vulnerable to complications such as dehydration.

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food that has
spoiled may also cause illness. Certain medications and excessive alcohol can irritate the
digestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptoms
of gastroenteritis include diarrhea, nausea and vomiting, and abdominal pain and cramps.
Sufferers may also experience bloating, low fever, and overall tiredness. Typically, the
symptoms last only two to three days, but some viruses may last up to a week.
A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medical
treatment is essential if symptoms worsen or if there are complications. Infants, young
children, the elderly, and persons with underlying disease require special attention in this
regard.
The greatest danger presented by gastroenteritis is dehydration. The loss of fluids through
diarrhea and vomiting can upset the body's electrolyte balance, leading to potentially life-
threatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydration
increases as symptoms are prolonged. Dehydration should be suspected if a dry mouth,
increased or excessive thirst, or scanty urination is experienced.
If symptoms do not resolve within a week, an infection or disorder more serious than
gastroenteritis may be involved. Symptoms of great concern include a high fever (102 ° F
[38.9 °C] or above), blood or mucus in the diarrhea, blood in the vomit, and severe abdominal
pain or swelling. These symptoms require prompt medical attention.

Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort and
convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve
the symptoms. These medications work by altering the ability of the intestine to move or
secrete spontaneously, absorbing toxins and water, or altering intestinal microflora. Some
over-the-counter medicines use more than one element to treat symptoms.

II.
Patient’s Profile

S.Q. is a female, 11/12 months old, residing at P2 Blk1 L38 Pabahay Nanadero,
Calamba City, Laguna. Her mother is J.Q., works part time in a shop and her father
is R.Q., factory worker. She has one sibling older than her, K.Q., 3 years old. S.Q.
was born on March 6, 2009, and born at Calamba, Laguna, Filipino in nationality.
Their whole family is Born Again in religion. She weighs 8.7 kg. She’s admitted on
January 30, 2010 at room 103-C, pedia ward with chief complaint of high fever for
2 days with emesis and has a diagnosis of Acute Gastroenteritis. And she was
discharged on January 6, 2010, Saturday at 1:30 pm. Their attending physicians
were Campos, Angelie, M.D. and Bonagua, Aireen, M.D.

III.
Health History & Chief Complain
Chief Complaint
She was admitted for having high fever for 2 days with vomiting.
Present Illness

S.Q. was only admitted to the hospital due to gastrointestinal problem now and was also
suspected of urinary tract infection by Dra. Campos. Aside from the diagnosis, no other
disease or complication was seen or diagnosed.

Past Health History

Mrs. Q says “ eto first time nya ma-admit after nya ipanganak.” S.Q. gets seasonal
cough and colds at times but never serious because it usually last only for a few days. They
always consult their doctor once sick. She is complete in her vaccinations except those which
would be taken on her 1 year of age.

Family Health History

No one in the family had any respiratory illness or allergies. On her father’s side,
almost all have hypertension. One member of their family died on a heart attack.
IV.
Gordon’s Pattern
Health Perception
As Mrs Q. stated, “lagi naman kami nagpapacheck up ni stephani. Napunta
talaga kami kay Dra. Campos. Malikot lang talaga yan pero inaalagaan yan sa bahay.”

S.Q. has a mannerism of sticking anything on her mouth. Whatever she touches she
directs it toward her mouth. Although, she doesn’t practice hand washing every now
and then. There are some medications she takes easily but there are also those
medications which is hard for her because of the taste.
Nutritional-Metabolic

S.Q. weighs 8.7 kg. She eats soft foods. She drinks 6-7 bottles of milk in a day. Mrs. Q provides
her daughter milk and food in accordance to age and doctor’s advise. She drinks formula milk. She
stop being breastfed when she was 10 ½ moths. She has no allergy.

Elimination

She defecates once or twice a day in her usual days. She changes diaper 3-5
times in a day when full or had defecated. She was advise to use Lactacid for her
perennial wash and calmoseptin ointment on her diaper rash.

Activity-Exercise

S.Q. is a very playful and active girl. She has lots of energy but cries when she
doesn’t like something. She smiles and laughs a lot. Her coordination, gait, balance is
not yet stable due to age. Her daily living activities were provided by her parents. There
is no musculoskeletal impairment. She usually plays after she wakes up in the morning.

Sleep-Rest

She sleeps at 8 P.M. in the evening and usually gets up 7 A.M. – 8 A.M. in the morning. After
playing or eating she takes a nap. She has straight undisturbed sleep at night.

Cognitive Perceptual

S.Q. has no sensory deficits. She response well to verbal stimulus by looking at you or having
facial expressions. “Bibo nga yan bata nay an, makulit pero mabilis mo naman makuha attention,” as
her mother stated.

Self-Perception
S.Q. is not afraid of new people around her. She is friendly and is easy to
accommodate.
Sexual-Reproduction
Prior to age, S.Q. is not yet oriented with any sexual matters.

