7 Gastroenteritis Nursing Care Plans

By Matt Vera, RN - Nov 4, 2011

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Gastroenteritisis an inflammation of the stomach and intestinal tract that primarily affects the small
bowel.The major clinical manifestations are diarrhea of varying degrees and abdominal pain and
cramping.Associated clinical manifestations are nausea, vomiting, fever anorexia, distention,
tenesmus (straining on defecation), and borborygmi (hyperactive bowel sounds).

Nursing Care Plans

Contents [hide]

1 Nursing Care Plans

1.1 Diarrhea

1.2 Acute Pain

1.3 Deficient Fluid Volume

1.4 Activity Intolerance

1.5 Other Possible Nursing Care Plans

2 See Also:

The nursing goals for patients with Acute Gastroenteritis are toward avoiding dehydration and
management of diarrhea. This post contains 4 nursing care plans and 3 possible nursing diagnoses
for AGE.

Diarrhea

Diarrhea is defined as an increase in the frequency, volume and fluid content of stool. Rapid
propulsion of intestinal contents through the small bowel results in diarrhea. Diarrhea is a hallmark
sign of gastroenteritis.

Assessment

Patient may manifest

Hyperactive bowel sounds

Audible borborygmi
Passage of loose liquid watery stools for more than 3 times
Poor skin turgor
Dehydration
Dry lips and oral mucosa
Altered LOC
Pain
Stomach cramping

Nursing Diagnosis

Diarrhea

Outcomes

Patient will verbalize understanding of causative factors and rationale for treatment regimen.
Patient will reestablish and maintain normal pattern of bowel functioning AEB passage of semi-
solid stools

Nursing Interventions Rationale

Establish rapport To gain patients trust
Assess general condition and vital signs For baseline data
For presence, location, and characteristics of
Auscultate abdomen bowel sounds
 Discuss the different causative factors and
For patient education
rationale for treatment regimen
To allow for bowel rest and reduce intestinal
Restrict solid food intake
workload
To preventfoods/substances that precipitate
Provide for changes in dietary intake
diarrhea
Limit caffeine and high-fiber foods and so as
To prevent gastric irritation
fatty foods
To decrease stress and anxiety that can
Promote use of relaxation technique
aggravate diarrhea
Encourage oral fluid intake of fluids containing
For fluid replacement
electrolyte
Recommend products like yogurt and cultured
To restore normal flora
milk
Emphasize importance of handwashing To prevent spread of infectious diseases

Acute Pain

One of the manifestations of gastroenteritis is abdominal pain. During the course of inflammation,
the bodys immune response, causing the release of cytokine and prostaglandin causing an increase
in vascular permeability and causes pain, which felt by the patient in the abdomen.

Assessment

Patient may manifest

 Abdominal Pain
Appears weak
Limited range of motion
Restlessness
Verbalization of pain with a pain
Facial grimaces
Irritability
Impaired thought process
Reduced interaction with people
sleep disturbances
Diaphoresis

Nursing Diagnosis

Acute Pain

Outcomes

Patient will report a decrease of pain.

Patient will be free from pain and demonstrate relaxational skills.

Nursing Interventions Rationale

Review factor that aggravate or alleviate pain
Instruct the SO to massage the area where
pain is elicited if not contraindicated
Encourage pain reduction techniques
Provide adequate rest
Provide diversional activities like socialization
Administer analgesics to maintain acceptable
level of pain if not contraindicated
To lessen/alleviate pain caused by various
factors (administer meds via IV push)
To reduce pain and promote relief/comfort
To promote healing and provide non-
pharmacological pain reduction techniques
To reduce pain and promote relief/comfort
For clients comfort and relief from pain
For clients comfort and relief from pain

Instruct client to perform deep breathing
exercises (DBE)
Monitor effectiveness of pain medications
Deep breathing exercises may reduce pain
sensation/ used in pain management
To promote timely intervention/ revision of
plan of care
Deficient Fluid Volume

Rapid propulsion of intestinal contents through the small bowels may lead to a serious fluid volume
deficit. The body would want to expel the foreign objective as much as possible thus it doesnt
undergo its normal speed, with that, the digestive system organs are not able to absorb the excess
fluids that are usually absorbed by the body.

Assessment

Patient may manifest

passage of loose watery stool

vomiting
abdominal cramping
dehydration
nausea
fatigue
weakness
nervousness
confusion
weight loss
decreased skin turgor
decreased urine output
dry mucous membrane
fever

Nursing Diagnosis

Deficient fluid volume RT excessive losses through normal routes AEB frequent passage of
loose watery stool

Outcomes

Patient will report understanding of causative factors for fluid volume deficit
Patient will maintain fluid volume at functional level AEB well hydrated, intake is equal as output,
and normal skin turgor.
 Nursing Interventions
Maintain adequate hydration, increase fluid
intake.
Provide frequent oral care
Administer Intravenous fluids as prescribed
Determine effects of age.
Restrict solid food intake, as indicated
Discuss individual risk factors/ potential
problems and specific interventions
Rationale
To prevent dehydration & maintain hydration
status.
To prevent from dryness
To deliver fluids accurately and at desired
rates.
Very young and extremely elderly individuals
are quickly affected by fluid volume deficit
To allow for bowel rest and to reduced
intestinal workload.
To prevent or limit occurrence of fluid deficit.

Activity Intolerance

Activity intolerance is insufficient physiological or psychological energy poor endure or complete

required or desired daily activities. Because of low hgb and hct level there will be decrease oxygen
being delivered to the tissues of the body since the hgb is responsible for the oxygenation of tissue.
As a compensatory mechanism, the body will increase its demand of oxygen by increasing
respiratory rate of the patient which results then to fatigue. Because of this there will be fast
consumption of ATP leading to weaker contractions thus causing muscle weakness. And if the
patient has muscle weakness there will be activity intolerance.

Assessment

Patient may manifest

Weakness
Restlessness
Physical inactivity
Increase respiratory rate
Fatigue
Low hgb count
Low hct count

Nursing Diagnosis
 Activity intolerance related to generalized weakness AEB limited physical activity.

Outcomes

Patient will identify negative factors affecting activity intolerance and eliminate or reduce their
effects.
Patient will participate willingly in necessary or desired activities.

Nursing Interventions Rationale

Provide health teaching on the client regarding
To enhance patient ability to participate in
the organization and time management
activity
technique to prevent while on activity
Provide enough air coming from the electric
To monitor patients response to activities
fan or from the window
Develop and adjust simple activity like brushing
To prevent overexertion
his teeth
Assist client with activity To protect patient from injury
Promote comfort measures on the activity To prevent over-exhaustion
Cluster nursing care To prevent over-exhaustion
Ascertain ability to stand and move about
To determine current status and needs
degree of assistance
Encourage complete bed rest For patient recuperation and recovery

Other Possible Nursing Care Plans

Imbalanced Nutrition: Less than Body Requirements due to insufficient intake and excessive
output;
Risk for Deficient Fluid Volume (if diarrhea does not occur or intake of fluids is insufficient but
does not have any signs of dehydration);
Hyperthermia RT inflammatory process.

See Also:
Nursing Care Plans
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Matt Vera, RN
https://nurseslabs.com

Matt Vera is a registered nurse and one of the main editors for Nurseslabs.com. Enjoys health technology and innovations
about nursing and medicine, in general.