Baliuag University COLLEGE OF NURSING Baliwag Bulacan

Submitted by: Emmanuel Ryan P. Francisco BSN III-D Group 4

May 25, 2011

I.

Introduction
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 gastroenteritis is an infection caused by a variety of viruses that result in vomiting or diarrhea or both. It is often called the "stomach flu," although it is not caused by the influenza viruses. Persons can reduce their chance of getting infected by frequent hand washing, prompt disinfection of contaminated surfaces with household chlorine bleachbased cleaners, and prompt washing of soiled articles of clothing. 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 can be a presenting symptom. This is the case in phlegm nous gastritis (gangrene of the stomach) where severe abdominal pain accompanied by nausea and vomiting of potentially purulent gastric contents can be the presenting symptoms. Fever, chills, and hiccups also may be present. The diagnosis of acute gastritis may be suspected from the patient's history and can be confirmed histologically by biopsy specimens taken at endoscopy.

collection of information specifically to the patients health condition. The study also includes the assessment of the physiological and psychological status, adequacy of support systems and care given by the family as well as other health care providers.

Classification
Bacterial gastroenteritis
 Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with antibiotics. Traveler's diarrhea is usually a type of bacterial gastroenteritis.  If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria, Shigella and Campylobacter, for example, andparasites like Giardia can be treated with antibiotics.

Viral gastroenteritis
 Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus. Viruses do
not respond to antibiotics and infected children usually make a full recovery after a few days

Symptoms and signs

        

Nausea and vomiting Diarrhea Loss of appetite Fever Headaches Abnormal flatulence Abdominal pain Abdominal cramps Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella, Shigella or some pathogenic strains of Escherichia coli) Fainting and Weakness Heartburn

 

Management
Rehydration
The primary treatment of gastroenteritis in both children and adults is rehydration, i.e., replenishment of water and electrolytes lost in the stools. This is preferably achieved by giving the person oral rehydration therapy (ORT) although intravenous delivery may be required if a decreased level of consciousness or an ileus is present. Complexcarbohydrate-based oral rehydration therapy such as those made from wheat or rice

may be superior to simple sugar-based ORS. Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in children under 5 years of age as they may make the diarrhea worse. Plain water may be used if specific ORS are unavailable or not palatable.

Diet
It is recommended that breastfed infants continue to be nursed on demand and that formula-fed infants should continue their usual formula immediately after rehydration with oral rehydration solutions. Lactose-free or lactose-reduced formulas usually are not necessary. Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea; therefore substantial amounts of soft drinks, juice, and other high simple sugar foods should be avoided.The practice of withholding food is not recommended and immediate normal feeding is encouraged. The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.

Medications
Antiemetics Antiemetic drugs may be helpful for vomiting in children. Ondansetron has some utility with a single dose associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting. Metoclopramide also might be helpful. However there was an increased number of children who returned and were subsequently admitted in those treated with ondansetron. The intravenous preparation of ondansetron may be given orally. Antibiotics Antibiotics are not usually used for gastroenteritis, although they are sometimes used if symptoms are severe (such as dysentery) or a susceptible bacterial cause is isolated or suspected. If antibiotics are decided on, a fluoroquinolone or macrolide is often used. Pseudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the causative agent and treating with either metronidazole orvancomycin. Antimotility agents Antimotility drugs have a theoretical risk of causing complications; clinical experience, however, has shown this to be unlikely. They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever.
[10]

Loperamide, an opioid analogue, is commonly used for the symptomatic

treatment of diarrhea. Loperamide is not recommended in children as it may cross the immature blood brain barrier and cause toxicity. Bismuth subsalicylate (BSS), an insoluble complex of trivalent bismuth and salicylate, can be used in mild-moderate cases. Antispasmotics Butylscopolamine (Buscopan) is useful in treating crampy abdominal pain.[33]

Alternative medicine
Probiotics

Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis. They reduce both the duration of illness and the frequency of stools Fermented milk products (such as yogurt) also reduce the duration of symptoms. Zinc The World Health Organization recommends that infants and children receive a dietary supplement of zinc for up to two weeks after onset of gastroenteritis. A 2009 trial however did not find any benefit from supplementation.

II.

