TABLE OF CONTENTS

TABLE OF CONTENTS..............................................................................................i I. INTRODUCTION...................................................................................................1 OBJECTIVES.........................................................................................................4 B. Specific Objectives:.....................................................................................4 A. Biographical Data ..........................................................................................6 B. Chief Complaint..............................................................................................6 C. History of Present Illness ...............................................................................7 D. Past Medical History.......................................................................................7 E. Personal and family History............................................................................7 F. Socio-Economic History..................................................................................8 G. Nutritional Status:..........................................................................................8 H. Genogram....................................................................................................11 I. Developmental Tasks ...................................................................................12 GENERAL SURVEY:............................................................................................17 III. LABORATORY AND DIAGNOSTIC EXAMINATION .............................................25 Fecalysis........................................................................................................... 25 Urinalysis..........................................................................................................26 Hematology......................................................................................................28 IV. ANATOMY AND PHYSIOLOGY...........................................................................30 V. PATHOPHYSIOLOGY.........................................................................................34 A. Symptomatology..........................................................................................34 ........................................................................................................................... 37 VI. SYNTHESIS OF CLIENTS CONDITION...............................................................38 A. Conclusion....................................................................................................38 B. Patients Prognosis.......................................................................................38 Recommendations............................................................................................41 VII. NURSING CARE PLAN.....................................................................................42

NCP#1..............................................................................................................42 NCP #2............................................................................................................44 NCP #3.............................................................................................................47 VIII. PHARMACOLOGICAL MANAGEMENT..............................................................49 Paracetamol ....................................................................................................49 Zinc Sulfate .....................................................................................................51 IX. DISCHARGE PLAN...........................................................................................54 X. EVALUATION OF THE OBJECTIVE OF THE STUDY..............................................56 XI. BIBLIOGRAPHY................................................................................................57

ii

I. INTRODUCTION

Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in acute diarrhea. The inflammation is caused most often by infection with certain viruses, less often by bacteria or their toxins, parasites, or adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis as food borne illness are due to norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and astrovirus. Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, 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. Dehydration is a lack of water in the body. It can be caused by not drinking enough fluids or by losing fluids because of heat exposure, sweating, vomiting,

diarrhea, or fever. Mild dehydration is easy to treat, but severe, untreated dehydration is a medical emergency.

Signs of dehydration include dry lips and mouth, lack of tears, and -- for infants -fewer than 6 wet diapers in a day, or diapers that seem lighter and less saturated with urine than usual.

Severe dehydration requires emergency treatment. An infant who wont eat or wake up, has a deeply sunken fontanel ('soft spot' in the skull) or eyes, or has very little urine output should be seen by a doctor immediately. Dehydration means that a child's body lacks enough or fluid. any Dehydration combination can of result these from not

drinking, vomiting, diarrhea,

conditions.

Rarely, sweating too much or urinating too much can cause dehydration . Infants and small children are much more likely to become dehydrated than older children or adults, because they can lose relatively more fluid quickly. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year and is a leading cause of death among infants and children under 5. The most common symptoms are diarrhea, vomiting and stomach pain, because whatever causes the condition inflames the gastrointestinal tract. Another reason to seek medical treatment is that some forms of acute gastroenteritis mimic appendicitis, which may require emergency treatment. As well, young children run an especially high risk of becoming dehydrated during a long course of the stomach flu. One should receive directions regarding how to help affected kids or adults get more fluids. Sometimes children, those with compromised immune systems, and the2

elderly may require hospitalization and intravenous fluids. Dehydration can actually cause greater nausea, and can begin to cause organ shut down if not properly addressed. Acute gastroenteritis is quite common among children, 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. Acute gastroenteritis remains a serious health issue, and is responsible for over 50,000 hospitalizations of children. In developing countries, acute

gastroenteritis is the leading cause of death for infants. Acute gastroenteritis should thus be taken seriously, and people should not hesitate to seek medical treatment for especially seniors and children who have been ill for more than a day. In the Philippine Health Statistic, gastroenteritis range as number 10 in the ten leading causes of infant mortality, with the rate of 0.5 and percentage of 4.1 cases in the Philippines by the year 2004 this was updated last February 12, 2008. Locally, In July 22, 2004, the Department of Health (DOH), Philippines declared an epidemic (outbreak) of a water/food-borne disease called acute gastroenteritis in 45 towns in Central Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily caused by ingestion of spoiled or bacterial contaminated water or food. According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the said intestinal infection were recorded in just 45 days (from May 31 to July16,3

2004). From the studies on the medical diagnoses of 81 cases, Dayrit concluded that infectious (transmittable) cholera disease was the main cause of the epidemic. (www.doh.gov.ph) Locally, here in Tagum City, at Davao Regional Hospital pediatric department acute gastroenteritis was considered number 3 among the most common pediatric cases. It is common in this area because some of the people are not aware regarding the proper handling and preparation of food. According to Kapalong District Hospital, there are 16 female infants and 29 male infants aged 0-12 months old with acute gastroenteritis with some dehydration confined there from the month of August.

