Bulacan State University

City of Malolos, Bulacan

College of Nursing

Case Study of Patient with Acute

Gastroenteritis
Submitted by:
Calma, Therese Josephine
Censon, Luwalhati
BSN – 3D

Submitted to:
Maribel Valencia, R.N.
I. INTRODUCTION

Acute Gastroenteritis

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 foodborne 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.

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 the 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.

Significance of the study:

his study will enable the students to understand better about acute gastroenteritis and will explain the different risk factors for
developing the disease, including consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor
sanitation Since we are client-centered, we really should consider our patient’s comfort and this study will give the students sufficient
knowledge that will help them to plan and implement nursing care plans that will satisfy patient’s needs.

II. 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
understanding the patient history, disease process and management.

B. Specific Objectives

1. To present a thorough assessment, through Nursing Health History, Gordon’s Typology 11 Functional Pattern, Physical Assessment, and
the interpretation of the laboratory examination done on the patient.
2. To discuss the anatomy and physiology, pathophysiology of the patient’s condition, usual clinical manifestations and possible complications
of this condition.
3. To have knowledge to the client medication and be familiar to that medication.
4. To formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to
help the patient recover.
III. PATIENT'S PROFILE

A. Biographical Data

Date: July 16, 2009 Clinical Area : Pedia ward room 202

Name : Ms. BB
Address : San Isidro II, Paombong, Bulacan
Date of Birth : November 5, 2005
Age : 3 ½ years old
Sex : Female
Civil Status : Single
 Nationality
Religious Preferences
Health care financing
Date of Admission
Diagnosis
: Filipino
: Born Again Christian
: Philhealth and Financial health assistance from baranggay health center
: July 15, 2009
: Acute Gastroenteritis with signs of dehydration

B. Chief Complaint

According to the significant others, the client was vomiting and defecating that’s why they rushed her to the hospital.

IV. HEALTH HISTORY

A. History of Present Illness

Prior to admission, the client was vomiting and defecating. Her stool was watery and its color is green. At first, they to the baranggay
health center and the midwife gave them medication. According to the midwife, the medication is for LBM, but after drinking the medication,
the client was still defecating and vomiting so the family decided to rush the client at Emilio G. Perez Memorial District Hospital the next day.

B. Past History

The client had fever, cough and colds. She had completed all vaccinations including BCG, DPT, Oral Polio Vaccine, MMR and
Hepatitis B vaccine. The patient had never been any of the childhood disease such as measles, mumps and chicken pox. The patient had
 no history of accident or any injury. She does not have allergy in any food or drug. She was not hospitalized before and she does not take any
medication or supplements to maintain her health.

C. Family History

According to the significant others of BB they have a familial disease of asthma, both on her father and mother's side. And an incident
of hypertension on his father's side.

Genogram:

Legends
 Paternal Maternal
LB EC
EB RC
56y/o 54 y/o 55 y/o
HPN 57 y/o
HPN

LP LO HE
VB KM MB PC JB AC JC
32 y/o 35 y/o 23 y/o
33 y/o 31 y/o 29 y/o 31 y/o 28 y/o 22 y/o 20y/o
ASTH ASTH ASTH

