Cebu Normal University

COLLEGE of NURSING
Cebu City

A MINI-CASE STUDY ON
Acute Gastroenteritis

Submitted by:
ANTE, Maria Christine Julthy
APOLINAR, Dan
CANETE, Kathrinne Kheo
CANIZARES, Jenelyn
CARCALLAS, Ma. Mailita
CENABRE, Gaiel Irene
CUYOS, Terrence Michael
DAKAY, Kristian
DATAN, Henry Jr.
GERVACIO, Siergs Smith
HERNANI, Ivy Marie
ICAMEN, Bernard John Ezra IV
MENCHAVEZ, Kristine Kaye
MILLOR, Kevin
MIRANDA, Claire Margarette
MODINA, Kriezzha
ONG, Eza Claire
ORACION, Clavel
PANTORILLA, Eliseria
RAMOS, Mark Rizaldy
ROSLINDA, Jan Alethea
URSAL, Ritter John
USMAN, Emir Sharilaji
ZAMORA, Nino Karol
Background and Rationale of the Study

Gastroenteritis or infectious diarrhea is a medical condition from

inflammation of the gastrointestinal tract that involves both the stomach and the
small intestine Acute gastroenteritis is the sudden onset of diarrhea and/or
vomiting, usually three or more bouts of diarrhea or vomiting and diarrhea. Acute
Gastroenteritis is an extended and possibly fatal attack of stomach flu. It is an
inflammation in the bowels caused mainly by an infection. Causes of Acute
Gastroenteritis include bacterial infection, infection by parasites like giardia,
accidental poisoning or exposure to toxins.
Gastroenteritis is defined as the inflammation of the mucus membranes of
the gastrointestinal tract and is characterized by diarrhea or vomiting. It is a
common childhood disease. Children in developing countries are particular at risk of
both morbidity and mortality. Etiologies include bacteria, viruses, parasites, toxins,
and drugs. Viruses are responsible for a significant percentage of cases affecting
patients of all ages. Viruses are responsible for approximately 70% of episodes of
acute gastroenteritis in children. Viral gastroenteritis ranges from a self-limited
watery diarrheal illness (usually < 1 wk) associated with symptoms of nausea,
vomiting, anorexia, malaise, or fever, to severe dehydration resulting in
hospitalization or even death.
Worldwide, gastroenteritis affects 3 to 5 billion children each year, and
accounts for 1.5 to 2.5 million deaths per year or 12% of all deaths among children
less than 5 years of age. In developed countries, such as the United States, acute
gastroenteritis seldom causes deaths, however, it still accounts for 300 deaths per
year. Moreover, it puts a heavy burden on the health care system. Acute
gastroenteritis causes 1.5 million visits to primary care providers each year and
220,000 hospital admissions for children under the age of 5 years. Though often
considered a benign disease, acute gastroenteritis remains a major cause of
pediatric morbidity and mortality around the world, accounting for 1.34 million
deaths annually in children younger than 5 years, or roughly 15% of all child deaths.
The difference can also be explained by the fact that, the incidence of acute
gastroenteritis is significantly higher in developing countries than the industrialized
countries. This may reflect that the decision of admission does not simply depend
on the clinical situations, but it can also be affected by the parents wishes and
other social factors.
According to Philippine Statistics Authority as of year 2010, diarrhea has
132,553 reported cases. Acute Gastroenteritis is a condition that causes irritation
and inflammation of the stomach and intestines. Diarrhea ranked second in the
Philippines among the 10 leading causes of morbidity in 2002
Gastroenteritis is the 10th leading cause of mortality of infants in the Philippines in
the year 2004 (984 deaths). Gastroenteritis is one of the leading causes of
morbidity and mortality in the Philippines in 2007.

