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Case Presentation of Patient with Acute Gastroenteritis
Presented by:
BSN 103-A/ Group A2
Flores, Ma. Fe Gabriel, Ivy
Garcia, KesselynGaringo, Jeovina
Gumasing, Mary JanineGutierrez, Sunshine
Hernandez, Baby JaneLamurena, JacquelynLopez, Christine Anne
Lualhati, RichardMapiscay, Ma. RichelMendoza, Rosa Mia
Nicolas, Jean Therese
ASSESSMENT
I. Patient’s Biographical DataNAME : Mrs. Green
ADDRESS : NHV, Tigbe, Norzagaray, Bulacan
DATE OF BIRTH : November 26, 1946
BIRTHPLACE : Leyte
BIRTH HISTORY : Home Birth
AGE : 62 years old
SEX : Female
HEIGHT : 5’1”
WEIGHT : 42 kgs.
FATHER’S NAME : Deceased
MOTHER’S NAME : Deceased
NO. of SIBLINGS : Six (6)
ORDINAL POSITION IN
THE FAMILY : Eldest
CIVIL STATUS : Widowed
NATIONALITY : Filipino
MEDICAL DIAGNOSIS : Acute Gastroenteritis
CHIEF COMPLAINT : Loose watery stool and vomiting
HISTORY OF PRESENT ILLNESS
Prior to admission, the patient complains of loose watery stool and vomiting.
HISTORY OF PAST ILLNESS
The patient reported that she had been hospitalized before with the same medical diagnosis of Acute Gastroenteritis.
II. General Physical AssessmentV/S: temp=36.5˚C, P=62bpm, R=19cpm, BP=120/80
SKIN: The patient’s skin’s moisture is dry due to dehydration. The texture is rough due to aging and signs of dehydration.
HEAD: The patient’s head was round and in proportion w/ the body. Hair color is white and has no dandruff and lice. The patient’s general appearance of face indicates a feeling of weakness.
NECK and SHOULDERS: The veins and clavicle are visible. The shoulders are asymmetrical. The neck muscles are weak.
EYES: The patient’s eyes are symmetrical to the ears. She manifested a blurred vision due to aging. Pale conjunctivae was noted. Sunken eyes was observed. The eyes appeared dry due to dehydration.
EARS: The client’s ear manifested a good hearing balance. There were no discharges noted.
NOSE: The client’s nasal septum is intact and in the midline. There were no discharges noted. Airs move freely as the client breathes through the nose.
MOUTH and THROAT: The client’s mouth has presence of lesions due to frequent vomiting. The lips were dry due to dehydration. The throat was functioning well. No dentures. (+) tartar. There is a black discoloration in the enamel. (+) breath odor.
CHEST: The chest is symmetric. The skin was sagged. The thorax is elliptical.
ABDOMEN: The skin of the abdomen is unblemished and uniform in color. Symmetric abdominal contour flattened and rounded. Audible bowel sounds. Symmetric movements cause by respiration. No tenderness noted.
EXTREMITIES: The fingers in both hands and feet are complete. The shape of the nails is spoon-shape, the consistency is smooth and the color is pinkish white.
SPINE: The spine of the patient is slightly curved. No presence of defects.
III. Significant Health PatternsA. SLEEP
Prior to Hospitalization: Her sleeping pattern before was normal. She was able to consume normal 8-hour sleeping time.During Hospitalization:
During her stay at the hospital she said that she was experiencing difficulty of sleeping.
B. ACTIVITY AND EXERCISEPrior to Hospitalization:
Mrs. Green was a street sweeper and a hog-raiser.During Hospitalization:
During her stay at the hospital, she was not able to perform activities because of restlessness due to her illness.
C. NUTRITIONPrior to Hospitalization:
She has good appetite. During Hospitalization:
During her stay at the hospital, she loses her appetite because of her illness.
IV. Work-ups and InterpretationsA. LABORATORY EXAMINATIONS
URINALYSISColor
Base on the result the color of the urine is yellow. The normal color of the urine must be transparent yellow or amber. Since the color of the urine is yellow it may indicate, food pigments or high-solute concentration.
pH
The pH of the patient’s urine is 8.0. Urinary pH is measured to determine the relative acidity or alkalinity of urine and assess the client’s acid- base status. Urine is normally slightly acidic. Less than 7 (acidic), greater than 7 (alkaline), 7 (neutral).
Specific Gravity
The specific gravity of the patient’s urine is 1.010. The specific gravity of urine normally ranges from 1.010 to 1.025. If the specific gravity increase urine becomes more concentrated.