BB CB
3 ½ y/o 1 y/o
ACTIVITIES OF DAILY LIVING

Functional Health Perception Prior to Hospitalization During Hospitalization

Nutritional Metabolic Pattern Ø The client eats four times a day > The client seldom eats at the hospital. She does
including breakfast, lunch, merienda and not have appetite for eating. She seldom drinks
dinner. According to the significant others, water or other fluids.
she always eats rice and soup. She can
drink 4 glasses of water in a day. She has
no eating discomforts. She does not have 3 days food recall
any dental problems because she has a July 14 July 15 July 16
complete set of teeth.
3 days food recall 2 cups rice 1 glass of water 2 pieces
July 11 July 12 July 13 1 bowl of ponkan
sinigang ½ glass of
3 cups rice 3 cups rice 3 cups rice soup water
3 cups soup 1 piece of egg 3 cups soup 2 glasses of
4 glasses of ½ piece paksiw 2 pices of water
water na bangus bread
3 glasses of 4 glasses of
water water
 Ø The client defecates everyday and her
stool is soft but formed and its color is
brown and has a foul odor. She urinates
Elimination Pattern
five times a day and is yellowish in color.
She has no discomfort in defecating and
urinating.
Ø The client has sufficient energy for
completing her desired required activities.
Activity-exercise Pattern 0- feeding
0- clothing
II- bathing
II- grooming
Ø The client sleeps about 10 hours a day.
From 8pm to 6am. She has no problem
falling asleep and does not take sleep
Sleep-rest Pattern medications. Her sleep is always
continuous especially when she is tired.
She takes a nap during afternoon. From
12:30pm to 3pm.
Ø The client defecates three times a day.
Her stool is watery and its color is green.
She urinates twice a day and it is yellowish
in color.
Ø The client does not have sufficient
energy for completing her desired required
activities.
II- feeding
II- clothing
II- bathing
II- grooming
Ø The client still sleeps 10 hours a day.
She only wakes up when her medications
are due. She has no problem falling asleep
and does not take any sleep medications.
She does not take naps.

Cognitive-Perceptual Pattern
Role-relationship Pattern
Value-belief Pattern
V. DEVELOPMENTAL TASK
Ø The client does not have difficulty in
hearing and has no hearing aid. According
to the significant others, whenever the
client feels pain or any discomfort, they Ø The client takes medications to relieve
always give her medications. any discomforts.
Ø The client lives with her mother, father
and grandparents. The structure of her
family is extended. And just like the typical
family, their family has problems wherein
they have difficulty in handling, as stated by Ø The Family of the patient especially her
the grandmother. parents are supportive and more caring.
Ø The client is a born again Christian.
According to the significant others, they
attend mass every Sunday.
 Erik Erikson-Psychosocial development

The patient is currently in the early childhood stage (3-6 y/o) wherein the central task is Initiative vs. Guilt. During this stage, initiative
adds to autonomy the quality of undertaking, planning, and attacking a task for the sake of being active and on the move. The child is learning
to master the world around him or her, learning basic skills and principles of physics; things fall to the ground, not up; round things roll, how to
zip and tie, count and speak with ease. Guilt is a new emotion and is confusing to the child; he or she may feel guilty over things which are not
logically guilt producing, and he or she will feel guilt when his or her initiative does not produce the desired results. At this stage the client
wants to begin and complete her own actions for a purpose.

Interpretation: Positive Resolution

Jean Piaget’s Cognitive Development

The patient is under the Pre-operational stage. In this period intelligence is demonstrated through the use of symbols, language use
matures, and memory and imagination are developed, but thinking is done in a nonlogical, nonreversible manner. Egocentric thinking
predominates. The patient was able to do make believe play and able to imitate others, like her mother doing some household chores as
verbalized by the "SO".

Interpretation: Positive Resolution

VI. PHYSICAL ASSESSMENT

Date: July 16, 2009 Clinical Area : Pedia ward room 202

BODY PARTS
TECHNIQUES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION
ASSESSED

1.Skin

a. Moisture Palpation Moisture in skin folds and axillae Dry skin Deviated due to slight
dehydration

b Texture Palpation Smooth Rough Deviated due to slight

dehydration

c. Turgor Inspection and Springs back immediately to Moves back slowly Deviated due to slight
Palpation previous state dehydration

2. Mouth Deviated due to slight

Inspection Pink in color, soft moist, smooth Dry lips
a. Lips texture, symmetrical no dehydration

tenderness, no lesions

b.Mucosa Inspection and Uniform pink color Dry and slightly pink in color Deviated from normal due
Palpation to slight dehydration

c. Gums Inspection and Pink gums, moist, firm texture Pink gums, dry, firm texture Deviated from normal due
Palpation to slight dehydration