Treatment for Acute Gastroenteritis will vary based on the cause. But in all
cases of the disease, doctors usually watch out for dehydration. The most common
complication is lack of fluid (dehydration) and electrolyte imbalance in the body. It
occurs if the water and sodium were lost in stools (feces), or when vomiting is
present, were not replaced by drinking adequate fluids. Severe dehydration can
lead to a drop in blood pressure. This can cause reduced blood flow to your vital
organs. If dehydration is not treated, kidney failure may also develop. Some people
who become severely dehydrated need a drip of fluid directly into a vein. Patients,
specifically children are therefore advised to take sips of oral rehydration salt
solution or pedialyte. Oral rehydration therapy is as effective as intravenous therapy
in treating mild to moderate dehydration in acute gastroenteritis and is strongly
recommended as the first line therapy.
Situational Appraisal
A. Patients Profile
Case 1:
A case of patient AJG, 1-year-old, female, child, Roman Catholic, was admitted for
the first time at Vicente Sotto Memorial Medical Center last January 10, 2016 with a
chief complaint of severe diarrhea, notable weakness and difficulty breathing.
Patient is diagnosed with AGE severe dehydration, severe anemia, sepsis,
hypokalemia. Currently, patients sepsis and hypokalemia has been already
addressed.
Case 2:
A case of patient CJD, 5 months old, male, child, Roman Catholic, from Labangon,
Cebu City was admitted for the first time at Vicente Sotto Memorial Medical Center
last January 17, 2016 with chief complaints of cough, increased temperature, and
watery stools. Patient is diagnosed with AGE with moderate dehydration and severe
pneumonia. Patient was already treated and is waiting for discharge.
Case 3:
A case of M.A.C., 2 Y3M18D, child, Catholic, admitted for the first time at
Vicente Sotto Memorial Medical Center (VSMMC) last January 17, 2015 due to
episodes of loose bowel stools associated with vomiting with an admitting diagnosis
of Acute Gastroenteritis with No Dehydration Electrolyte Imbalance Hyponatremia,
Hypokalemia. Upon assessment, patient noted to have general body weakness,
eyes are slightly sunkened, delayed responses and slowed movement observed.
Child was stenic with good skin turgor, able to perform full range of motion. Patient
height (80 cm) and weight (10.3 kg) were slightly inadequate for age (Ideal: WT.
27.5 lb. (12.5 kg) Ht.34.2" (86.8 cm). SO reported that child has no longer
experienced vomiting on the day of assessment, stool was small into pieces- no
longer loose. Patient has good appetite, consumes fruits like apple and watermelon,

and fluid intake is increased. On the day of assessment, patient was able to
evacuate 2 worms (ascaris) due to the anti-helminthic medication.
Case 4:
A case of patient A.N.S., 5 months old, female, Roman Catholic from Quadra,
Lagtang, Talisay City, Cebu admitted at VSMMC for the third time last December 24,
2015 at 6:04 PM with chief complaints of vomiting after milk feeding, persistent
weight lost and episodes of loose watery stools. Patient was admitted on August,
2015 for hyperbilirubinemia and on October 2015 for neonatal pneumonia; neonatal
sepsis.
Case 5:
A case of L.G. 2 years old child, male cataholic from Cebu City with a weight of 7.2
kg.was admitted for the first time at VSMMC on January 19, 2016. Admitting
diagnosis was Acute Gastroentertitis with some dehydration, severe acute
malnutrition.
Case 6:
A Case of J.C., 4 years old, male, from Poblacion, Samboan, Cebu, admitted
for the first time at VSMMC last December 25, 2015 with the chief complaint of
vomiting.
Case 7:
A case of RM, 1 year 7 months old, was admitted at VSMMC for the first time
on January 19, 2015 due to diarrhea. An impression of Acute Gastroenteritis with
some dehydration; Hypokalemia was made.
Case 8:
A case of J.E., 9 months and 9 days, with a height of 69cm and weight of 6.7kg,
Male, Roman Catholic from Lilo-an Cebu, was admitted for the second time on
January 12, 2016 in Vicente Sotto Memorial Medical Center due to episodes of loose
watery stools, with a diagnosis of 1) Acute Gastroenteritis with Severe Dehydration,
2) T/C electrolyte imbalance, 3) S/P Hydration. Upon assessment, the patient no
longer have any sign of diarrhea and dehydration.
Medical Diagnosis
Case 1: AGE severe dehydration, severe anemia, sepsis, hypokalemia.
Case 2: AGE with moderate dehydration and severe pneumonia.

Case 3: Acute Gastroenteritis with No Dehydration Electrolyte Imbalance

Hyponatremia, Hypokalemia.
Case 4: Acute Gastroenteritis with some dehydration; failure to thrive
Case 5: Acute Gastroenteritis with some dehydration, severe acute malnutrition.
Case 6: Acute Gastroenteritis with some dehydration; T/C Electrolyte Imbalance
Case 7: Acute Gastroenteritis with some dehydration; Hypokalemia
Case 8: 1) Acute Gastroenteritis with Severe Dehydration, 2) T/C electrolyte
imbalance, 3) S/P Hydration.

B. History of Patients Illness

Case 1:
Afternoon PTA, patient was brought to Saint Anthony Mother and Child Hospital due
to difficulty of breathing. IVF was started, oxygen via face mask at 10L/minute. BP
was taken of 60/40 mmhg, PR: 70. RR: 40. Dopamine was given 10mg/kg at 20
gtts/minute and sodium bicarbonate was given. After resuscitation BP increased to
80/40 mmhg, PR: 130, RR: 50. Patient was then referred at VSMMC for further
evaluation and management.
Case 2:
1 week PTA, patient had onset of cough and coryza with clear nasal discharges,
sought consult at a clinic near in their residence. Afterwhich, patients condition now
associated with loose watery yellow stools. Persistence of condition now associated
with body malaise thats why the parents brought their child to VSMMC for
management and treatment.
Case 3:
SO reported that child has no longer experienced vomiting on the day of
assessment, stool was small into pieces- no longer loose. Patient has good appetite,
consumes fruits like apple and watermelon, and fluid intake is increased. On the
day of assessment, patient was able to evacuate 2 worms (ascaris) due to the antihelminthic medication.
Case 4:
1 month PTA, patient was noted to vomit every after milk feeding, and condition
tolerated, noted weight loss along with poor appetite.
2 weeks PTA, condition persisted, noted worms/ parasites/ coming out from her
mouth, was brought to local health center, given unrecalled medications taken for 1
week, noted weight loss, condition tolerated.
1 week PTA, noted no appearance of worms/ parasites on the vomitus
Morning PTA, still with persistent weight loss, patient was fed with rice porridge,
condition worsened with 5 episodes of loose watery stools to continuous weight loss

and poor skin turgor, failure to thrive and poor appetite, then was brought to
VSMMC.