BLOOD CHEMISTRYBlood Urea Nitrogen
The BUN of the patient is 48.3 mg/dl, the normal findings is 8-25 mg/dl. There is an increase in BUN that may cause dehydration, BUN measures amount of urea in blood. Directly related to metabolic function of the liver.
Creatinine
The creatinine of the patient is 0.6 mg/dl, the normal finding of the creatinine is 0.5-1.7 mg/dl. Creatinine is exerted entirely in kidney and therefore directly proportional to glomerular filtration rate.
HEMATOLOGY
HemoglobinThe hemoglobin of the patient is 90g/L.
The normal findings of hemoglobin is 115 to 155g/L. There is a decrease in hemoglobin that may possibly cause hemolytic anemia and bone marrow suppression.
HematocritThe hematocrit of the patient is 26%, the
normal finding is 36 to 46%. Hematocrit measures the percentage of red blood cells in the total blood volume. It reported as percentage because it is the proportion of RBC’s to the plasma. There is also a decrease in hematocrit that may possibly cause diet deficiency anemia.
WBC CountThe WBC count of the patient is 5.0 x 10g/L, the
normal findings of WBC is 4 to 11x10g/L. High WBC count are often seen in the presence of bacterial infection; by contrast, WBC count may be low if a viral infection is present.
RBC CountThe RBC count of patient is 3.11 x 10 g/L, the
normal finding of RBC is 4-7 x 10 g/L. Her RBC count decreases and the possible cause of this is Iron Deficiency Anemia.
Differential CountThe result of the patient lymphocyte is 19%, the
normal value is 25-35%. There is a decrease in lymphocyte that may cause severe malnutrition.
The result of patient monocytes is 4%, the normal value is 2-5%.
ANATOMY AND PHYSIOLOGY
DIGESTIVE SYSTEM
The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste.
Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.
The Digestive Process: The start of the process - the mouth:
The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus –
After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach – The stomach is a large, sack-like
organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.
In the small intestine – After being in the stomach, food
enters the duodenum, the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder), pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.
In the large intestine – After passing through the small intestine, food passes
into the large intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon.
The end of the process –
Solid waste is then stored in the rectum until it is excreted via the anus.
Digestive System Glossary:
anus - the opening at the end of the digestive system from which feces (waste) exits the body.
appendix - a small sac located on the cecum.ascending colon - the part of the large intestine that run upwards; it is located
after the cecum.bile - a digestive chemical that is produced in the liver, stored in the gall bladder,
and secreted into the small intestine.cecum - the first part of the large intestine; the appendix is connected to the cecum.chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for further digestion.descending colon - the part of the large intestine that run downwards after the
transverse colon and before the sigmoid colon.duodenum - the first part of the small intestine; it is C-shaped and runs from the
stomach to the jejunum.epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. When you swallow, the epiglottis
automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the windpipe.esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements (called peristalsis) to force food from the throat into the stomach.gall bladder - a small, sac-like organ located by the duodenum. It stores and
releases bile (a digestive chemical which is produced in the liver) into the small intestine.
ileum - the last part of the small intestine before the large intestine begins.jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks down fats) and some blood proteins.mouth - the first part of the digestive system, where food enters the body. Chewing and salivary enzymes in the mouth are the beginning of the digestive process (breaking down the food).pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small intestine.peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is involuntary - you cannot control it. It is also what allows you to eat and drink while upside- down.rectum - the lower part of the large intestine, where feces are stored before they are excreted.salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into smaller molecules.sigmoid colon - the part of the large intestine between the descending colon and the rectum.stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in a bath of acids and enzymes.transverse colon - the part of the large intestine that runs horizontally across the abdomen.
PATHOPHYSIOLOGY
Non-modifiable Factor: Age Modifiable Factors: Lifestyle; Diet; Hygiene
Etiology: E. Hystolytica, Salmonella, Shigella, Campylobacter jejuni, E. Coli, Norovirus, Adenovirus
Person to person (hands) Contaminated food and/or water
Ingestion of Pathogens
Direct invasion of the bowel wall Endotoxins are released
Stimulation and destruction of mucosal lining of the bowel wall
Digestive and absorptive malfunction
Excessive Gas Formation
GI Distention
Nausea and Vomiting
F & E Imbalance
Dehydration
Dry lips, dry mouth, fatigue, irritability
Secretion of fluid & electrolytes in the intestinal lumen
Increased Peristaltic Movement
Diarrhea
DRUG STUDY
Drugs Mechanismof action
Indication Contraindication Adverseeffect
Nursingconsideration
Generic name;NIFEDIPINE
Brand name;Nifediac cc
Classification;Calcium channelBlocker
Dosage; 5mg PRN
Variableseffects on AVNodeeffective andFunctionalRefractoryperiod.
