I.

Introduction:

Gastroenteritis (also known as gastric flu, although unrelated to influenza) is inflammation of

the gastrointestinal tract, involving both the stomach and the small intestine and resulting in acute
diarrhea. It can be transferred by contact with contaminated food and water. The inflammation is
caused most often by an infection from certain viruses or less often by bacteria, their toxins,
parasites, or an adverse reaction to something in the diet or medication. 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.
At least 50% of cases of gastroenteritis due to foodborne illness are caused by 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.

A. Current trends

Rotavirus Vaccine Offers New Tool to Combat Severe Diarrhea in Developing World
(Jan. 28, 2010) —Rotavirus is the leading cause of severe, acute gastroenteritis among infants and
young children throughout the world and is responsible for an estimated 527,000 deaths among
children under five each year. More than 90% of childhood deaths attributed to rotavirus infection
occur in developing countries.

One of the rotavirus vaccines Rotarix, developed by GlaxoSmithKline Biologicals (GSK)

was tested in the Phase III clinical trial in Malawi and South Africa, which found that the vaccine
reduced the overall incidence of severe rotavirus diarrhoea by 61.2%, although vaccine efficacy
was lower in Malawi (49.4%) compared with South Africa (76.9%). The vaccine was able to
prevent more rotavirus diarrhoea episodes in Malawi because of a higher rate of severe disease in
the country.

http://www.sciencedaily.com/releases/2010/01/100127182456.htm
 II. Nursing Assessment

A. PERSONAL DATA

1. Demographic data

In order to keep the life of our patient in private and to keep confidentiality let us just call
him Butad, 46 year old; male separated with his wife. He is 11th among the 12 children he
currently residing in Dolores Angeles city. He was admitted on April 15, 2010 and diagnosed as
AGE and discharge last April 20, 2010.

2. Socio-Economic and Cultural Factors

He is a jeepney driver and work 6 days a week with one day rest. His daily income
300/day most of his income is spends on food. Butad stop schooling when he was on his 1 st year
high school. He is a roman catholic. He was not able to attend mass regularly because of his
work. Butad doesn’t believe in faith healers and albularyo he directly goes to the hospital when
he feels sick.

History of Past Illness

Butad had fever and cough months before the admission.

History of Present Illness

Butad experience dizziness and vomiting at 3:00 pm on April 15, 2010. He went
straightly to ONA and got admitted on the same date.

F. Diagnostic and Laboratory Procedure

Diagnostic / Date Indications or Results Normal Analysis and

laboratory ordered Purposes (1st,2nd,3rd) Values Interpretations
procedure of Results
Date (units used in
results in hospital) (book-based)
To determine
the presence
Fecalysis Date of parasites Color: brown Color: brown Brown stools
ordered and and soft in
characteristic Consistency: Consistency: consistency
April 15, of stool. soft soft indicate normal
2010 bowel
movement.

Date
 results in

April 16, No eggs or

2010 parasite seen
Others: no No ova or indicates that the
ova or parasite seen patient is free
parasite seen from intestinal
parasite
infestation.

1. PHYSICAL EXAMINATION (IPPA Cephalocaudal Approach)

Initial Assessment upon Admission (April 15, 2010) Lifted from the chart .

a. Physical Assessment
Head / EENT: sclera pink conjunctiva
Chest: (-) retractions,
Cardiovascular: normal rate, regular rhythm
Abdomen: flabby, mass, soft, non tender
Extremities: fall and equal pulses

Nurse-Patient Interaction #1 (April 19, 2010)

Vital Signs as follows:

T: 36 °C
P: 89bpm
R: 16cpm
BP:110/90 mmHg

Appearance and Mental Status

 Butad was received sitting on bed, conscious and coherent, afebrile, wearing short and t-
shirt. He was able to perform full ROM. He is able to understand and comprehend spoken
words.
Integumentary
Skin: (-) jaundice with good skin turgor; brown in color
Hair: black, long, straight and oily; with equal distribution;
Nails: pale nail beds; with no evidence of clubbing or unusual dryness or cracking;
convex nail curve; good capillary refill of 2 seconds; normal angle
Color: brown
Head
Skull: normocephalic, well-rounded and symmetrical in shape; no nodules or masses; no
abnormal prominence noted
Face: symmetrical facial movement; symmetrical facial feature; no lesion; no masses,
nodules and abnormal prominence
Eyes and Vision: iris are black in color; eyes are symmetrical; evenly distributed thin
eyebrows are symmetrically aligned; (-) ptosis; (+) PERRLA; pupils appears black and
equal in size, round; pink palpebral conjunctiva
Ear and Hearing: (+) whisper test; no lesions or abnormal discharges or swelling noted;
with minimal cerumen; hears normal conversation; pinna can be easily folded
Nose: symmetrical and straight; no evidence of deviated nasal septum; no tenderness;
uniform in color; presence of clear secretion; no flaring noted
Mouth: (-) halitosis; no teeth missing, teeth are white and shiny lips is pinkish in color;
tongue can move freely