Case 5:
2 days PTA, patient has been having episodes of loose bowel movements and
mother said that her son looked fatigued and drowsy, thus sought consult.
Case 6:
Present condition started 8 days PTA, onset of vomiting several episodes per day, no
bleeding, no mucous, amounts to at least cup.
4 days PTA, persistence of condition prompted consult at Malabuyoc District
Hospital and was then referred to VSMMC for further management.
Case 7:
Upon history taking, the mother verbalized that the child had 4-5 episodes of
watery stools per day starting December 26, 2015. On January 1, 2016, the mother
brought the child to Eversley Hospital for consultation. Cefuroxime was prescribed
and was taken by the child for 7 days which provided 1-week resolution of the
condition after the completion of the prescribed medication. However, the condition
persisted and thus the mother brought the child to Eversley Hospital for laboratories
and diagnostic. They were then advised to seek consult at VSMMC.
C. Assessment Findings
Case 1:
Clients complaint upon Admission:
Clients chief complaint upon admission was severe diarrhea, notable
weakness and difficulty breathing.
Stressors perceived by the client and SOs:
Notable present stressors perceived by SO primarily revolves around their
financial instability strained further due to hospitalization. Mother also verbalized
insufficient provision of nutrition to patient due to lack of money.

Physical Assessment:
Patient has scalp rash, dry skin, weight of 7kg and height of 75 cm. At the
present, patient already have no sunken eyes and skin turgor is good.

Case 2:
Clients complaint upon Admission:
Clients chief complaint upon admission was cough, increased temperature,
and watery stools.
Stressors perceived by the client and SOs:
Stressors perceived by SOs are 1) their financial constraints and 2) They were
concerned that their 5-month old child was hospitalized at a very young age.
Physical Assessment:
Patient has a weight of 7.2 kg and height of 67 cm. At present, patient was
already treated for diarrhea, dehydration, and pneumonia and is waiting for
discharge. No other unusualties.
Case 3:
Upon assessment, patient noted to have general body weakness, eyes are slightly
sunkened, delayed responses and slowed movement observed. Child was stenic
with good skin turgor,able to perform full range of motion. Patient height (80 cm)
and weight (10.3 kg) were slightly inadequate for age (Ideal: WT. 27.5 lb (12.5 kg)
Ht.34.2" (86.8 cm).
Case 4:
Physical growth: weight: 3.1 kg; height: 55cm; head circumference: 37cm; chest
circumference: 36cm; abdominal circumference: 35cm; arm circumference: 3cm
Physical examination:
Skin: brown, warm and dry
Neck: with erythematous lesions @ neck area (left side)
Eyes: normal eyelids, black eyes, anicteric sclera, PERRLA
Nose: slight amount of discharges
Ears: normal pinna and external canal with intact tympanic membrane; prominent
Mouth: pink lips; pale
Dental development: no presence of teeth yet
Chest (lungs): symmetrical; ribs are very visible; slightly warm; crackles are heard
Breast: midline; no abnormalities; brown areola
Heart: no bruising noted; palpable pulsation on the apex
Abdomen: no visible lumps; slightly warm; no unusual sounds heard; normoactive
bowel sounds
Genitalia: female; there are no bruises or lesions
Anus: anal opening is normal, with erythematous lesions at buttocks area

Back and extremities: spine: midline, no abnormalities

Extremities: wasting is noted
Joints: passive extension and flexion
Muscle: with muscle wasting
Reflexes: Babinski reflex
Behavior: sleeps, drinks milk, cries, wakes up
Motor functioning: responds to her mother by smiling
Case 5:
Weight 7.2 kg
Height 74 cm
Head circumfereence 44 cm
abdominal Circumference
Mid arm circumference 14 cm
Seen pt with slight pallor, and moderate thirst. Upon assessment, pt has good skin
turgor and eyes are not sunken.
Case 6:
Physical growth: weight: 12kg; height: 96cm; head circumference: 50cm; chest
circumference: 52cm; abdominal circumference: 44cm; arm circumference: 10cm
Physical examination:
Skin: brown, warm and dry, with good skin turgor
Neck: negative nuchal rigidity, trachea at midline
Eyes: Sunken eyes, anicteric sclerae, pale palpebral conjunctiva
Nose: Very dry nostrils, with nose bridge at midline; patent
Ears: Pinna aligned with inner and outer canthus of eyes, no pain nor discharge
present
Mouth: pink lips; pale tongue
Dental development: With complete set of deciduous teeth
Chest (lungs): symmetrical; resonance upon percussion, crackles heard on both lung
fields
Breast: free from lesions
Heart: no bruising noted; palpable pulsation on the apex; no murmurs
Abdomen: non protruberant; no hernias; hyperactive bowel sounds
Genitalia: complete male genitalia; uncircumcised
Anus: No imperforate anus; patent
Spine: Complete; non-scoliotic; very prominent
Extremities: muscle wasting is noted
Joints: free mobility, but weak upon movement
Muscle: with muscle wasting
Behavior: Very weak and irritable, wants to change position frequently
Motor functioning: Unable to tolerate activity especially on changing position and
ADLS