Chronic stableangina with outVasospasmincluding anginadue to increaseseffort, especiallyin client, whocannot take betablockers ornitrates whoRemainSymptomaticfollowing clinicaldoses of thisdrugs.Essential tohypertension
Hypersensitivity,lactation
CV;PeripheralAndPulmonaryedema,Hypotensio, palpitation,And tachycardia.
Do not confusenifedipine withNicardipine (theyalso a calciumchannel blocker)
Drugs Mechanism of action
Indication Contraindication Adverse effect
Nursing Consideration
Generic name;Ceftriaxone
Brand name;Rocephin
Classification; Cephalosporin
Dosage; 1ampule=50 mlTIV q12
One-third to two-thirds excreted unchanged in the urine
Lower respiratory tract infection due to streptococcus pneumonia, staphylococcus aureus. Skin and skin structure infections
Increase in serum creatinine presence of casts in the urine.
. IM injection should be deep into the body of a large muscles.
. do not mixed drug with other antibiotics.
.stability of solutions for IM or IV use varies depending
on the diluents used. Check package insert carefully.
Drugs Mechanism of action
Indications Contraindications Adverse effect
Nursing consideration
Generic name; Ranitidine
Brand name; zantac
Classifications; histamine H2 receptor blocking drug.
Dosage; 1 ampule TIV q8
Competitively inhibits gastric acid secretion blocking the effect of histamine on histamine H2 receptors. Food increases the bioavailability.
Short-term and maintenance treatment of duodenal ulcer.Short term of treatment of active benign gastric ulcer.
Cirrhosis of the liver, impaired renal or hepatic function.
GI; Constipation, nausea and vomiting, diarrhea, abdominal pain,pancreatitis
. do not confuse
zantac with xanax or zyrtex.
Drugs
Generic name; Paracetamol
Brand name; Acetaminophen
Classification
non-narcotic analgesicDosage; adults; 325-650mg every 4 hour(per orem)Caplets, capsules, oral liquid, or syrup
Mechanism of action
Decrease fever by
Hypothalamic effect
leading to sweating
and vasodilation.
Indications
Control of pain due to headache, Dysmenorrh
ea, muscular pain and
Arthritis To reduce fever in
bacterial or viral
infections.
Contraindications
Renal insufficiency
anemia, clients with cardiac or pulmonary disease are
more susceptible to acetaminophen
toxicity.
AdverseEffect
Few when taken in usual therapeutic
doses. Chronic and even acute toxicity can
develop after long syptom-free usage
Nursing Considerations
. do not exceed dose of 4g/24hour in adults and 75mg/kg/day in children.
.do not take for more than 5 days for pain in children, 10days for pain in adults, or more than 3 days for fever in adults or children without consulting provider.
.take extended relief product with water; do not crush, chew or dissolve before swallowing.
Drugs Mechanism of action
Indications Contraindications Adverseeffect
Nursing considerations
Generic name;Metoclopramide
Brand name;reglan
Classifications; gastrointestinal stimulant
Dosage;10mgIV q8
Dopamine antagonist that acts by increasing sensitivity to Acetylcholine results in increased motility of the upper GI tract and relaxation of the pyloric sphincter and duodenal bulb. Gastric emptying time and GI transit time are shortened.
Parenteral; facilitates small bowel intubation, Stimgastric emptying, and Increase intestinal Transit of barium to aid in radiologic Examination of stomach.
Gastrointestinal hemorrhage, obstruction or perforation; epilepsy.
CNS; restlessness
, drowsiness, fatigue, anxiety, insomnia, headache,dizziness
. inject slowly IV order 1-2mins to prevent transient feelings of anxiety and restlessness.Check packaged insert if drugs is to be admixed.
Drugs Mechanism of action
Indications Contraindications Adverse effect
Nursing consideration
Generic name; Ferrous sulfate
Brand name; feosolClassification; anti anemic iron
Dosage; adults, 150-250mg (1-2 time per day)Per orem
Iron is absorbed from the duodenum and upper jejunum by active mechanism through the mucosal cells where it combines with the protein Transferrin.
.prophylaxis and treatment of iron deficiency and iron deficiency anemias..dietary supplement for iron.
Hemosiderosis, peptic ulcer,
Constipation, gastric irritation, nausea, abdominal cramps, anorexia, vomiting, diarrhea, dark colored stools.
. For infants and young children, administer liquid preparation with a dropper. Deposit liquid well back against the cheek.. Eggs and milk and coffee and tea consumed with a meal or 1hour after may significantly inhibit absorption of dietary iron.. Do not crash or chew sustained release products.
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subj. data:
“ Madalas akong dumumi at nasusuka ako”. As verbalized by the patient.