OBJECTIVES A. General Objectives: This study aims to convey familiarity and to provide an effective nursing care to a patient diagnosed with Acute Gastroenteritis through patient history, disease process and management. B. Specific Objectives: Establish rapport to gain clients cooperation in attaining relevant information. Gather all relevant information about the patient that will serve us our baseline data for the fulfillment of this case study,4

understanding

the

Trace patients family history through family genogram, including the past and present health history of the patient,

Perform the head-to-toe physical assessment of the patient that will indicate the aspect of his condition,

Trace the pathophysiology of the patient who have acute gastroenteritis including the underlying symptoms and its predisposing and precipitating factors,

Review the anatomy and physiology of the affected organs, Enumerate those prescribed medications of the patient, Formulate nursing care plans based on the problem and evaluate the appropriate interventions to be apply, and

Create

a

prognosis

that

will

evaluate

patients

condition,

list

recommendations, and evaluate the overall outcome of the study.

5

II. ASSESSMENT

A. Biographical Data Name Age Gender Address Birth date Birthplace Race Religion Marital Status Occupation Admitting Diagnosis Attending Physician Source of Data : Patient X : 1 year old & 2 months : Male : Prk.15 Ilaboon, Kapalong ,Davao del Norte : June 20,2010 : Well Family Narciso Lying-In : Filipino : Roman Catholic : Single : Not Applicable : Acute Gastroenteritis with some Dehydration : Dr.Alan J. Tionco, MD : Caregiver/mother

B. Chief Complaint The patient is 1 year old & 2 months. He was admitted due to loss bowel movement and vomiting.

6

C. History of Present Illness According to his mother last night of August 31, 2011, the day prior to admission he was given one glass of water coming from deep well. And then, Patient X had onset of loss bowel movement, abdominal pain, and fever. The patient was brought to the clinic for check-up he was then referred to Kapalong District Hospital for admission. D. Past Medical History Illness Cough & Fever Diarrhea Age 6 mos. 8 mos. Duration 1-2 days 1-2 days Treatment Paracetamol Herbal leaves

E. Personal and family History Patient X was come from Labuon, Kapalong, Davao del Norte. He was raised up by his mother and father giving his needs. His grandmother in maternal side at present 52 years old , diagnosed with Asthma & Heart Disease. His grandmother on the paternal side at present age of 50 and was treated to Quack Doctor due to colic when she was on mid 40s and his grandfather at present age of 51, well and alive. His mother and father didnt acquire diseases from their parents at present. They have their three offsprings .The oldest 7 years old was experienced vomiting and diarrhea right before the admission of our client. With present illness of Acute

7

Gastroenteritis with some Dehydration and was admitted to Kapalong District Hospital. F. Socio-Economic History Patient X was born on June 20, 2010. He was the youngest among the three offspring of Mr. and Mrs. X. According to his mother, he likes thumb sucking, and he always bites his nails, thats why he occasionally scolded but most of the time the mother allowed to sucked with it. Because he repeatedly do it and this is also according to his mother for his early weaning age. He likes hang-out by pointing to their neighbors and he was carried with his mother, he wears smile when he was in good mood. Rarely, he can easily left on their neighbors care, whenever his mother had to do important things. If no one will able to watch over him or pick him up he would cry. His father routine early in the morning prior to work in Banana Plantation is to teach Patient X how to speak and intonation of A, B, C and count 1, 2, 3 and so on... His father has a regular job and has estimated income of 4,000-5,000 pesos it is including list of expenses in the company like health insurances. His mother was a housewife only without business matter in their home, she was suppose and responsible to care their children.

G. Nutritional Status:

Age 1st 3 months

kinds of foodstuff Pure

How to prepare Wipe the

Servings

nipple 15-30 mins.8

Age

kinds of foodstuff Breastfeeding

How to prepare

Servings

and areola prior to 40-60 cc per BF feeding. -Proper 6-8 session of BF latching per day. bottle feed

4 months-5 mos.

on. Breastfeeding and Boiled water from 4-5 sometimes commercial milk(Bear brand) deep well

for consumed per day

about 10-15 mins. 1 bottle=140 cc. Sterilized equipments Commercial milk 1 -1 1/2 cup of rice and

6 months-8 mos.

Breastfeed,

Commercial milk, mixed with boiled cook cooked rice added water from deep soup. with soup variety or

of well for about 10- 2 cup of lugaw mins. /serving

cooked 15

rice lugaw only sometimes no alternative or Not sterilized mixed with meat Equipments, but in and vegetables. glass they of water drinks

coming from deep well filtration sterilization. without or

9

Age

kinds of foodstuff

How to prepare Commercial milk 2-3

Servings cup of

9 months-1yr. & 2 Breastfeed, mos.(at present) commercial

milk, mixed with boiled lugaw /serving

cooked rice added water from deep with soup variety or of well for about 10mins.