Case 7:
The childs physical appearance is sthenic without physical abnormalities. All
extremities are able to do active ROM. However, with the weight of 10 kg, the
mother reported that the child had lost weight in relation to its customary weight
prior to episodes of LBM. Furthermore, the tissues of the mid-arm are soft and saggy
to touch which is an evidence of weight loss.
Although the child already had a good skin turgor, pallor on the lips and body
weakness was reported. The mother verbalized that prior to admission; the child
could barely carry his head and would fall down on the bed if the child is left
unsupported when sitting. Baseline serum potassium result was 1.34 mmol/L.
However, upon the time of assessment, the child could carry his head already and
sits up on bed unsupported but cannot stand up due to severe body weakness. 7
episodes of loose watery stool in 24 hours were observed during the care. No
growth or developmental delay were observed.
Case 8:
Upon assessment, the patient no longer has any sign of diarrhea and dehydration.
Sunkening of eyes were not present. Stool was no longer watery and loose; has
returned to usual pattern of defecation (once a day) with a semi-formed stool as
verbalized by mother. Patient has a slightly dry skin, has good skin turgor. Crackles
was heard upon auscultating the lung fields; presence of cough was also noted.
Child is easily irritated.

D. Anatomy and Physiology of the Organ/s Involved

Anatomy and Physiology of Acute Gastroenteritis

Digestive System
The digestive system consists
of

two

linked

alimentary
accessory
The

parts:

the

and

the

canal
digestive

alimentary

essentially

organs.

canal
tube,

is

some

9 meters (30 feet) long, that

extends

from

the

mouth

to anus,

with

its

longest

section- the intestines- packed

into the abdominal cavity. The
alimentary

tube

consists

of

linked organs that each plays

their own part in digestion:
mouth, pharynx,

esophagus,

stomach, small intestine, and

large intestine. The accessory
digestive organs consist of the
teeth

and

tongue

in

the mouth; and the salivary

glands, liver, gallbladder, and
pancreas, which are all linked
by ducts to the alimentary
canal.
The stomach is a J- shaped enlargement of the GI tract directly under the diaphragm
in the epigastric, umbilical and left hypochondriac regions of the abdomen. When
empty, it is about a size of a large sausage;

The mucosa lies in large folds, called rugae. Approximately 10 inches long but the
diameter depends on how much food it contains. When full, it can hold about 4 L (1
galon) of food. Parts of the stomach includes cardiac region which is defined as a
position near the heart surrounds the cardio esophageal sphincter through which
food enters the stomach from the esophagus;
Fundus which is the expanded part of the stomach lateral to the cardiac region;
Body is the mid portion;
The pylorus is a funnel shaped which is the terminal part of the stomach. The
pylorus is continuous with the small intestine through the pyloric sphincter, or valve.
With the gastric glands lined with several secreting cells the zymogenic (peptic)
cells secrete the principal gastric enzyme precursor, pepsinogen. The parietal
(oxyntic) cells produce hydrochloric acid, involved in conversion of pepsinogen to
the active enzyme pepsin, and intrinsic factor, involved in the absorption of Vitamin
B12 for the red blood cell production. Mucous cells secrete mucus. Secretions of the
zymogenic,

parietal

and

mucus

cells

are

collectively

called

the

gastric

juice. Enteroendocrine cells secrete stomach gastrin, a hormone that stimulates

secretion of hydrochloric acid and pepsinogen, contracts the lower esophageal
sphincter, mildly increases motility of the GI tract, and relaxes the pyloric
sphincter. Most digestive activity occurs in the pyloric region of the stomach. After
food has been processed in the stomach, it resembles heavy cream and is called
chyme. The chyme enters the small intestine through the pyloric sphincter.