Neck: no pain; no abnormal distention of jugular vein; trachea is located in the normal
position-midline; lymph nodes are not palpable and not swollen
Lymph Nodes:
anterior and posterior lymph nodes are not palpable; no generalized enlargement of lymph nodes
Thorax and Lungs: no abnormal shape and symmetry of the thorax; spine is vertically
aligned; spinal column is straight; there is full and symmetric chest expansion; no
tenderness; rales noted on both lung fields
Peripheral Pulses: there is a symmetrical pulse volume with full and regular pulsations
Abdomen: Hyperactive bowel sounds 40, mass rounded and flabby.
 Muscles: (-)tremors with good muscle tone and with equal size on both sides of the body; can
perform full range of motion
Bones: there are no deformities; no tenderness or swelling; minimal joint movements
Upper Extremities: symmetrically aligned (-) edema
Lower Extremities: symmetrically aligned; (-) edema
Reflexes: Patellar reflex is present as evidence by the extension or kicking out of the leg was
elicited by Mr. Jaundice
Motor Function: Kimi can perform range of motion with full resistance applied.
Pain Sensation: Kimi is able to discriminate “sharp” and “dull” sensations.
Position and kinesthetic sensation: Kimi is able to determine the position of fingers and toes.
Cranial Nerves:
CN I: able to distinguish isopropyl alcohol and chocolate drink
CN II: able to see far objects and texts, functional peripheral vision
CN III, IV, VI: (+)PERRLA, (-)ptosis, (-)nystagmus
CN V: able to feel and distinguish pinprick, wisp of cotton, hot and cold
CN VII: able to purse lips, raise the eyebrows and forehead and tightly close the eyes,
CN VIII: could hear a whispering voice.
CN IX, X: (+) gag reflex, (+) cough reflex; able to speak clear and loud
CN XI: able to elevate shoulders; turn head side to side, push head forward with resistance
CN XII: (-) tongue deviation,

Nurse-Patient Interaction #1 (April 20, 2010)

Vital Signs as follows:

T: 35.4 o C
P: 93bpm
R: 18cpm
BP:100/70mmHg

Appearance and Mental Status

Butad was received sitting on bed, conscious and coherent, afebrile, wearing
short and t-shirt. He was able to perform full ROM. He is able to understand and
comprehend spoken words.
Integumentary
 Skin: (-) jaundice with good skin turgor; brown in color
Hair: black, long, straight and oily; with equal distribution;
Nails: pale nail beds; with no evidence of clubbing or unusual dryness or cracking;
convex nail curve; good capillary refill of 2 seconds; normal angle
Color: brown
Head
Skull: normocephalic, well-rounded and symmetrical in shape; no nodules or masses; no
abnormal prominence noted
Face: symmetrical facial movement; symmetrical facial feature; no lesion; no masses,
nodules and abnormal prominence
Eyes and Vision: iris are black in color; eyes are symmetrical; evenly distributed thin
eyebrows are symmetrically aligned; (-) ptosis; (+) PERRLA; pupils appears black and
equal in size, round; pink palpebral conjunctiva
Ear and Hearing: (+) whisper test; no lesions or abnormal discharges or swelling noted;
with minimal cerumen; hears normal conversation; pinna can be easily folded
Nose: symmetrical and straight; no evidence of deviated nasal septum; no tenderness;
uniform in color; presence of clear secretion; no flaring noted
Mouth: (-) halitosis; no teeth missing, teeth are white and shiny lips is pinkish in color;
tongue can move freely