cooked 15 sometimes Not sterilized

rice lugaw only

Equipments, but in glass they of water drinks

coming from deep well filtration sterilization without or

10

H. GenogramLola C 51 Ast. & HD W&A (GM) Lolo C 52 W&A (GF) Lolo V 51 W&A (GF) Lola V 50 W&A (GM)

Mrs . X 31 W&A

Mr.X 33 W&A

BBJ 7 W&A

BBU 5 W&A

Patient X 1 yr. & 2 mos. AGE

Legend: -femaleGastroenteritis -male

W & A- Well & Alive Ast-AsthmaGF/GM-Grandfather/Mother HD-Heart Disease AGE-Acute

I. Developmental Tasks

12

THEORIST / THEORY Sigmund Freud Psychosex ual Theory

STAGES / TASK Oral stage

NORMAL

ACTUAL

JUSTIFICATION The first stage of personality he development

FINDINGS FINDINGS During the Patient X likes

Birth- 1 yr. oral stage, the Thumb old infant's primary source interaction occurs through mouth. sucking,

always put his where is center of nails under his of pleasure is in tongue and do the thumb sucking the His mouth. It baby's gets

mother much satisfaction

The provide pacifier from putting all alternative sorts of things in its mouth to

mouth is vital as

for eating, and for sucking but the derives infant most time of

the satisfy and thus the its id demands.

pleasure from mother allowed oral stimulation through gratifying activities such as tasting and sucking. Because infant the is13

to

suck

with

finger because he repeatedly

do it .

THEORIST / THEORY Sigmund Freud Psychosex ual Theory

STAGES / TASK Oral stage

NORMAL

ACTUAL

JUSTIFICATION The first stage of personality he development

FINDINGS FINDINGS During the Patient X likes

Birth- 1 yr. oral stage, the Thumb old infant's primary source interaction occurs through mouth. sucking,

always put his where is center of nails under his of pleasure is in tongue and do the thumb sucking the His mouth. It baby's gets

mother much satisfaction

The provide pacifier from putting all alternative sorts of things in its mouth to

mouth is vital as

for eating, and for sucking but the derives infant most time of

the satisfy and thus the its id demands.

pleasure from mother allowed oral stimulation through gratifying activities such as tasting and sucking. Because infant the is14

to

suck

with

finger because he repeatedly

do it .

THEORIST / THEORY Jean Piaget Cognitive Developm ent

STAGES /

NORMAL

ACTUAL

JUSTIFICATION

TASK FINDINGS Sensori Differentiates motor self

FINDINGS Patient X can During this stage, simple a child has little in

from do reflexes as

(Birth 2 objects. yrs. old) -Recognizes

such relatively

grasping, competence

self as agent sucking

and representing the

of action and closing fingers environment begins to act repetitively. intentionally: e.g. pulls During a stage , using images, or An no of

this language, his symbols. of infant has

string to set knowledge mobile motion shakes in the world

is awareness

or limited to their objects or people a sensory that are not

rattle to make perceptions a noise. and activities

immediately at a

motor present given Object

Achieves object permanence: realizes things

moment.

-Also loved to permanence hidden the

is

that obtain objects

awareness

by that objects and15

THEORIST / THEORY

STAGES / TASK

NORMAL

ACTUAL

JUSTIFICATION people continue

FINDINGS FINDINGS continue to reaching exist when even behind no screen.

a to exist even if they are out of sight. In infants, when a person hides, the infant has knowledge no that

longer present to the sense. (Atherton J S, 2011))

they are just out of sight.

16

J. Physical Assessment

GENERAL SURVEY: The patient smiles whenever he was played by the interviewer, and he sometimes frown. He was playful and active.

VITAL SIGNS TAKEN AS FOLLOWS: Temperature : 37.6

NORMAL FINDINGS:

INTERPRETATION:

-36.5- 37.2 c

-High temperature may indicate infection.

Pulse Rate: 132 cpm Respiratory Rate: 30bpm

-120- 160 cpm -30-60 bpm

-normal finding -normal finding (P.M. Dillon, Nursing Health Assessment)

ANTHROPOMETRIC MEASUREMENT: Length: 50 cm Weight (previous) : 2200g (current): 2220g -45-55 cm -2500- 4000 g -33-35 cm -Anthropometric measurements deviating from normal may be cause by underlying disease or17

Head circumference: 35 cm -30.5-33 cm Abdominal circumference: 34 cm Chest circumference: 32cm -30.5- 33 cm

inadequate eating or nutritional pattern.

(P.M. Dillon, Nursing Health Assessment)

SYSTEM/TECHNIQUE NORMAL FINDINGS INTEGUMENTARY Inspection, Palpation Skin -Light brown, tanned skin -Moisture in skin folds and axillae -Smooth texture -Springs back immediately to previous state

ACTUAL FINDINGS

INTERPRETATION

-Pale

-The patients skin color is abnormal.