3. Abdomen
Bowel sounds Auscultation Audible bowel sounds Hyperactive bowel sound Deviated due to diarrhea

VII. REVIEW IF SYSTEM

Digestive System

The primary function of the digestive system is to break down the food we eat into smaller parts so the body can use them to build and
nourish cells and provide energy. There occurs propulsion which is the movement of food along the digestive tract. The major means of
propulsion is peristalsis, a series of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs and
that forces food to move forward. It secretes digestive enzymes and other substances liquefies, adjusts the pH of, and chemically breaks down
the food. Mechanical digestion is the process of physically breaking down food into smaller pieces. This process begins with the chewing of
food and continues with the muscular churning of the stomach. Additional churning occurs in the small intestine through muscular constriction
of the intestinal wall. This process, called segmentation, is similar to peristalsis, except that the rhythmic timing of the muscle constrictions
forces the food backward and forward rather than forward only. Chemical digestion which is the process of chemically breaking down food into
simpler molecules. The process is carried out by enzymes in the stomach and small intestines. Then absorption or the movement of molecules
(by passive diffusion or active transport) from the digestive tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the
digested food into the body. And lastly, defecation which is the process of eliminating undigested material through the anus.

But because of acute gastroenteritis the normal functions were altered. The infectious agents that cause acute gastroenteritis causes
diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production.
These mechanisms result in increased fluid secretion and/or decreased absorption leading to diarrhea. This produces an increased luminal
fluid content that cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients.
VIII. ANATOMY AND PHYSIOLOGY

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.

IX. PATHOPHYSIOLOGY

Modifiable Factors: Lifestyle; Diet; Hygiene

Non-modifiable Factor: Age

Secretion of fluid & Increased secretion of Cl

electrolytes in the Increased
Stimulation and peristaltic
destruction of mucosal lining of the Inhibition
& HCO3 of in
ions Nathe
DirectPerson
intestinal lumen to
invasion person
of the (hands)
bowel wall movement
bowel
Digestive andDiarrheaIngestion
wall
absorptive malfunction reabsorption
Endotoxins
Contaminated
of Pathogens Excessive gas formation
bowel are released
food and/or water
GI Distention
 Etiology: Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,
Clostridium, Escherichia coli, Yersinia,Norovirus, adenovirus

Nausea & vomiting

Fluid and electrolytes imbalance

Dehydration

Dry lips, dry mouth,

flushed skin, fatigue,
irritability

X. LABORATORY FINDINGS

Complete Blood Count:

Blood Test Standard Range Actual Findings Interpretation

WBC 5.10 x 109/L 22.3 x 109/L The body is fighting against an infection

RBC 3.80-5.80 1012/L 5.53 x 1012/L Normal

HGB 110-165 g/L 136 g/L Normal

HCT .350-.500 1/l 0.441 1/l Normal

PLT 150-390x 109/liter 156 x 109/liter Normal

PCT .133 10-2/l Normal

-2
.100-.500 10 /l
MCV 80 fL Normal
80 – 97 fL
MCH 24.6 L An indication of microcytic, hypochromic anemia
26.5 - 33.5 L
MCHC 308 Lg/l An indication of iron deficiency anemia
315-350 Lg/l
RDW 15.1% An indication of iron deficiency anemia
10.0-15.0 %
MPV 8.5 fL Normal
6.5-11.0 fL
% LYM 15.7 L% Normal
17-48 L %
%MON 8.3 L % Normal
4-10 L%
% GRA 81.0 H% Indicates presence of infection
43-76 H%
# LYM 3.5 109/L Indicates presence of infection
1.2-3.2 109/L
#MON 0.7 109/L Normal
0.3-0.8 109/L
 #GRA 18.1 109/L Indicates presence of infection
1.2-6.8 109/L
Blood type: O

RH : +

Fecalysis:

Microscopic Findings Normal Values Actual Findings Analysis/Interpretation

Ova/ parasite NOPS Entamoeba Invasion of microorganism
RBC 0-5/hpf 3-5/hpf Normal
Mucus 0- + Invasion microorganisms
Bacteria Negative(-) ++++ Invasion microorganisms
Pus Cells 0 8-12/hpf Invasion of microorganisms
XI. DRUG STUDY