Patients Profile

Clients Name: Aaron Teodoro Age: 5 years old Birthday: June 20, 2005 Address: Bagna, City of Malolos Bulacan Civil Status: Single Sex: Male Nationality: Filipino Religion: Roman Catholic Informant: Reymalyn Teodoro (Mother) Date of admission: May 24,2011 Time of admission: 4:00 PM Chief complaint: LBM Admitting diagnosis: AGE with mild dehydration Attending physician: Dr. Crisostomo

III.

HEALTH HISTORY

a. Family Health History According to Reymalyn Teodoro, the mother of my patient there is no history of any illnesses on her side. She has no vices neither drinks alcoholic beverages. Her husband, Christian Teodoro on the other hand has a history of hypertension, Diabetes and other Heart Diseases. He drinks occasionally mostly twice a month with minimum amount of alcohol.

b. Past Health History The mother claimed that her childs past illnesses were a typical cough, colds and fever that usually lasted for three days. Over the counter medicines such as Paracetamol (Calpol) was used to treat for fever and Dimetapp for colds. The mother claimed that her child has completed the vaccination required. At 8 months old her child was confined to BMC because of AGE. c. History of Present Illness 4 Days Prior to Admission client had watery stools yellowish in color, no blood was noted, no mucous is present and is foul smelling. The average frequency per day is 6 time and is associated with vomiting. 2 days prior to admission the client elicits the same condition but because of fever the mother decided to visit the nearest Health Center. She was advised to give biogesic syrup to manage fever, aside from this no other management was given. Because of the worsening condition the mother decided to bring her son to Bulacan Medical Institution for better management of the condition.

Activities of daily Living

A. Circulation During admission his current pulse rate is 114 beats per minute. His lips, nail beds as well as his conjunctiva were pinkish in color. On the assessment time his latest temperature is 37.9 degrees Celsius per axilla B. Respiration During the assessment, no respiratory distress is noted. The current respiratory rate is 28 breaths per minute. C. Food and Fluid Prior to admission, the patients usual eating habit is a complete meal which consists of 3 main meals and 2 snacks in between. Usually he eats breakfast at 8:00 in the morning; consist of a cup of rice and an egg . His lunch is at 12:00 noon which is also consisting of a cup of rice and a usual viand of fried pork, chicken or fish. Same goes with his supper at 7 in the evening. His snacks would be in between breakfast and lunch which is consist of biscuits and other junkfoods. He also have a snack between lunch and supper, which consist of a bread usually bought to a near bakeshop. In a day he would consume 6 glasses of water(water is taken from the supply of

nawasa and is boiled befire drinking), 1 glass of soft drinks (depends on the availability).

During admission he would have his breakfast at 6am which is usually rice porridge. His lunch at 12:00 noon which is consisting of a piece of meat sometimes accompanied by soup. His supper is at 7 in the evening which is consisting of the a cup of rice and the viand prepared by the dietary department. According to mother there is no change in the appetite of his son. He is also eating banana as advised. An ongoing IVF of 0.3 NaCl 500cc regulated at 18 drops per minute. He usually consume 10-12 glasses of water a day. D. Elimination Prior to admission the client usually defecates once a day, usually in the morning during his bath time. He has a formed stool usually brownish in color. The patient urinates 5-6 times a day with a total urine output of 800cc per day.

During admission the client defecates 3 to times a day in no particular time. His stool is loose and has a foul odor. He urinates 2-3 times from 7-3 shift in the morning with a total urine output of 300cc per shift. E. Personal hygiene Prior to admission the client usually takes a bath in the morning after he ate his breakfast. He is assisted by his mother. He is also assisted in brushing his teeth and cutting his nails. The patient changes clothes every day.

During the admission the client cant take a bath but instead her mother renders sponge bath. He changes clothes every day. F. Usual pain During assessment the client complains abdominal pain due to his condition, he also complained about the itching of his eyes. .

