y

What is gastroenteritis? Gastroenteritis is a general term for irritation and inflammation of the gastrointestinal tract. The hallmark symptoms of gastroenteritis are nausea, vomiting and diarrhea. Gastroenteritis is quite common and can occur in any age group or population. Gastroenteritis is most frequently caused by a viral infection and is commonly referred to as viral gastroenteritis, the stomach flu, or the 24-hour or 48-hour bug. This type of infectious gastroenteritis is contagious. A bacterial infection, such as Salmonella food poisoning, can cause bacterial gastroenteritis, which is also contagious. Similar gastrointestinal symptoms can also result from a variety of other conditions that are not contagious, such as alcohol intoxication or irritable bowel syndrome. Gastroenteritis can lead to serious complications such as dehydration, especially in infants, young children, the elderly, or people with chronic diseases. The underlying disorder, disease or condition that is causing gastroenteritis can also cause complications. Seek prompt medical care if you have symptoms of gastroenteritis that do not improve after a day or two. Seek immediate medical care ( call 911) if you, your child, or someone you are with, have symptoms of gastroenteritis accompanied by lethargy, change in alertness, delirium, a seizure, rectal bleeding, or a lack of urination. What are the symptoms of gastroenteritis? The symptoms of gastroenteritis can range from mild to severe and may vary depending on the underlying cause. Symptoms of viral gastroenteritis, caused by a viral infection, generally resolve within 24 to 48 hours. Other causes of gastroenteritis can last longer.. Symptoms of gastroenteritis can include: y Abdominal gas, bloating or belching y Abdominal pain or cramps y Blood-streaked stools y Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains) Nausea, which may be described as feelings of wooziness, queasiness, retching, sea-sickness, car-sickness, or an upset stomach y Vomiting including multiple episodes y Watery diarrhea including multiple episodes y Weakness (loss of strength) Serious symptoms that might indicate a life-threatening condition Gastroenteritis can lead to serious or life-threatening complications in some cases, including dehydration and gastrointestinal bleeding. Seek immediate medical care (call 911) if you, your child, or someone you are with, are experiencing any of the following life-threatening symptoms: y Change in alertness or consciousness y Delirium y Extreme thirst y Lack of urination or fewer wet diapers in infants y Lethargy y Rectal bleeding y Seizure y Shallow, raspy, or difficulty breathing y Sunken fontanel (soft spot) in an infants head y Unresponsiveness What causes gastroenteritis? Gastroenteritis is most frequently caused by a gastrointestinal viral infection. Similar symptoms can also result from a variety of other conditions including: y Alcohol intoxication y Anthrax infection y Bacterial gastrointestinal infection, such as salmonella food poisoning, campylobacter infection, or travelers diarrhea y Dysentery y Indigestion y Irritable bowel syndrome y Medication side effects y Parasite infections, such as Giardia infection y Stress y Toxic ingestion, such as eating poisonous plants, mushrooms or chemicals What are the risk factors for gastroenteritis? A number of factors increase the risk of developing gastroenteritis. They include: y Close contact with a person who has viral gastroenteritis y Eating eggs or meats that are raw or undercooked y Eating excessively large meals, especially if consumed rapidly y Eating expired foods or leftovers that have been refrigerated for more than two to three days y Having a compromised immune system due to such conditions as HIV/AIDS, diabetes, kidney disease, or cancer or cancer treatment y High stress levels or anxiety