DOSAGE, ROUTE, NURSING

DRUG NAME INDICATION / ACTION CONTRAINDICATIONS ADVERSE EFFECTS
FREQUENCY RESPONSIBILITIES

1. Cefuroxime 250 mg - It interferes with the - Hypersensitivity to N and V, anorexia, - Protect drug
TIV final step in the formation cephalosphorins abdominal cramps or from sunlight
(q 8 hrs.) of the bacterial cell wall. pain and headache. - Instruct the
- Lower respiratory tract client to take with
infection food to enhance
absorption

2. Ranitidine 12mg - Inhibits gastric acid - Cirrhosis of the Abdominal pain, - Take as directed
TIV secretion by blocking the liver headache, dizziness, with immediately
(q 6 hrs.) effect of histamine on - Impaired renal or malaise, N and V following meals
histamine H2 receptors. hepatic function - Store at room
- GERD temperature
3. 125mg/ 3.5 ml - Inhibits growth of - Active organic - nausea, dry mouth, - Take with food
Metronidazole PO amoebae by binding to disease of the CNS vomiting, diarrhea or milk to reduce GI
(q 8 hrs.) DNA, resulting in loss of - Blood dyscrasias upset
helical structure, strand - Drug may turn
breakage, inhibition of urine brown, don’t be
nucleic acid synthesis and alarmed.
cell death.
- Amoebiasis
XII. NURSING CARE PLAN
ASSESSMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION
STUDY

Subjective: Diarrhea Introduction of After 8 hours of Independent: Goal met

bacteria into the GI
related to Nursing Intervention,
tract >Monitor I/O. >These assessments After 8 hours of
physiological client will be able to
are used to monitor Nursing Intervention,
Objective: factors reestablish and
volume status. client will be able to
(parasites) Release of maintain normal
>Hyperactive bacterial toxins reestablish and
pattern of bowel
bowel sounds maintain normal
functioning. >Restrict solid food
>To allow for bowel pattern of bowel
>vomiting intake.
Disrupts the rest/ reduced functioning.
mucus lining of the
>BM (4x), intestinal workload
stomach
watery and
> Increase oral > To ensure
greenish in
fluid intake and adequate amt. of
color Release of HCl
cause gastric return to normal fluid is taken by the
irritation diet as tolerated. pt.

Dependent:
Increase gastric
motility/peristalsis > Administer > To decrease
antidiarrheal gastrointestinal
medications as motility and minimize
Increase gastric indicated. fluid loses
motility

Frequent
defecation

(DIARRHEA)
ASSESSMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTION RATIONALE EXPECTED
STUDY OUTCOME

Subjective: Risk for Digestive and After 2 hrs of nursing Independent Goal Meet
deficient fluid absorptive intervention the ct with
>Monitor I/O >To ensure accurate After 2 hrs of nursing
volume r/t malfunction the help of the "SO"
balance, being picture of fluid status. intervention the ct
Objective: excessive will be able to
aware of altered with the help of the
loss of fluids demonstrate behaviors
>watery stool intake or output. "SO" was able to
and Increased secretion to prevent
>To prevent demonstrate
>vomiting electrolytes. of fluid and development of fluid >Offer fluids
occurrence of deficit behaviors to prevent
electrolytes in the volume deficit. between meals &
development of fluid
lumen regularly
volume deficit.
throughout the day.

> Promote intake of

Increased water >To facilitate
high-water content
content of the stools hydration
foods and/or
acompanied by
electrolyte
vomiting
replacement drinks.

Dependent:
Imbalanced fluid and
>Provide
electrolytes > Fluids may be
supplemental fluids
given if the ct. is
as indicated.
unable to take oral
Risk for deficient fluid fluid, or when rapid
volume fluid resuscitation is
required.
Reference:
> To decrease
MSN, LeMone and
>Administer gastrointestinal
Burke, pp 754, 757
medications motility and minimize