-Dry skin

-Deviated due to slight dehydration

-Rough -Poor skin turgor of 4 seconds before getting back to normal (P.M. Dillon, Nursing Health18

SYSTEM/TECHNIQUE NORMAL FINDINGS

ACTUAL FINDINGS

INTERPRETATION

Assessment) HEENT Inspection, palpation, used of pen light Head

-soft and flat fontanels

-sunken fontanels

-

Abnormal finding

-

Deviated due to slight dehydration

-symmetrical face movement

-symmetrical face movement

-

Normal finding

(P.M. Dillon, Nursing Health Assessment) Eyes -positive red light -positive red light -normal finding reflex in both eyes reflex in both eyes

-presence of tears - tears not noted - Deviated upon crying -equal upon crying

due

to

slight dehydration

and -sunken eyes and - Abnormal finding19

SYSTEM/TECHNIQUE NORMAL FINDINGS symmetrical

ACTUAL FINDINGS weak

INTERPRETATION

- Indication neuromuscular

of

problems and sign of dehydration -positive capillary -positive capillary - Normal finding

reaction to light

reaction to light (P.M. Nursing Dillon, Health

Ears

-ears

align

Assessment) with - ears align with -normal finding

external canthus of external canthus of the eyes -positive reflex the eyes startle -startle noted (P.M. Nursing Nose -Smooth, symmetric Dillon, Health reflex -normal finding

Assessment) -Smooth, -normal finding with symmetric with

same color as the same color as the face face (P.M. Nursing Dillon, Health20

SYSTEM/TECHNIQUE NORMAL FINDINGS Mouth/ Throat

ACTUAL FINDINGS

INTERPRETATION

- Pink in color, soft -Dry lips moist

Assessment) -abnormal finding -Deviated due to

slight dehydration -Uniform pink color -Dry and slightly -Deviated pink in color from

normal due to slight dehydration

-Pink gums, moist, -Pink gums, dry, firm texture -positive firm texture sucking -positive sucking -normal finding

and rooting reflex

and rooting reflex (P.M. Nursing Dillon, Health

RESPIRATORY Auscultation, observation

- RR: 30- 60 bpm

-RR : 30 bpm

Assessment) -Normal finding. Respiration initiated by chemical and

mechanical of birth. - Lung is clear from adventitious sounds.

events

- Lung is clear -normal finding from adventitious sounds. (P.M. Dillon,21

SYSTEM/TECHNIQUE NORMAL FINDINGS

ACTUAL FINDINGS

INTERPRETATION

Nursing CARDIOVASCULAR Auscultation, observation -positive pulse -no murmurs -no cyanosis -cyanosis noted -murmurs noted femoral -femoral noted (P.M. Nursing GASTROINTESTINAL Palpation, auscultation -positive sounds -anus patent bowel -Hyperactive bowel sound -anus patent pulse not

Health

Assessment) not -normal findings

Dillon, Health to

Assessment) -Deviated due diarrhea -normal finding

-bowel movement -bowel movement -Abnormal of once a day and of 4 times with Indication a soft, yellow watery stool diarrhea decrease volume.

finding. of due to fluid

stools daily

-round abdomen

-abdominal distension

-Abnormal

finding.

This may indicate portal hypertension22

SYSTEM/TECHNIQUE NORMAL FINDINGS

ACTUAL FINDINGS

INTERPRETATION

and increase fluids in the stomach. (P.M. Nursing Assessment) GENITOURINARY Inspection, palpation -voided per day 2-3times -voided 2 times -normal findings Dillon, Health

- 2-3 ml/kg/hr urine output for infants (P.M. Nursing Assessment) MUSCULOSKELETAL Inspection, Observation -10 fingers and 10 -10 fingers and 10 -all were in normal toes -C curve of supine toes noted -C curve of supine noted -equal gluteal folds -equal gluteal folds noted -full range of -full range of23

Dillon, Health

findings

SYSTEM/TECHNIQUE NORMAL FINDINGS motion extremities

ACTUAL FINDINGS of motion extremities of

INTERPRETATION

(P.M. Nursing Assessment)

Dillon, Health

24

III. LABORATORY AND DIAGNOSTIC EXAMINATION

Fecalysis Laboratory test Color Result Greenish Normal Findings Brown Interpretation Green stool can also be a symptom of various intestinal disorders that interfere with the normal digestion process. Source: Consistency Soft Soft and bulky, small and dry, depending on the diet http://www.bettermedicine.com Consistency of stool can vary considerably in healthy

individuals depending on their diets. Thus, individuals who eat large amounts of

vegetables will have looser stools than individuals who eat few vegetables Source: http://www.medicinenet.com

25

Urinalysis Laboratory test Color Result Yellow Normal Findings Straw - Dark yellow Interpretation Normal urine is typically light yellow and clear without

any cloudiness. Source: Appearance Clear Clear Hazy http://smrtx.com Normal urine clear and has is a

straw-yellow color. Source: Sugar Negative Negative http://smrtx.com Glucose is not usually urine. Source: Mucous Threads Few http://smrtx.com Mucus threads in a urinalysis considered normal amounts. Source: Pus cells 3-6/hpf http://smrtx.com Pus cells in urine26

found

in

are to be

in

small

Laboratory test

Result

Normal Findings

Interpretation represent an abnormality, though not necessarily one. of a

serious presence cells

The pus an

signifies of

infection

some

sort is present. Source: Specific Gravity 1.019 1.003-1.029 Health and Nutrition Since the specific gravity of the

glomerular filtrate in Bowman's space

ranges from 1.007 to 1.010, any

measurement below this range indicates hydration and any measurement above it indicates relative dehydration. Source:

27

Laboratory test Albumin

Result Positive

Normal Findings

Interpretation The Doctors Doctor

Hematology Laboratory test Hemoglobin Result 126 Normal Findings Male (140-170) Interpretation This shows that a low hemoglobin count can

also be caused by an abnormality or disease. In these situations, a low hemoglobin count is

referred to as anemia. Source: Leukocyte 14.2 5-10x10g/l http://www.mayoclinic.com This indicates low sodium in Source: http://www.mayoclinic.com Segmenters (often just segs) are one of the types of neutrophils found in the blood. They if would the be the blood.