Physical Assessment
a) Temperature: 37.9 degrees Celsius per axilla b) Respiratory rate:28 breaths per minute c) Pulse rate: 114 beats per minute

Received patient awake lying on bed with an ongoing IVF of 0.3 NaCl 500cc at 480cc level regulated at 18 drops per minute infusing well at his right arm. The client is wearing blue short together with a white sando. In general the clients skin is light brown in color. Skin is warm to touch, and has flushed skin on the face. On that time his

temperatire is 37.9 degrees Celsius per axilla. There is redness on both eyes and the client complains itchiness. .No signs of dehydration noted. Upon inspection and palpation of the abdomen the client complains abdominal pain but cannot distinguish which particular part is aching.

IV.

ANATOMY AND PHYSIOLOGY:

DIGESTIVE SYSTEM The digestive system consists of two linked parts: the alimentary canal and the accessory digestive organs. The alimentary canal is essentially a tube, some 9 meters (30 feet) long, that extends from the mouth to anus, with its longest section- the intestines- packed into the abdominal cavity. The lining of the alimentary canal is continuous with the skin, so technically its cavity lies outside the body. The alimentary tube consist of linked organs that each play their own part in digestion: mouth, pharynx, esophagus, stomach, small intestine, and large intestine. The accessory digestive organs consist of the teeth and tongue in the mouth; and the salivary glands, liver, gallbladder, and pancreas, which are all linked by ducts to the alimentary canal.

STOMACH It is a J- shaped enlargement of the GI tract directly under the diaphragm in the epigastric, umbilical and left hypochondriac regions of the abdomen. When empty, it is about the size of a large sausage; the mucosa lies in large folds, called RUGAE.

Approximately 10 inches long but the diameter depends on how much food it contains. When full, it can hold about 4 L ( 1 galloon) of food. Parts of the stomach includes cardiac region which is defined as a position near the heart surrounds the cardioesophageal sphincter through which food enters the stomach from the esophagus; fundus which is the expanded part of the stomach lateral to the cardia region; body is the mid portion; and the pylorus a funnel shaped which is the terminal part of the stomach. The pylorus is continuous with the small intestine through the pyloric

sphincter, or valve. With the gastric glands lined with several secreting cells the zymogenic (peptic) cells secrete the principal gastric enzyme precursor, pepsinogen. The parietal (oxyntic) cells produce hydrochloric acid, involved in conversion of pepsinogen to the active enzyme pepsin, and intrinsic factor, involved in the absorption of Vitamin B12 for the red blood cell production. Mucous cells secrete mucus. Secretions of the zymogenic, parietal and mucus cells are collectively called the gastric juice. Enteroendocrine cells secrete stomach gastrin, a hormone that stimulates secretion of hydrochloric acid and pepsinogen, contracts the lower esophageal sphincter, mildly increases motility of the GI tract, and relaxes the pyloricsphincter. Most digestive activity occurs in the pyloric region of the stomach. After food has been processed in the stomach, it resembles heavy cream and is called CHYME. The chyme enters the small intestine through the pyloric sphincter.

VI.

Pathophysiology with Anatomy & Physiology

Diagnosis: AGE with mild DHN

Name of the patient:Aaron Teodoro

Definition: Acute Gastritis is defined as diarrheal disease of rapid onset, often with nausea, vomiting, fever, abdominal pain and loose bowel movement. It is an inflammation of the mucous membranes of the stomach often caused by an infection.

Predisposing Factors:  Environment  Hygiene

Precipitating Factors: ~ Age(6 years old) ~ Gender(Male)

VII.

MEDICAL MANAGEMENT RATIONALE

a. Medical Orders and Rationale

DOCTORS ORDER

 Please admit to pedia ward  For further management and under the service of Dr.Atlusan / Dr.Asis  To provide easy digestion of food  Feeding with SAP without experiencing pain upon digestion  To provide access for intravenous  Start D5 0.3NaCL 500ml @ 100cc/hr  Labs: y CBC  To screen the patients blood component and to detect any abnormalities. This also serves as a baseline data to evaluate y Urinalysis effectiveness of blood transfusions.  To screen the patients urine components and to detect any y SE abnormalities.  To screen the patients feces & to detect any abnormalities  To measure daily I & O of the client  To have baseline data and for comparison of future data / for monitoring of patients condition.  To provide access for intravenous medications. treatment of condition

 I & O q shift  v/s q4H

 IVF with D5 0.3NaCl 500ml @ 100cc/hr  Continue medications

medications.  To help for fast recovery .