Gastroenteritis Overview Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal

tract). The most common symptoms of gastroenteritis are diarrhea, nausea, and crampy abdominal pain, vomiting. Many people also refer to gastroenteritis as "stomach flu." This can sometimes be confusing because influenza (flu) symptoms include headache, muscle aches and pains, and respiratory symptoms, but influenza does not involve the gastrointestinal tract. The term stomach flu presumes a viral infection, even though there may be other causes of infection. Viral infections are the most common cause of gastroenteritis; but bacteria, parasites, and food-borne illnesses (such as from shellfish that has been contaminated by sewage or from eating raw or undercooked shellfish from contaminated water) can also be the offending agents. Many people who experience vomiting and diarrhea that develops from these types of infections or irritations think they have "food poisoning," when they actually may have a food-borne illness. Travelers to foreign countries may experience "traveler's diarrhea" from contaminated food and unclean water. The severity of infectious gastroenteritis depends on the immune system's ability to resist the infection. Electrolytes (these include essential elements of sodium and potassium) may be lost as the affected individual vomits and experiences diarrhea. Most people recover easily from a short episode of vomiting and diarrhea by drinking fluids and gradually progressing to a normal diet. But for others, such as infants and the elderly, the loss of bodily fluid with gastroenteritis can causedehydration, which is a life-threatening illness unless the condition is treated and fluids are restored. The most recent data from the CDC, show that deaths from gastroenteritis have increased dramatically. In 2007, 17,000 people died from gastroenteritis, overwhelmingly, these people were older and the most common infections wereClostridium difficile and norovirus.

Gastroenteritis Causes Patient CommentsShare Your Story Gastroenteritis has many causes. Viruses and bacteria are the most common. Viruses and bacteria are very contagious and can spread through the consumption contaminated food or water. In up to 50% of diarrheal outbreaks, no specific agent is found. The infection can spread from person to person because of improper handwashing following a bowel movement or handling a soiled diaper. Gastroenteritis caused by viruses may last one to two days. However, some bacterial cases can continue for a longer perioDeficient Fluid Volume NDx: Deficient fluid volume RT excessive losses through normal routes AEB frequent passage of loose watery stool 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

Planning

Interv

Subjective:(none)Objective: The patient manifested: passage of loose watery stool vomiting abdominal cramping dehydration nausea fatigue weakness

Short term:After 4 hours of nursing interventions, the patient will report understanding of causative factors for fluid volume deficitLong Term: After 3 days of Nursing Interventions, the patient will maintain fluid volume at functional level AEB well hydrated, intake is equal as output, and normal skin turgor.

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The patient may manifest: nervousness confusion weight loss decreased skin turgor decreased urine output dry mucous membrane fever

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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.

Pathophysiology

Adequate fluid balance in humans depends on the secretion and reabsorption of fluid and electrolytes in the intestinal tract; diarrhea occurs when intestinal fluid output overwhelms the absorptive capacity of the gastrointestinal tract. The 2

primary mechanisms responsible for acute gastroenteritis are (1) damage to the villous brush border of the intestine, causing malabsorption of intestinal contents and leading to an osmotic diarrhea, and (2) the release of toxins that bind to specific enterocyte receptors and cause the release of chloride ions into the intestinal lumen, leading to secretory [2] diarrhea.

Even in severe diarrhea, however, various sodiumcoupled solute co-transport mechanisms remain intact, allowing for the efficient reabsorption of salt and water. By providing a 1:1 proportion of sodium to glucose, classic oral rehydration solution (ORS) takes advantage of a specific sodium-glucose transporter (SGLT-1) to increase the reabsorption of sodium, which leads to the passive reabsorption of water. Rice and cereal-based ORS

may also take advantage of sodium-amino acid transporters to increase reabsorption of fluid and electrolytes.[2]
History

The history and physical examination serve 2 vital functions: (1) differentiating gastroenteritis from other causes of vomiting and diarrhea in children and (2) estimating the degree of dehydration. In some cases, the history and physical

examination can also aid in determining the type of pathogen responsible for the gastroenteritis, although only rarely will this affect management.

Diarrhea
Determine the duration of diarrhea, the frequency and amount of stools, the time since the last episode of diarrhea, and the quality of stools. Frequent, watery stools are more consistent with viral

gastroenteritis, while stools with blood or mucous are indicative of a bacterial pathogen. Similarly, a long duration of diarrhea (>14 days) is more consistent with a parasitic or noninfectious cause of diarrhea.

Vomiting
Determine the duration of vomiting, the amount and quality of vomitus (eg, food contents, blood, bile), and time since the last episode of

vomiting. When symptoms of vomiting predominate, one should consider other diseases such as gastroesophageal reflux disease (GERD), diabetic ketoacidosis, pyloric stenosis, acute abdomen, or urinary tract infection.

Urination
Determine if there is an increase or decrease in the frequency of urination as measured by the number of

wet diapers, time since last urination, color and concentration of urine, and presence of dysuria. Urine output may be difficult to determine with frequent watery stools.

Abdominal pain
Determine the location, quality, radiation, severity, and timing of pain, based on a report from the parents and/or child. In general, pain that precedes vomiting and

diarrhea is more likely to be due to abdominal pathology other than gastroenteritis.

Signs of infection
Determine the presence of fever, chills, myalgias, rash, rhinorrhea, sore throat, cough, known immunocompromised status. These may indicate evidence of systemic infection or sepsis.

Appearance and behavior

Elements include weight loss, quality of feeding, amount and frequency of feeding, level of thirst, level of alertness, increased malaise, lethargy, or irritability, quality of crying, and presence or absence of tears with crying.

Antibiotics
A history of recent antibiotic use increases the likelihood of Clostridium difficileinfection.

Travel

History of travel to endemic areas may make prompt consideration of organisms that are relatively rare in the United States, such as parasitic diseases or cholera