Segmenters

0,68

(0,40-0,60)

elevated

overall

white count is up, usually due to some kind28

Laboratory test

Result

Normal Findings

Interpretation of infection. Source:

Lymphocytes Thrombocytes Hematocrit

0,32 280 42

(0,20-0,40) (150-380x10g/l) Male (40-52)

http://www.mayoclinic.com Lymphocyte is just within the normal range. Platelet is just within the normal range. Hematocrit is just within the normal range.

29

IV. ANATOMY AND PHYSIOLOGY

SALIVARY GLAND Any of the organs that secrete saliva, a substance that moistens and softens food, into the oral cavity of vertebrates. NASAL PASSAGE The walls of the nasal passages are coated with respiratory mucous membranes which contain innumerable tiny hair-like cells that act to move waves of mucus toward the throat. Dust, bacteria, and other particles inhaled from the air are trapped by the mucus in the nose, carried back, swallowed and dropped into the gastric juices to nullify any potential harm they might do. MOUTH The mouth is the beginning of the digestive tract; and, in fact, digestion starts here when taking the first bite of food. Chewing breaks the food into pieces that are more easily30

digested, while saliva mixes with food to begin the process of breaking it down into a form your body can absorb and use. ESOPHAGUS Located in your throat near your trachea (windpipe), the esophagus receives food from your mouth when you swallow. By means of a series of muscular contractions called peristalsis, the esophagus delivers food to your stomach. STOMACH The stomach is a hollow organ, or "container," that holds food while it is being mixed with enzymes that continue the process of breaking down food into a usable form. Cells in the lining of the stomach secrete a strong acid and powerful enzyme that are responsible for the breakdown process. When the contents of the stomach are sufficiently processed, they are released into the small intestine. LIVER A. Location and size of the liver- largest gland in the body, weighs approximately 1.5 kg; lies under the diaphragm; occupies most of the right hypochondrium and part of the epigastrium. B. Liver lobes and lobules- two lobes separated by the falciform ligament 1. Left lobe- forms about one sixth of the liver 2. Right lobe- forms about five sixths of the liver; divides into right lobe proper, caudate lobe, and quadrate lobe

31

3. Hepatic lobules- anatomical units of the liver; small branch of hepatic vein extends through the center of each lobule C. Functions of the liver 1. Glucose Metabolism 2. Ammonia Conversion 3. Protein Metabolism 4. Fat Metabolism 5. Drug Metabolism 6. Bile Formation PANCREAS The pancreas secretes digestive enzymes into the duodenum, the first segment of the small intestine. These enzymes break down protein, fats, and carbohydrates. The pancreas also makes insulin, secreting it directly into the bloodstream. Insulin is the chief hormone for metabolizing sugar.

GALL BLADDER The gall bladder is a pouch-shaped organ which lies near the liver. It accepts bile from the liver, and stores it. When food is digested, the gallbladder releases bile into the small intestine where it is able to help dissolve fats.

32

SMALL INTESTINE Made up of three segments the duodenum, jejunum, and ileum the small intestine is a 22-foot long muscular tube that breaks down food using enzymes released by the pancreas and bile from the liver. LARGE INTESTINE The parts of the food that cant be digested get pushed into the large intestine, also called the colon. It is about 5 feet long. Its function is to move the waste from the small intestine on to the rectum. a. Ascending colon b. Transverse colon c. Sigmoid colon RECTUM The rectum (Latin for "straight") is an 8-inch chamber that connects the colon to the anus. ANUS The anus is the last part of the digestive tract. It is a 2-inch long canal consisting of the pelvic floor muscles and the two anal sphincters (internal and external). The lining of the upper anus is specialized to detect rectal contents.

33

V. PATHOPHYSIOLOGY

A. Symptomatology Signs and Symptoms Abdominal pain Present in the patient Rationale The lining of the stomach suffer erosion and perforations, sometimes Nausea and vomiting even bleeding The scarring and narrowing of the passageway of the stomach causes nausea Dry skin and vomiting Caused by dehydration due to N&V. Dry mouth Caused by dehydration due to N&V Sunken eyeballs Caused by dehydration due to N&V.

B. Etiology

34

Precipitating factors: Ingestion of contaminated food and water

Present in the patient

Rationale

H. Pylori,E.Histolytica, Salmonella, Shigella,Campylobacter jejuni, E.Coli, Norovirus, Adenovirus are the causative agents of AGE.