y Not washing hands after contact with a person who has bacterial or viral gastroenteritis Not washing hands frequently, especially after using the bathroom, touching pet feces, handling reptiles, or touching raw foods or foods potentially contaminated with bacteria or parasites or viruses y Taking certain medications, such as antibiotics and chemotherapy Gastroenteritis can lead to the serious complication of dehydration in some cases. People most at risk for dehydration include: y Infants y People with chronic illnesses, such as diabetes or cancer y Small children y The elderly Reducing your risk of gastroenteritis Not all people who are at risk for gastroenteritis will develop the condition, but you can lower your risk of developing or transmitting gastroenteritis by: y Avoiding contact with a person who has food poisoning, gastroenteritis, or symptoms such as vomiting and diarrhea y Defrosting foods in the refrigerator or microwave, not on the counter y Drinking alcohol in moderation y Keeping poisonous or toxic plants or products out of reach of young children y Not keeping reptiles as pets in homes, especially with infants and young children y Refrigerating or freezing leftovers right away and eating them within two to three days of refrigerating. Leftovers from restaurants should be eaten within 24 hours. y Throwing out expired food, old leftovers, or perishable food that has been sitting at room temperature for two hours or longer y Washing hands frequently during and after contact with a person who has food poisoning, gastroenteritis, or symptoms such as vomiting and diarrhea y Washing hands frequently, especially after using the bathroom, touching pet feces, handling reptiles, changing diapers, or touching raw foods y Washing plates, utensils, and cutting boards that have been exposed to raw meats or poultry in hot soapy water before reusing How is gastroenteritis treated? Treatment plans for gastroenteritis are individualized depending on the underlying cause and your age, medical history, and any other conditions you may have. Treatment generally involves a multifaceted plan that addresses the cause; minimizes the discomfort of nausea, vomiting, and diarrhea; and decreases the risk of dehydration. When gastroenteritis is caused by a self-limiting condition, such as viral gastroenteritis, treatment includes: y Not eating solid foods to rest the stomach and intestines until symptoms have passed y Drinking plenty of fluids (water or rehydrating fluid, such as Pedialyte) to ensure adequate hydration In some cases, medications are used to treat gastroenteritis. Antibiotics may be prescribed when gastroenteritis is caused by a bacterial infection, such as in bacterial food poisoning due to Shigella,Salmonella, or Campylobacter infection. Treatment of severe gastroenteritis that does not resolve or leads to dehydration may require hospitalization and rehydration with intravenous fluids. What are the possible complications of gastroenteritis? Complications of gastroenteritis can be serious, even life threatening in some cases. Complications can include: y Severe dehydration, which can lead to an electrolyte imbalance and shock y Aspiration, which is when contents of the stomach flow into the lungs during vomiting (a rare occurrence) y A rip in the esophagus (Mallory-Weiss tear) due to multiple violent episodes of retching and vomiting (a rare occurrence) y

Acute Gastroenteritis (AGE)Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly thestomach and intestine. It is frequently referred to as the stomach or intestinal flu, although theinfluenzavirus is not associated with this illness. Major symptoms includenausea andvomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied byfever and overall weakness. Gastroenteritis typically lasts about three days. Adults usuallyrecover without problem, but children, the elderly, and anyone with an underlying disease aremore vulnerable to complications such asdehydration.Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food that hasspoiled may also cause illness. Certain medications and excessive alcohol can irritate thedigestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptomsof gastroenteritis include diarrhea, nausea and vomiting, and abdominal painand cramps.Sufferers may also experience bloating, low fever, and overall tiredness. Typically, thesymptoms last only two to three days, but some viruses may last up to a week.A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medicaltreatment is essential if symptoms worsen or if there are complications. Infants, youngchildren, the elderly, and persons with underlying disease require special attention in thisregard.The greatest danger presented by gastroenteritis is dehydration. The loss of fluids throughdiarrhea and vomiting can upset the body's electrolyte balance, leading to potentially life-threatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydrationincreases as symptoms are prolonged. Dehydration should be suspected if adry mouth,increased or excessive thirst, or scanty urination is experienced.If symptoms do not resolve within a week, an infection or disorder more serious thangastroenteritis may be involved. Symptoms of great concern include a high fever (102 F[38.9 C] or above), blood or mucus in the diarrhea, blood in the vomit, and severe