Summary of Medical and Surgical Management

A. Laboratories and Diagnostic Studies

Case 1:
Complete Blood Count
Hemoglobin

63

g/L

96 156

MCV

55.90

fl

76 91

MCH

16.50

Pg

23 31

MCHC

296

g/L

320 360

RDW

21.50

11.5 14.5

Monocyte

12.90

2 11

mmol/L

98 107

Low-Indicates
anemia
Low-Indicates
iron deficiency
anemia
Low-Indicates
iron deficiency
anemia
Low-Indicates
iron deficiency
anemia
High-high
variation in rbc
size due to iron
deficiency
High-indicates
infection

CHEMISTRY
CHLORIDE

95.1

Low- Indicates
dehydration

Case 2:
WBC Count
Hemoglobin
Hematocrit

30.83
103
0.29

10^9/L
g/L
L/L

6.0 18.0
104 160
0.35 0.51

MCV

66.70

Fl

83 107

MCH
RDW

23.80
16.50

Pg
%

25 35
11.5 14.5

Infection
Anemia
Dehydration;
anemia; RBC
destruction
Indicates
RBCs are
smaller than
normal
(microcytic);
caused by
iron
deficiency
anemia or
thalassemias
, for
example.
Anemia
Indicates
mixed

Platelet
Count

523.00

10^9/L

150 450

Neutrophil

48

18 38

Monocyte

2 11

Eosinophil

1-4

Potassium

2.47

mmol/L

3.50 5.30

population
of small and
large RBCs;
young RBCs
tend to be
larger.
Maybe due
to
inflammator
y bowel
disease
and/or folate
deficiency
Acute
bacterial
infections
the body is
low on
infection
resistance
A low
eosinophil
level is
usually not a
cause for
concern and
is actually
quite
common.
Eosinophils
can
be too low
due to
administrati
on of
steroids.
Hypokalemia

Case 3:
Chemistry (January 19, 2016)
Sodium
Potassium

RESULT
133.8 mmol/L
2.40 mmol/L

Clinical Microscopy (January 17, 2016)

REFERENCE
135-148
3.50-5.30

REMARKS
Hyponatremia
Hypokalemia

Result
Fecalysis
Gross Examination
Color
Consistency
MICROSCOPIC
EXAMINATION
Entamoeba coli
Entamoeba histolytica/
dispar
Ascaris lumbricoides
Fertilized Ova
Giardia Lamblia

Green
Watery

POS (+)

Interpretation:
Green stools
In most cases, stool color changes are not symptoms of disease. Changes in stool
color may be due to diarrhea may cause green or yellow stools.
If stool passes through the intestine too quickly, there might not be enough time for
bile to be digested and broken down to provide the normal brownish stool color. Bile
that is chemically changed by bacteria in the intestine can be greenish-brown. It
takes time for the bile to be fully changed in the intestine and become brown again,
and if the transit time is short, the stool remains green colored.
Watery
When you have diarrhea, your bowel movements (stools) are loose and watery.
Stools that are liquid or watery are always abnormal and considered diarrheal.
Possitive Fertilized Ova
Ascaris lumbricoides is the name of round worm which is a parasite which is found
in the bowel of those infected with it. There are eggs of the worm in the stool and
therefore you might be having the worms in your bowel.
Hematology (January 17, 2016)
RESULT

REFERENCE

REMARKS

70.40

76-92

Indicates RBCs are

smaller than
normal
(microcytic);

Complete Blood Count

MCV

caused by iron
deficiency anemia
or thalassemias,
for example.
Dehydration

5.44

3.40-5.20

16.90

11.5-14.5

Indicates mixed
population of
small and large
RBCs; young RBCs
tend to be larger.

64.90 %

22-46

24.20%

37-73

0.30%

1-4

0.80%

0-2

Acute bacterial
infections
the body is low on
infection
resistance
A low eosinophil
level is usually not
a cause for
concern and is
actually quite
common.
Eosinophils can
be too low due to
administration of
steroids.
Acute infection

RBC Count
RDW

Differential Count
Neutrophil
Lymphocyte

Eosinophil

Basophil
Case 4:
Hematology
Hematocrit

0.33 L/L

0.35-0.51

MCV

75.80 fl

83-107

RDW

18.70 %

11.5-14.5

14.20 %

2-11

Dehydration;
anemia; RBC
destruction
Microcytic red
blood cells
Iron deficiency
anemia

Differential count
Monocyte

Parasitic infection

Case 5:
Sodium
Potassium
Chloride

Result
158 mmol/L
2.87 mmol/L
127.1 mmol/L

Reference
135-148
3.5-5.3
98-107

Indication
Elevated
Low
Elevated

Case 6:
Complete blood count taken on January 13, 2016
Results
Hemoglobin

87

Hematocrit

0.25

MCV

77.30

RBC Count

3.26

Unit

Reference

Significanc
e

COMPLETE BLOOD COUNT

g/L
102 152 Decrease
d
L/L
0.36
Decrease
0.46
d
fl
78 94
Decrease
d
10^12/L
4.00
Decrease
5.20
d

Implication
anemia
anemia
anemia
anemia

Case 7:
BLOOD CHEMISTRY
Taken 1/13/2016
Sodium &
Potassium
POTASSIUM

Result

Unit

Reference

Implication

3.41

Mmol/L

3.5 5.3

Decreased
(may be due
to vomiting)