Predisposing actor: Age (1year ) Rotavirus and adenovirus are particularly

prevalent in children younger than 2 years. Very young children are particularly susceptible to secondary dehydration and secondary nutrient malabsorption. http://emedicine.medscape.com/article/928598overview#a0199 hygiene If the person is poor in their hygiene their is a possibility the he ingest the bacteria that soon it will caused A.G.E Environment Poor management of environment triggers the growth of bacteria that sooner it will ingested by the person leading to serious complication.

35

C. Diagram

PRECIPITATING FACTORS Ingestion of contaminated food & water

PREDISPOSING FACTORS Poor personal hygiene Age Environment

Ingestion of contaminated food and water Invasion of gastric mucosa

Release of endotoxins Stimulation & disturbance of mucosal lining of the bowel wall. Pain Bleedin g Ulceration

Malfunction in absorption

Excessive gas formation

GI Distention

S/S: Nausea & Vomiting, Flatus

Secretion of fluids & electrolyte in the intestinal lumen

Increase secretion of Cl & HCO3 ions in the bowel 36

Increase peristalsis

Mild Diarrhea (23 stools) Fluid & Electrolyte imbalance Increase protein in the lumen

Inhibition of sodium reabsorption

Lower intestine is overwhelmed & unable to absorb the lost fluid Intense Diarrhea (4x) (watery stools)

If not treated Serious fluid volume deficit S/S: Hypotensi on Hypovole mic shock

If treated

DEATH

Nsg. Interventions: Avoid ingestion of contaminated foods and water Increase OFI Encouraged to take foods such as: -Non-oily foods Avoid activities that may predispose condition.

Medical Interventions: Administer medications: -Antidiarrheal Controlling symptoms of persistent diarrhea Prevention of 37

VI. SYNTHESIS OF CLIENTS CONDITION

A. Conclusion Based on the aforementioned result, the overall prognosis of the client is fair. Therefore proper monitoring is needed and modifications on the clients lifestyle must be properly monitored. . B. Patients Prognosis

CRITERIA Onset Illness of

GOOD 3

FAIR 2

POOR 1

JUSTIFICATION The mother of the patient is aware of the condition, seldom medical due to patients but seeks attention, financial They

concerns.

only seek medical attention when the

38

condition severe. The Family support

was patients

mother is hands-on in caring for the patient. attends to And the

Willingness to take treatment regimen

patients needs. The patient did not drink the medicine immediately and

there was delay in purchasing prescribed Nutrition medicines. The patient only the

eats porridge, and have not eaten any meat vegetables. patient water well. from or The drinks the

39

Duration illness

of

The patient is still in the hospital.

Age

AGE occurs most in young children in no industrialized

countries. Gender does not Gender affect prevalence AGE. Race Blacks are the the of

most affected race. Asians come

second and whites are the least.

40

Computation: Good: 2x3= 6 Fair: 4x2= 8 Poor: 2x1= 2 16 16/ 8 = 2 (Fair Prognosis) Legend: Good: 3 pts. Rating: Fair: 2 pts. Poor: 1 pt.

Good: 2.4 3.0

Fair: 1.7 2.3

Poor: 1 1.6

Recommendations The group has listed the following recommendations to improve the patients state of health. Sterilize drinking water by boiling for at least 30 minutes and store in a clean container Increase oral fluid intake Maintain proper hygiene Be sure to take adequate rest and sleep. Encourage regular oral care41

VII. NURSING CARE PLAN

NCP#1 ASSESSMENT Subjective Cues: NURSING OBJECTIVE NURSING INTERVENTION EVALUATION

DIAGNOSIS CRITERION Fluid volume Within 2 days of Independent: deficit dehydration r/t providing nursing to care, will maintain fluid electrolytes 2 volume at a and Patient may reduce fluid intake GOAL MET during periods of vomiting, diarrhea and so on.increasing oral fluid intake to replace the fluid loss. -Monitored v/s,comparing with Patient regained and After 2 days of nursing care, -increase oral fluid Intake

Objective Cues:

consider

-Watery,loose electrolyte stool(4x/day) in mod. imbalance amt -Sunken noted -Sunken fontanel Acute Gastroenteritis Rationale: eyeballs Acute

functional level as evidenced by: will defecate

patients normal/ previous readings

semi-formed stool served as a baseline data.

maintained fluid42

ASSESSMENT noted Dry lips & mucus

NURSING

OBJECTIVE

NURSING INTERVENTION

EVALUATION at a

DIAGNOSIS CRITERION Gastroenteritis is at least 2 times a an inflammation day will manifest lips

-Observed for fever, changes in,skin volume

turgor, dryness of skin and mucous functional level membranes, pain. Symptoms reflective of DHN/ as by: evidenced

membrane noted. Distended noted Poor sucking noted Delayed refill noted Pale skin Wt=2220grarms. of capillary 4seconds

on the stomach & GI tract which is

abdomen manifested diarrhea, abdominal associated

moist mucous

and

by

hemoconcentration with consequent -Defecating and vasoocclusive state. Dependent: -Administered fluids as indicated semi-formed stool at 2 times a day.

membranes pain with

capillary refill in 2-3 seconds weight

nausea, vomiting, fever, abdominal distention& excessive elimination of caused and

of replaces losses/deficits. Fluids must -manifesting will be given immediately to decrease moist lips and

2220grs

increase to 2500 hemoconcentration and prevent further mucus grs interaction Collaborative: Review laboratory data membranes and capillary refill of 2-3 seconds

TPR as follows: waste

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ASSESSMENT T-37.6 P-132bpm RR-30cpm

NURSING DIAGNOSIS electrolyte imbalance Reference: Medical Surgical

OBJECTIVE CRITERION

NURSING INTERVENTION For accuracy of data taken.