abdominal pain or swelling. These symptoms require prompt medical attention.Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort andconvenience, a person may use over-the-counter medications such as Pepto Bismol to relievethe symptoms. These medications work by altering the ability of the intestine to move or secrete spontaneously, absorbing toxins and water, or altering intestinal microflora. Someover-the-counter medicines use more than one element to treat symptoms. I I . P a t i e n t s P r o f i l e S.Q. is a female, 11/12 months old, residing at P2 Blk1 L38 Pabahay Nanadero,Calamba City, Laguna. Her mother is J.Q., works part time in a shop and her father is R.Q., factory worker. She has one sibling older than her, K.Q., 3 years old. S.Q.was born on March 6, 2009, and born at Calamba, Laguna, Filipino in nationality.Their whole family is Born Again in religion. She weighs 8.7 kg. Shes admitted onJanuary 30, 2010 at room 103-C, pedia ward with chief complaint of high fever for 2 days with emesis and has a diagnosis of Acute Gastroenteritis. And she wasdischarged on January 6, 2010, Saturday at 1:30 pm. Their attending physicianswere Campos, Angelie, M.D. and Bonagua, Aireen, M.D .I I I . H e a l t h H i s t o r y & C h i e f C o m p l a i n Chief ComplaintShe was admitted for having high fever for 2 days with vomiting.Present IllnessS.Q. was only admitted to the hospital due to gastrointestinal problem now and was alsosuspected of urinary tract infection by Dra. Campos. Aside from the diagnosis, no other disease or complication was seen or diagnosed.Past Health HistoryMrs. Q says eto first time nya ma-admit after nya ipanganak. S.Q. gets seasonalcough and colds at times but never serious because it usually last only for a few days. Theyalways consult their doctor once sick. She is complete in her vaccinations except those whichwould be taken on her 1 year of age.Family Health History No one in the family had any respiratory illness or allergies. On her fathers side,almost all have hypertension. One member of their family died on a heart attack. I V . G o r d o n s P a t t e r n

Health PerceptionAs Mrs Q. stated, lagi naman kami nagpapacheck up ni stephani. Napuntatalaga kami kay Dra. Campos. Malikot lang talaga yan pero inaalagaan yan sa bahay.S.Q. has a mannerism of sticking anything on her mouth. Whatever she touches shedirects it toward her mouth. Although, she doesnt practice hand washing every nowand then. There are some medications she takes easily but there are also thosemedications which is hard for her because of the taste. Nutritional-MetabolicS.Q. weighs 8.7 kg. She eats soft foods. She drinks 6-7 bottles of milk in a day.Mrs. Q provides her daughter milk and food in accordance to age and doctors advise.She drinks formula milk. She stop being breastfed when she was 10 moths. She hasno allergy. EliminationShe defecates once or twice a day in her usual days. She changes diaper 3-5times in a day when full or had defecated. She was advise to use Lactacid for her perennial wash and calmoseptin ointment on her diaper rash. Activity-ExerciseS.Q. is a very playful and active girl. She has lots of energy but cries when shedoesnt like something. She smiles and laughs a lot. Her coordination, gait, balance isnot yet stable due to age. Her daily living activities were provided by her parents. Thereis no musculoskeletal impairment. She usually plays after she wakes up in the morning. Sleep-RestShe sleeps at 8 P.M. in the evening and usually gets up 7 A.M. 8 A.M. in themorning. After playing or eating she takes a nap. She has straight undisturbed sleep atnight. Cognitive PerceptualS.Q. has no sensory deficits. She response well to verbal stimulus by looking atyou or having facial expressions. Bibo nga yan bata nay an, makulit pero mabilis monaman makuha attention, as her mother stated. Self-PerceptionS.Q. is not afraid of new people around her. She is friendly and is easy toaccommodate. Sexual-ReproductionPrior to age, S.Q. is not yet oriented with any sexual matters Coping StressIn her age, she usually cries when something is wrong about her. Simple smile or cry is a sign of her comfort, distress or feelings. She is familiarized to her familymembers and long for them when she doesn t want the situation like giving of medications or other procedures. Role-RelationshipShe doesn t know the concept of death yet due to age. Forms words like dede and dada . She knows her family members and can easily familiarize the peoplearound her. Value-Belief The family is Born Again. They regularly attend church together with all themembers of the family. They don t usually believe in hilot . Once one is sick in thefamily, they go immediately to the hospital or for check-up.