Result

Hematology
Unit
Reference

Interpretation
COMPLETE BLOOD
CLINICAL MICROSCOPY
COUNT
Result 5.5 17.5 Implication/Interpretation
WBC Count
28.85
10^9/L
Infection
Fecalysis
Hemoglobin
93
g/L
96 156
Possible iron and/or
GROSS EXAMINATION
vitamin deficiency
Color
Yellow Green
anemia
Soft
Hematocrit
0.28
L/L
0.34 0.48 Anemia
Consistency
MCV
71.80
fl
76 92
Iron Deficiency Anemia
MICROSCOPIC
EXAMINATION
RDW
19.10
%
11.5 14.5 Iron Deficiency Anemia
Entamoeba
coli 707.00
Platelet
Count
10^9/L
150 450
Maybe due to
Entamoeba histolytica/dispar
inflammatory bowel
Ascaris lumbricoides
disease and/or folate
Giardia lamblia
deficiency
Bacteria
Moderate
Bacterial infection of the
DIFFERENTIAL
GIT
COUNT
REMARKS
No Parasite Seen
Neutrophil
67.40
%
22 46
Indicative of Bacterial
Lymphocyte
25.30
%
37 73
Infection as Opposed to
Viral Infection
Eosinophil
0.30
%
14
Increased production of
cortisol that may be due
to stress due to infection

January 21, 2015 Repeat Sodium and Potassium after fast treatment of
Hypokalemia
Result

Unit

CHEMISTRY
Reference

Sodium and Pottasium

Sodium
141.8
Pottasium
2.65

mmol/L
mmol/L

135 148
3.50 5.30

Chloride

mmol/L

98 107

110.3

Implication/Interpretatio
n
Hypokalemia; Loss of
potassium in the stool

Case 8:
Complete Blood Count (taken: 1/18/2016)

Component
WBC Count
Hemoglobin
Hematocrit

Result
11.89
105
0.33

Reference

Unit

Interpretation

4.8 10.8
120 160
0.37 0.47

10^9 / L
g/L
L/L

Possible Infection
Anemia
Anemia

MCV
69.30
MCH
21.90
MCHC
316
Differential Count

81 99
27 31
330 370

pg
g/ L

Anemia
Anemia
Anemia

Neutrophil
Lymphocyte
Basophil

40 -74
19 48
02

10^9 / L
%
%

Infection
Infection
Allergic Reactions

39.40
46.60
0.70

Urinalysis (taken: 1/15/2016)

Test
Color
Transaparency
Specific Gravity
PH
Glucose
Protein
RBC
WBC

Result
Yellow
Cloudy
1.025
6.5
Negative
+
2-4
11-15

Unit

/hpf
/hpf

Interpretation
NORMAL
NORMAL
NORMAL
NORMAL
NORMAL
NORMAL
NORMAL
Infection/inflammation

Hyaline Cast
Squamous E. Cells
Bacteria
Mucus Threads

2-5
Moderate
Rare
Loaded

/lpf
/lpf
/hpf
/hpf

NORMAL
NORMAL
NORMAL

B. Pharmacologic Therapy (present a summary of medications, dosage,

route and indications)
Common medications

Folic acid
Zinc sulfate
Paracetamol
Ampicillin
Amikacin

PO medications
Medicati
on

Classif
cation

Folic
acid

Vitamin
Folic
acid
derivati
ve

Zinc
sulfate

Copper
absorpt
ion
inhibito
r
Nutritio
nal
supple
ment
Mineral

PO

Antiulc
erative

PO

Sucralfa
te

Ro
ut
e
PO

Indication

Responsibilities

Nutritional health
Maintain health
Patients with
megaloblastic
anemia

1. Assess patients folic acid

deficiency before starting
therapy
2. Evaluate CBC
3. Dont confuse folic acid with
folinic acid

To prevent or
treat zinc
deficiency
To promote
healing of
irritated intestinal
mucosa and as
supplement for
proper growth
and adequate
transport of water
and electrolytes
Therapy for
duodenal ulcer,
gastric ulcer

1. Be aware that zinc chloride

contains aluminum, which may
accumulate to the point of
toxicity if patients kidney
function is impaired.

1. Assess patients GI symptoms

before therapy
2. Give drug on an empty stomach
3. Instruct patient to take drug 1
hour before meal and bedtime

Diphenh
ydramin
e
hydrochl
oride

Antihist
amine
Antitus
sive
Antiem
etic
Sleep
aid

PO

Pyrantel
Pamoate

Anti
helmint
hics
Bronch
odilator
(therap
eutic);
adrener
gics
(pharm
acologi
c)

PO

Salbuta
mol

ne
bu
liz
er

allergy symptoms
nonproductive
cough
to prevent motion
sickness
treat vertigo
sedation
nighttime sleep
aid
Treatment of
Enterobiasis
(Pinworms)
1. To control and
prevent
reversible
airway
obstruction
caused by
asthma or
chronic
obstructive
pulmonary
disorder (COPD)
2. Quick relief for
bronchospasm
3. For the
prevention of
exerciseinduced
bronchospasm
4. Long-term
control agent
for patients with
chronic
or persistentbro
nchospasm
5. For relief nasal
congestion and
reversible
bronchospasm.

or as prescribed
4. tell patient to avoid alcohol,
smoking, spicy foods
5. tell patient to sleep with head of
bed elevated
1. reduce GI distress by giving drug
with food or milk
2. advise to avoid taking other OTC
drugs that contain
diphenhydramine to prevent
additive effects

1. Do not drive or engage in other

potentially hazardous activities until
response to drug is known.