EVALUATION -weigth 2500grms -fever will of

subside with the temperature less than 37. of

Nsg. 10th Ed by Brunners Suddarth NCP #2 ASSESSMENT SUBJECTIVE: NSG. DIAGNOSIS Ineffective OBJECTIVE Within 2 hrs of nursing intervention, patients body temperature will decrease to its normal value INTERVENTIONS INDEPENDENT: >established rapport. RATIONALE >to gain trust and cooperation from the patient specially the patient is still an infant. &

EVALUATION GOAL MET. >After 2 hrs. Of nursing interventions, the patients body temperature decreases from44

Init siya mam as thermoregulation verbalized by the mother. related to inflammatory process secondary OBJECTIVE: -dry skin to Acute Gastrointeritis

ASSESSMENT -warm to touch -dry lips -flushed face -Temperature is 37.6 C Timed assessed. 8AM.

NSG. DIAGNOSIS Scientific basis: Fever must always be investigated to determine whether infection is the source. There is evidence that fever, mediated by the hypothalamus, may potentiate beneficial functions in the syndrome of reactions known as acute phase reaction. These

OBJECTIVE 36.5-37.5C

INTERVENTIONS >TSB

RATIONALE > To promote heat loss by evaporation and conduction.

EVALUATION 37.6 to 36.8C

Timed evaluated: 10pm.

>promote surface cooling by loosening the clothes.

> To promote heat loss by evaporation and conduction.

>asses fluid loss and facilitates oral fluid intake to accomplished fluid replacement.

>increase metabolic rate and diaphoresis associated with fever causing loss of body fluids.

>monitor vital signs.

>To provide

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ASSESSMENT

NSG. DIAGNOSIS reaction includes changes in lever protein synthesis; alteration in serum metals, such as iron; and increase production of certain classes of white blood cells and other immune system cells.

OBJECTIVE

INTERVENTIONS >provide Health teachings to patients mother regarding the proper way of taking care of her son while on hyperthermia.

RATIONALE baseline data. >To give accurate information to the mother.

EVALUATION

DEPENDENT: >administered Paracetamol as ordered by the physician.

>This is to reduce body temperature.

COLLABORATIVE: >Refer to laboratory.

> for further investigations,

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ASSESSMENT

NSG. DIAGNOSIS

OBJECTIVE

INTERVENTIONS

RATIONALE regarding patients condition

EVALUATION

NCP #3 ASSESSMENT SUBJECTIVE: NSG. DIAGNOSIS Acute pain related OBJECTIVE Within 7 hours of nursing intervention, the patient will: -be free from pain -will use medication as prescribed Scientific basis: It is believed that the pain occurs >Provide comfort measures. And encouraged adequate rest periods. >Teach the mother additional >use of these strategies along Time evaluated: INTERVENTIONS Independent: >Monitor vital signs. >this usually altered by acute pain >to prevent fatigue RATIONALE EVALUATION GOAL MET. After 7 hours of nursing intervention, the patient was free from pain as evidenced by face pain rating scale of 0.

sige rag hilak ang to inflammation of bata, dili sya mahimutang, as verbalized by the mother. the gastrointestinal tract secondary to acute gastroenteritis. OBJECTIVE: -crying -watery stool -twice diaper

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changes -with face pain

when the increase acid content of the

strategies to relieve pain and discomfort.

with analgesia may produce more effective pain relief

2:00 pm

rating scale of 5, 0 stomach and being the lowest and 5 being the most painful. -sunken eyes

deudenum erodes the affected area and stimulates the exposed nerve Dependent: >Administered analgesic as ordered by the physician. Reference: Smeltzer, S. Et al., Medical Surgical Nursing, 10th ed. Vol 1.

>to relieve pain

-TPR

as endings.

follows: T-37.6 P-132bpm

RR-30cpm

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VIII. PHARMACOLOGICAL MANAGEMENT

Date / Shift 09/012/11 7-3

Name of Drug Generic Name: Paracetam ol

Dosage/ Time/Ro ute 1tsp. q4o PRN

Indications

Contraindic Mechanism ations of action

Side Effects Drowsin ess, dizzines s, nausea, vomiting , abdomin al pain, rashes.

Nursing Responsibilities Instruct the mother to increase the oral fluid intake of the patient. Monitor the temperature of the patient. Assess for allergic

Referen ce PPD s Nursing Drug Guide(2nd

Indicated for the rapid lowering of fever in colds,

Contraindic Decreases ated to hypersensi tivity of the drug. fever by inhibiting the effects of pyrogens on the hypothalami c heat regulating

Brand name:

influenza.