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General Assessment: Playful and active, neatInitial Vital Sign: T=36.4C RR=27 PR=11

A n a t o m y & P h y s i o l o g y Digestion is the process by which food is broken down into smaller pieces so that the bodycan use them to build and nourish cells and to provide energy. Digestion involves themixing of food, its movement through the digestive tract (also known as thealimentarycanal), and the chemical breakdown of larger molecules into smaller molecules. Every piece of food we eat has to be broken down into smaller nutrients that the body canabsorb,which is why it takes hours to fully digest food.The digestive system is made up of the digestive tract. This consists of a long tube of organs that runs from themouthto theanusand includes the esophagus, stomach, smallintestine, and large intestine, together with theliver , gall bladder , and pancreas, which produce important secretions for digestion thatdraininto the small intestine. The digestivetract in an adult is about 30 feet long.Mouth and Salivary GlandsDigestion - begins in the mouth, where chemical andmechanical digestion occurs. Saliva or spit, produced by the salivary glands (located under thetongueand near the lower jaw), is released into the mouth. Saliva begins to break downthe food, moistening it and making it easier to swallow. A digestiveenzyme(calledamylase) in the saliva begins to break down thecarbohydrates(starches and sugars). Oneof the most important functions of the mouth is chewing. Chewing allows food to bemashed into a soft mass that is easier to swallow and digest later.Esophagus - Once food is swallowed, it enters the esophagus, a muscular tube that is about10 inches long. The esophagus is located between the throat and the stomach. Muscular wavelike contractions known as peristalsis push the food down through the esophagus tothe stomach. A muscular ring (called the cardiac sphincter) at the end of the esophagusallows food to enter the stomach, and, then, it squeezes shut to prevent food and fluid fromgoing back up the esophagus.Stomach - a J-shapedorganthat lies between the esophagus and the small intestine in theupper abdomen. The stomach has 3 main functions: to store the swallowed food and liquid to mix up the food, liquid, and digestive juices produced by the stomach; and to slowlyempty its contents into the small intestine.Small Intestine Most digestion and absorption of food occurs in the small intestine. Thesmall intestine is a narrow, twisting tube that occupies most of the lower abdomen betweenthe stomach and the beginning of the large intestine. It extends about 20 feet in length. Thesmall intestine consists of 3 parts: the duodenum (the C-shaped part), the jejunum (thecoiled midsection), and the ileum (the last section). The small intestine has 2 importantfunctions. First, the digestive process is completed here by enzymes and other substancesmade by intestinal cells, the pancreas, and the liver. Glands in the intestine walls secreteenzymes that breakdown starches and sugars. The pancreas secretes enzymes into the smallintestine that help breakdown carbohydrates, fats , and proteins . The liver produces bile ,which is stored in the gallbladder . Bile helps to make fat molecules (which otherwise arenot soluble in water) soluble, so they can be absorbed by the body. Second, the smallintestine absorbs the nutrients from the digestive process. The inner wall of the smallintestine is covered by millions of tiny fingerlike projections called villi .The villi arecovered with even tinier projections called microvilli. The combination of villi andmicrovilli increase the surface area of the small intestine greatly, allowing absorption of nutrients to occur. Undigested material travels next to the large intestine.Large intestine - forms an upside down U over the coiled small intestine. It begins at thelower right-hand side of the body and ends on the lower left-hand side. The large intestineis about 5-6 feet long. It has 3 parts: thececum, thecolon,and therectum. The cecum is a pouch at the beginning of the large intestine. This area allows food to pass from the smallintestine to the large intestine. The colon is where fluids and salts are absorbed and extendsfrom the cecum to the rectum. The last part of the large intestine is the rectum, which iswherefeces(waste material) is stored before leaving the body through the anus. The main job of the large intestine is to remove water and salts (electrolytes) from the undigestedmaterial and to form solid waste that can be excreted.Bacteriain the large intestine help to break down the undigested materials. The remaining contents of the large intestine aremoved toward the rectum, where feces are stored until they leave the body through theanus as a bowelmovement