Obj. data:
-dry skin, lips
-body malaise
-sunken eyes
-paleness
-poor skin turgor
-restlessness
V/S:
T- 36.6˚C
P- 63 bpm
R- 19 cpm
BP- 120/80 mmHg
Deficient Fluid Volume
related to frequent
elimination of loose watery
stool and vomiting
LTG:
After 72 hrs. of nsg. Intervention, the patient will be able to maintain the fluid volume at functional level by:
1.)Health teaching on patient on how to attain normal hydration status.
2.)Maintain normal fluid volume and replace fluid loss.
-Giving advice on the
patient to increase
fluid intake.
-Encourage
increase oral fluid
intake
-To promote
understanding
and avoid
rercurrence of
Illness
-To reduce risk
of skin
breakdown
Goal was met.
After 72 hrs. of
nsg. Intervention
the patient was
able to maintain
her fluid volume
in functional
level as
evidenced by:
-The patient
demonstrated
proper
understanding
on the
health teaching
-Fluid volume
was normalized
STG:
After 8 hrs. of
nsg.
Intervention, the
patient will be
able to
improve her
body fluid
Volume at
functional level:
1.)Note the
cause of fluid
volume deficit.
2.)Note physical
signs associated
with dehydration.
.
-Determine the
effects of age.
-Compare usual
and current
weight
-Elderly
individuals are at
high risk
because of
decreasing
response/
effectiveness of
compensatory
Mechanism
-Indicator of
overall fluid
nutritional status
STG:
After 8hrs. of
nsg.
Intervertion
the patient
improved her
body fluid
volume,
evidenced by:
-The cause of
fluid volume
deficit was
determined
-Physical signs
associated with
dehydration is
noted and
Examined
3.)Establish 24
hrs. fluid
replacement,
needs, and
routes, as
ordered.
4.)Evaluate the
degree of fluid
deficit
5.)Promote
comfort and
safety of the
patient
6.)Promote
wellness
-Advice intake
of foods with
high fluid
content
-Measure
client’s output
-Encourage
change in
position
frequently
-Provide optimal
skin care
-Provide
frequent
oral and eye care
-To provide
hydration
-To ensure
accurate data of
fluid status
-To prevent
stasis and
reduce risk of
tissue injury
-To prevent
injury from
Dryness
-To prevent
injury from
dryness
-Establish 24
hrs. fluid
replacement,
needs, as
ordered
-The degree of
fluid is
evaluated
-Comfort and
safety of the
patient was
Promoted
-Wellness
promoted
-Discuss factors
and ways to
prevent
dehydration
-Assist client to
measure her
own intake and
output
-Recommend
restriction of
caffeine and
Alcohol
DEPENDENT
-Administer IV
fluids as
Indicated
-To educate the
patient
-Help determine
baseline
symptoms
-To prevent
frequent
Urination
-Fluids may be
given in this
manner, if client
is unable to take
oral fluid, or
when rapid
fluid
resuscitation is
required.
-Administer
medications as
ordered
-Review
laboratory data
Antiemetics or
antidiarrheals
limit gastric/intestinal
losses
-To evaluate degree
of fluid and
electrolyte
imbalance and
response to
therapist
DISCHARGE PLAN
Patients with Acute Gastroenteritis, watchers are instructed to take the following plan for discharge:
M- Medications should be taken regularly as prescribed , on exact dosage, time, & frequency, making sure that the purpose of medications is fully disclosed by the health care provider.
- Home medication : Ranitidine tablet (Zantac)E- Exercise should be promoted in a way by stretching hand and
feet every morning and exercise burping every after meal.T- Treatment after discharge is expected for patients and watcher
with Acute Gastroenteritis to fully participate in continuous treatment.- Usually supportive, treatment consists of nutritional
support and increase fluid intake.H- Hygiene must be maintained for patients with Acute Gastroenteritis. Promotion of personal hygiene should be encouraged such as, daily bathing and always wash hands w/ warm water and soap handling foods, esp. after using the bathroom
O- OPD such as regular follow-up check-ups should be greatly encouraged to clients watcher with Acute Gastroenteritis as ordered by physician to ensure the continuing management and treatment.
D- Diet should be promoted, such as soft and bland diet that cannot irritate the GI tract.
S- Signs and Symptoms.-Clinical manifestations vary depending on the pathologic organism and the level of GI tract involved. AGE produces symptoms such as: diarrhea, abdominal discomfort, nausea and vomiting, fever, body malaise-In children and elderly and debilitated people, AGE produces the same symptoms, but the inability of the patient to tolerate electrolyte losses leads to a higher mortality.
-THE END-