Provide oral care or let

patient gurgle after inhalation
to get rid of the unpleasant
aftertaste of the inhalation.

Auscultate lungs for presence

of adventitious breath sounds
that may signal pulmonary
edema, airway resistance or
bronchospasm.

Inspect clients nail bed and

oral mucosa for pallor.

Place client in position of

comfort to facilitate optimum
rest and sleep.

Emphasize with the family

and the client the importance of
wiping off sweat to avoid easy
breakdown of skin integrity.

Instruct client to report

palpitations and increasing
difficulty of breathing.

Potassiu
m
Bicarbo
nate
(K-Lyte)

Potassi
um
supple
ment

PO

Hypokalemia,
hormone problems
such as
hyperaldosteronism,
or treatment with
"water
pills"/diuretics.
For relief of severe
prolonged diarrhea a
nd vomiting.

Take this medication exactly as

prescribed by your doctor. Do
not take it in larger amounts or
for longer than recommended.
Follow the directions on your
prescription label.

Do not chew the effervescent

tablet or swallow it whole.

Drop the tablet into a glass and

add at least 4 ounces (one-half
cup) of cold water or fruit juice.
When the tablet has completely
dissolved, begin drinking the
mixture slowly, over 5 to 10
minutes in all.

To make sure you get the entire

dose, add a little more water to
the same glass, swirl gently and
drink right away.

Take this medication with food

or just after a meal.

Do not stop taking this

medication without first talking
to your doctor. If you stop
taking potassium suddenly,
your condition may become
worse.

Store potassium bicarbonate and

potassium citrate at room
temperature away from moisture
and heat. Keep the medication in a
closed container.
Multivita
mins +
iron

Multipl
e
vitamin

PO

Treat or prevent
vitamin deficiency

Take this medication by mouth,

usually once daily or as

directed. Follow all directions on

the product package, or take as
directed by your doctor.

Moxiflox
acin

Fluoroq
uinolon
es

PO

Treating eye
infections caused by
certain bacteria.

Do not take more than the

recommended dosage. If you
are uncertain about any of the
information, consult your doctor
or pharmacist.

This medication is best taken on

an empty stomach 1 hour
before or 2 hours after meals.
Take with a full glass of water (8
ounces or 240 milliliters) unless
your doctor directs you
otherwise.

If stomach upset occurs, you

may take this medication with
food.

Do not lie down for 10 minutes

after taking this medication.
Consult your doctor or
pharmacist for details for your
particular brand.

Moxifloxacin drops are only

for the eye. Do not get it in your
nose or mouth.
To use moxifloxacin drops in
the eye, first, wash your hands.
Tilt your head back. Using your
index finger, pull the lower eyelid
away from the eye to form a
pouch. Drop the medicine into
the pouch and gently close your
eyes. Immediately use your
finger to apply pressure to the
inside corner of the eyelid for 1
to 2 minutes. Do not blink.

Remove excess medicine around

your eye with a clean, dry tissue,
being careful not to touch your
eye. Wash your hands to remove
any medicine that may be on
them.
To prevent germs from
contaminating your medicine, do
not touch the applicator tip to
any surface, including the eye.
Keep the container tightly closed.
To clear up your infection
completely, use moxifloxacin
drops for the full course of
treatment. Keep using it even if
you feel better in a few days.
If you miss a dose of
moxifloxacin drops, use it as
soon as possible. If it is almost
time for your next dose, skip the
missed dose and go back to your
regular dosing schedule. Do not
use 2 doses at once.
Moxifloxacin drops only
works against bacteria; it does
not treat viral infections (eg, the
common cold).
Long-term or repeated use of
moxifloxacin drops may cause a
second infection. Tell your doctor
if signs of a second infection
occur. Your medicine may need
to be changed to treat this.
Be sure to use moxifloxacin
drops for the full course of
treatment. If you do not, the
medicine may not clear up your
infection completely. The
bacteria could also become less
sensitive to this or other
medicines. This could make the
infection harder to treat in the
future.