Coping Stress

In her age, she usually cries when something is wrong about her. Simple smile or
cry is a sign of her comfort, distress or feelings. She is familiarized to her family
members and long for them when she doesn’t want the situation like giving of
medications or other procedures.
Role-Relationship

She doesn’t know the concept of death yet due to age. Forms words like “dede”
and “dada”. She knows her family members and can easily familiarize the people
around her.

Value-Belief

The family is Born Again. They regularly attend church together with all the members of the
family. They don’t usually believe in “hilot”. Once one is sick in the family, they go immediately to the
hospital or for check-up.

V.
Head-to-Toe Assessment
General Assessment: Playful and active, neat
Initial Vital Sign: T=36.4°C RR=27 PR=118
and coordination

Normal for
age (11
months)

Behavior and
appearance
Inspection

Makes eye
contact with
examiner,
hyperactive
expresses feelings
with response to
the situation

Makes eye contact

with examiner,
hyperactive expresses
feelings with
response to the
situation

Normal
VI.
Anatomy & Physiology

Digestion is the process by which food is broken down into smaller pieces so that the body
can use them to build and nourish cells and to provide energy. Digestion involves the
mixing of food, its movement through the digestive tract (also known as the alimentary
canal), and the chemical breakdown of larger molecules into smaller molecules. Every
piece of food we eat has to be broken down into smaller nutrients that the body can absorb,
which is why it takes hours to fully digest food.

The digestive system is made up of the digestive tract. This consists of a long tube of
organs that runs from the mouth to the anus and includes the esophagus, stomach, small
intestine, and large intestine, together with the liver, gall bladder, and pancreas, which
produce important secretions for digestion that drain into the small intestine. The digestive
tract in an adult is about 30 feet long.

Mouth and Salivary GlandsDigestion - begins in the mouth, where chemical and
mechanical digestion occurs. Saliva or spit, produced by the salivary glands (located under
thetongue and near the lowerjaw), is released into the mouth. Saliva begins to break down
the food, moistening it and making it easier to swallow. A digestivee nz yme (called

amylase) in the saliva begins to break down the carbohydrates (starches and sugars). One
of the most important functions of the mouth is chewing. Chewing allows food to be
mashed into a soft mass that is easier to swallow and digest later.

Esophagus - Once food is swallowed, it enters the esophagus, amus c ular tube that is about
10 inches long. The esophagus is located between the throat and the stomach. Muscular
wavelike contractions known asper is tals is push the food down through the esophagus to
the stomach. A muscular ring (called thec ar diac sphincter) at the end of the esophagus
allows food to enter the stomach, and, then, it squeezes shut to prevent food and fluid from
going back up the esophagus.

Stomach - a J-shaped organ that lies between the esophagus and the small intestine in the
upper abdomen. The stomach has 3 main functions: to store the swallowed food and liquid
to mix up the food, liquid, and digestive juices produced by the stomach; and to slowly
empty its contents into the small intestine.

Small Intestine - Most digestion andabs or ption of food occurs in the small intestine. The
small intestine is a narrow, twisting tube that occupies most of the lower abdomen between
the stomach and the beginning of the large intestine. It extends about 20 feet in length. The
small intestine consists of 3 parts: the duodenum (the C-shaped part), theje junum (the
coiled midsection), and theile um (the last section). The small intestine has 2 important
functions. First, the digestive process is completed here by enzymes and other substances
made by intestinal cells, the pancreas, and the liver. Glands in the intestine walls secrete
enzymes that breakdown starches and sugars. The pancreas secretes enzymes into the small
intestine that help breakdown carbohydrates,fats, andpr ote ins. The liver producesbile,
which is stored in thegallbladde r. Bile helps to make fat molecules (which otherwise are
not soluble in water) soluble, so they can be absorbed by the body. Second, the small
intestine absorbs the nutrients from the digestive process. The inner wall of the small
intestine is covered by millions of tiny fingerlike projections calledvilli. The villi are
covered with even tinier projections called microvilli. The combination of villi and
microvilli increase the surface area of the small intestine greatly, allowing absorption of
nutrients to occur. Undigested material travels next to the large intestine.

Large intestine - forms an upside down U over the coiled small intestine. It begins at the
lower right-hand side of the body and ends on the lower left-hand side. The large intestine
is about 5-6 feet long. It has 3 parts: the cecum, the colon, and the rectum. The cecum is a
pouch at the beginning of the large intestine. This area allows food to pass from the small
intestine to the large intestine. The colon is where fluids and salts are absorbed and extends
from the cecum to the rectum. The last part of the large intestine is the rectum, which is
where feces (waste material) is stored before leaving the body through the anus. The main
job of the large intestine is to remove water and salts (electrolytes) from the undigested
material and to form solid waste that can be excreted. Bacteria in the large intestine help to
break down the undigested materials. The remaining contents of the large intestine are
moved toward the rectum, where feces are stored until they leave the body through the
anus as a bowel mo
XI.
Nursing Care Plan