V I I I . C o u r s e i n t h e W a r d On day 1, January 30, 2010, at 8:40 am S.Q. is for check up with her attending physician due to high fever for 2 days associated with vomiting. She was seen andexamined by Dra. Campos and was advised to be admitted for further test and treatmentdue to suspected UTI. She was diagnosed with Acute Gastroenteritis. An IVF D5 INM500 ml x 10cc/hr is hooked and CBC was done. She was brought to pedia ward ataround 11:00 am and received by nurse on charge. Monitoring of input and output wasordered by the doctor with increase fluid intake. Medications were Paracetamol drops 1ml every 4 hours for fever. 1 dose was given on admission and following doses for every 4 hours was given.On the second day, January 31, 2010, IVF was changed to #2 D5 INM 500 ml x 10cc/hr at 9:50 am. She was seen by Dra. Campos at 10:15 am and given an order of urinalysisand fecalysis. She was prescribed with Omeprazole (Omepron) 5mg IV once a day, 1 st dose is given at 8:00 am the next morning. Also, Zinc Sulfate (E-Zinc) drops (0.6 ml)once daily was ordered. Her fever decreases gradually unitl there administration of paracetamol every 4 hours for fever was discontinued. She is being given Ceftriaxone(Xtenda) 750 mg IV once a day side drip every 12 noon. She was playful all throughout the day. The laboratoty results was followed up.On the third day, February 1, 2010, Monday, she was crying when received. She hasfever of 37.9 C and administration of Paracetamol drops 1 ml every 4 hours wasresumed. She has been irritable all day. 10:40 am Dra. Campos, examined S.Q. and wasrefered to Dr. Zablan due to decreased results of urinalysis. All laboratory results

wereseen by Dra. Campos. During the afternoon, her fever subsides to 37.2 C . IVF #3 D5INM 500 ml x 10 cc/hr was hooked at 1:00 pm. All medications were given.On the fourth day, February 2, 2010, Tueasday, she has no fever, negative vomiting and playful. Dra. Campos had her round at 4:50 pm and checked S.Q. she ondered continueall medications and treatment and wait for Dr. Zablans assessment. IVF #4 D5 INM500 ml x 10 cc/hr was hooked at 11:30 am.On the fifth day, February 3, 2010, Wednesday, Dr. Zablan had his round at 11:30 am.Findings were with positive diaper rash, decrease laboratory results and afebrile, novomiting. He ordered repeat UA from AM (clear catch), urine culture and sensitivity,use of Lactacid pink for perennial wash, and apply Calmoseptin ointment to diaper rash3x a day. IVF #5 INM 500 ml x 10cc/hr was hooked at 12:15 nn.On the sixth day, February 4, 2010, Thursday, Dra. Campos ordered continue allmedications and follow order of Dr. Zablan. IVF #6 INM 500 ml x 10cc/hr was hookedat 11:00 am. S.Q. is received active, playful but cries at times. All medications weregiven on time. Dr. Zablan saw laboratory results and advise client to increase fluidintake and replace loses with PLRS. Follow up urine culture and sensitivity. Repeat urinalysis and notify him when WBC is 1-3. IVF #7 INM 500 ml x 10cc/hr was hookedat 1:00am.On the seventh day, February 5, 2010, Friday, Dra Campos ordered continue allmedeications and treatments. Proceed to Dr. Zablan s orders. All 8:00 am medicationswere given. S.Q. is taking a bath, playful and laughing when received. IVF wasregulated. IVF was ordered to shift to D5 IMB L x 20 cc/hr. IVF #8 IMB L x 20cc/hr was hooked at 11:30 am. Dr. Zablan had his round at 11:45, he checked S.Q. andthe laboratory test. He said all test were now stabilized and normal. He ordered followup of urine culture and sensitivity and advised periodic complete emptying of urinary bladder.On the eighth day, February 6, 2010, Saturday, all findings were on normal range. S.Q.is afebrile, no vomiting, diminished diaper rash, and was active and playful. Allmorning medications were given. IVF #9 imb l X 20 cc/hr was hooked at 10:45 am.Dra. Campos, advised that they may go home. S.Q. was discharge at 1:30 pm