Paraceta
mol

Analge
sic,
antipyr
etic

PO

-Temporary reduction
of fever; temporary
relief of minor aches
and pains caused by
common cold and
influenza, headache,
sore throat,
toothache, backache,
menstrual cramps,
minor arthritis pain
and muscle aches

Administer if fever is more than

38.5C

IV medications
Medications

Classifcations

Ampicillin

Aminopenicillin
Antibiotic

Amikacin

Aminoglycoside
Antibiotic

Rout
e
IV

Indication

GI infection

IV

To treat serious
gram-negative
bacterial
infections( e.g.
septicemia, resp
tract, CNS, skin,
intra-abdominal,)

Responsibilities
1. Obtain history
of patients
infection before
therapy
2. Give at least 1
hour for
bacteriostatic
antibiotics
3. Stop drug
immediately if
anaphylaxis
occurs
1. Obtain
specimen for
culture and
sensitivity tests
before first
dose
2. Drug potency
isnt affected if
solution turns
light yellow
3. Patient should
be well
hydrated
4. Emphasize
importance of

5.

Ranitidine

H2-receptor
antagonist
Antiulcerative

IV

for duodenal and

gastric ulcer
gastroesophageal
reflux

1.

2.

3.

Ceftriaxone

third
generation
cephalosporin
antibiotic

IV

serious infections
of intraabdominal, bone,
joint skin, lower
respiratory tract
and urinary
system

1.

2.

3.

Metronidazol
e

Antiprotozoal
Antibiotic

IV

amebic hepatic
abscess

1.

drinking 2liters
of fluid daily,
unless
contraindicated
Measure
amikacin
concentrations
as ordered
assess
patients GI
condition
before therapy
dont add
additives to
premix
solutions
stop primary IV
solution
infusion during
piggybabck
administration
assess
patients
infection before
therapy
before giving
first dose,
obtain
specimen for
culture and
sensitivity test
calciumcontaing
products must
not be given IV
within 48 hours
of ceftriaxone,
including
solutions given
through a
different IV line
and at a
different site,
because it may
precipitate in
the lungs and
kidneys and
could be fatal
assess
patients

Cefipime

Anti-infective
Fourth
generation
cephalosphorin
s

IV

Omeprazole

Proton pump
inhibitor

IV

D5 NSS

Isotonic IVF

IV

intestinal
amebiasis

Treatment of
infections
caused by
susceptible
organisms:
uncomplicated
skin and skin
structure
infections,
bone and joint
infections,
uncomplicated
and
complicated
urinary tract
infections,
respiratory
tract infections
To treat duodenal
ulcer, gastric ulcer,
heartburn on 2 or
more days per week

Temporary treatment
for shock if any

infection before
therapy
2. watch carefully
for edema,
especially in
patients also
receiving
corticosteroid
because it may
cause sodium
retention
3. give IV drug by
slow infusion
over 1 hour;
dont give by
direct IV
injection
4. discontinue
primary iv
infusion during
metronidazole
infusion
1. Assess prior to
giving
hypersensitivity.
2. Reinforce
completion of
dosage.

1. Assess
patients
condition
before therapy
2. warn patient
not to crush or
chew tablet
3.
1. Watch out for
signs of

D 545

Hypertonic IV
solution

IV

plasma expander is
unavailable and for
patient having
addisons crisis. For
replacement or
maintenance of fluid
and electrolytes.
Intravenous solutions
containing dextrose
and sodium chloride
are indicated for
parenteral
replenishment of
fluid, minimal
carbohydrate
calories, and sodium
chloride as required
by the clinical
condition of the
patient.

hypervolemia such
as bounding pulse
and SOB.

1. Double check
use to patients
with congestive
heart failure,
severe renal
insufficiency
2. Closely monitor
regulation for it
may cause
overhydration or
solute overload.

Problem Analysis
A. Summary of Nursing Diagnoses (prioritized)

Dysfunctional gastrointestinal motility related to irritation of gastrointestinal

tract and altered peristaltic movement as evidenced by hyperactive bowel
sounds, abdominal pain, vomiting, and diarrhea.

Imbalanced Nutrition: Less than Body Requirements related to insufficient

intake and excessive output

Deficient isotonic fluid volume related to active fluid volume loss through GIT
secondary to acute gastroenteritis.

Activity intolerance R/T generalized muscle weakness secondary to

underlying disease process

Impaired physical mobility related to decreased muscle strength and altered

cellular metabolism as evidenced by unwillingness to move and limited range
of movement

Discharge Summary:

Clients with Acute Gastroenteritis 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.
E - Exercise should be promoted in a way by stretching hand and feet every
morning.
T - Treatment after discharge is expected for patients and watcher with Acute
Gastroenteritis to fully participate in continuous treatment.
H - Health teachings regarding the importance of proper hygiene and handwashing,
food and water preparation, intake of adequate vitamins especially vitamin C-rich
foods to strengthen the immune response and increasing of oral fluid intake should
be conveyed.
O - OPD such as regular follow-up check-ups should be greatly encouraged to clients
with Acute Gastroenteritis as ordered by physician to ensure the continuing
management and treatment.
D - Diet which is prescribed should be followed. Laxative-containing food should be
avoided. To include fruits especially banana in the diet is significant.
S Spirituality wherein you encourage the family to resume to their spiritual
practices.