Edition)

Classificati on:

centers and by a

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Date / Shift

Name of Drug Analgesic and Antipyretic

Dosage/ Time/Ro ute

Indications

Contraindic Mechanism ations of action hypothalami c action leading to sweating

Side Effects

Nursing Responsibilities reaction. If allergic occurs drug may have to be discontinued. Inform the mother what are the side effects of the drug sothat the mother would be aware. Watched for

Referen ce

Drawing:

and vasodilations .

50

Date / Shift

Name of Drug

Dosage/ Time/Ro ute

Indications

Contraindic Mechanism ations of action

Side Effects

Nursing Responsibilities any unusualities to the patient.

Referen ce

Date / Shift 09/012/11 7-3

Name of Drug Generic Name: Zinc Sulfate

Dosage/ Time/Ro ute 1tsp. OD 15 days

Indications

Contraind Mechanism ications of action

Side Effects

Nursing Responsibilities

Referenc e http://ima ges.searc h.yahoo.c om/searc h/images; _ylt=A2K Jke2_kV9 OVDQAV51

Treatment or prevention of zinc

Contraind Participate icated in patients hypersen sitive to iodine. in synthesis and stabilization of proteinsand nucleic acids in

Nausea, bad taste, diarrhea, vomiting, mouth irritation, and, rarely, mouth sores. Nasal

Explain to the mother the need for zinc administrat ion to the patient.

Brand name:

6am6pm

deficiencie s.

Classificatio n: Vitamins and Minerals

subcellular and membrane transport system.

and throat irritation may occur with the zinc spray. There have been case

Instruct the mother to increase the oral fluid intake of the patient.

KOJzbkF ?p=zinc %20sulfat e %20syrup &fr=fptbhpd10&ei =utf8&n=30& x=wrt&fr2 =sggac&sado =1 http://ww w.drugs.c om/npp/zi nc.html52

Drawing:

reports of apparent zincinduced copper deficiency, immune system dysfunction, and myeloneuropa thy. An

Inform the mother what would be the side effect of the drug. Tell patient to report signs of hypersensi

increase in genitourinary symptoms and prostate cancer has been related to zinc supplementati on.

tivity promptly. Watched for nausea and vomiting. Watched for any unusualitie s.

Lippincot Williams & Wilkins(2 007) drug handbook .

53

IX. DISCHARGE PLAN

Medication Instruct the family members of the patient about the home meds as prescribed by the physician, including the name of the drug, purposes, time will be taken/ administered, dosage of the drug, and also the side effects. If side effects occur immediately consult the attending physician. Instruct the family members of the patient not to change any of the medication, do not stopped the medications, and do not add any kind of medications without consulting the physician. Instruct the family members of the patient not to take other over the counter drugs without the physicians advised. Exercise

Instruct the family members of the patient to maintain all the activities and restrictions that can affect the condition.

Treatment Instruct the family members of the patient to drink more fluids such as water, or a sports drink (Gatorade). Instruct the family members of the patient that to breastfeed if possible.

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Hygiene Instruct the family members of the patient to maintain hygienic measures like taking a bath everyday and maintain oral care. Instruct the family members of the patient to wash hands before and after meal.

Out-Patient Orders Instruct the family members of the patient to follow the scheduled time for medical check-ups to know the progress of the condition and for further management. Instruct the family members of the patient to strictly follow the medications and diets.

Diet Instruct the family members of the patient to avoid eating greasy foods such as: chocolates. Instruct the family members of the patient to increase the fluid intake.

Spiritual Encourage the family members of the patient to always keep GOD as the center of their lifes and pray for good health and safety.

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X. EVALUATION OF THE OBJECTIVE OF THE STUDY

Having this case presentation, each member of the group involved to the said study was able to assess properly every single data, thoroughly assessed every system involved regarding the patients condition and mapped out and traced the pathophysiology. On the latter part, the students were able to come up with a nursing care plan that is very helpful in restoring the clients present condition. We were able to trace the patients family history through family genogram, gathered all possible resources and relevant datas regarding the past and present history of Patient Xs illness. With the data gathered, we are able to identify vital informations such as predisposing and precipitating factors that greatly contribute to Patient Xs present illness The group was able to identify, determine and understand the underlying general health problems of our client. The study improves our skills and knowledge pertaining on caring patients with such changes.

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XI. BIBLIOGRAPHY

(Kapalong District Hospital) Book: Dillon, P.M. Nursing Health Assessment, Assessing the Newborn and Infant. F.A Davis Company: Philadelphia. Edition 2, page 849- 878. Smeltzer, S et.al., Medical Surgical Nursing Lippincott Williams & Wilkins, C&EPublishing, Inc.10th Edition Web: http://www.emedicinehealth.com/gastroenteritis/page4_em.htm http://www.webmd.com/digestive-disorders/gastroenteritis http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm http://www.cchs.net/health/health-info/docs/1600/1699.asp?index=7041 http:// /doc/38440400/18150141-Case-Study-AGE-With-Signs-of-Dehydration

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