Neck: no pain; no abnormal distention of jugular vein; trachea is located in the normal
position-midline; lymph nodes are not palpable and not swollen
Lymph Nodes:
anterior and posterior lymph nodes are not palpable; no generalized enlargement of lymph nodes
Thorax and Lungs: no abnormal shape and symmetry of the thorax; spine is vertically
aligned; spinal column is straight; there is full and symmetric chest expansion; no
tenderness; rales noted on both lung fields
Peripheral Pulses: there is a symmetrical pulse volume with full and regular pulsations
Abdomen: Hyperactive bowel sounds 40, mass rounded and flabby.
Muscles: (-)tremors with good muscle tone and with equal size on both sides of the body; can
perform full range of motion
Bones: there are no deformities; no tenderness or swelling; minimal joint movements
Upper Extremities: symmetrically aligned (-) edema
Lower Extremities: symmetrically aligned; (-) edema
 Reflexes: Patellar reflex is present as evidence by the extension or kicking out of the leg was
elicited by Mr. Butad
Motor Function: Butad can perform range of motion with full resistance applied.
Pain Sensation: Butad is able to discriminate “sharp” and “dull” sensations.
Position and kinesthetic sensation: Butad is able to determine the position of fingers and
toes.

Cranial Nerves:
CN I: able to distinguish isopropyl alcohol and chocolate drink
CN II: able to see far objects and texts, functional peripheral vision
CN III, IV, VI: (+)PERRLA, (-)ptosis, (-)nystagmus
CN V: able to feel and distinguish pinprick, wisp of cotton, hot and cold
CN VII: able to purse lips, raise the eyebrows and forehead and tightly close the eyes,
CN VIII: could hear a whispering voice.
CN IX, X: (+) gag reflex, (+) cough reflex; able to speak clear and loud
CN XI: able to elevate shoulders; turn head side to side, push head forward with resistance
CN XII: (-) tongue deviation,

F. Diagnostic and Labolatory Procedure

Diagnostic / Date Indications Results Normal Analysis and

laboratory ordered or Purposes (1st,2nd,3rd) Values Interpretations
procedure of Results
Date (units used in
results in hospital) (book-based)

Fecalysis Date Color: brown Color: brown Brown stools and

ordered soft in
Consistency: Consistency: consistency
July 15, soft soft indicate normal
2009 bowel movement.

Date
results in
No eggs or
 July 16, parasite seen
2009 indicates that the
patient is free
from intestinal
Others: no ova No ova or parasite
or parasite parasite seen infestation.
seen

Nursing Responsibilities:
Prior:
a. Explain the procedure to the patient as well as to the SO.
b. Prepare the materials needed – a clean leak proof container with cap, applicator sticks
and tissue or paper towel for wiping.
c. Instruct patient, or SO, on how to obtain stool sample, or assisting them to the bathroom,
providing privacy and proper draping.
d. Maintain aseptic technique, using clean gloves in obtaining the stool sample.

During:
a. Obtain stool sample using applicator stick.
b. Ensure that no urine water or soil or other material gets in the container.
After:
a. Cover the specimen cup and label.
b. Document the procedure, the time and date performed, and the patient’s response to the
procedure.
c. Assist the patient in returning to bed.
d. Leave the area clean and in order.
Nursing Responsibilities

Before the procedure:

•Check the doctor’s orders.

•Explain to the patient that small amount of blood will be drawn from her and that
blood will be tested to measure if her blood cells are within normal values and to
detect some blood abnormalities such as anemia, polycythemia or detect
infections.
•Inform the client that there are no fluid restrictions or fasting.
•Inform the patient that he will experience mild pain at the site of extraction during
collection.
•Ensure that the patient understands the procedure.
•Prepare laboratory request and inform laboratory.
•Inform the client of the scheduled extraction.

During the procedure:

•Provide comfort measures to decrease the client’s anxiety.
•Place the client in a comfortable position.
•Maintain aseptic technique.
•Assist medical technologist if necessary.

After the procedure:

•Instruct patient to apply slight pressure at the site of extraction for a few minutes.
•Place the patient in a comfortable position and leave his room quietly.
•Document the time and procedure done. Then, obtain results and secure it in
the patient’s chart. Refer
III. Anatomy and Physiology

Digestion is the break down of food to molecules that are small enough to be absorbed
into the circulation. Mechanical digestion breaks the large foods particles down into smaller ones.
Chemical digestion involves the breaking down of covalent chemical bonds in organic molecules
by digestive enzymes. Absorption begins in the stomach, where some small, lipids-soluble
molecules, such as alcohol and aspirin, can diffuse through the stomach epithelium into the
circulation. Most absorption occurs in the duodenum, and jejunum, although some occurs in the
ileum. Some molecules can diffuse through the intestinal wall. Others must be transported across
the intestinal wall. Transport requires carrier molecules and includes facilitated diffusion, co
transport, and active transport. Co transport and active transport require energy to move the
transported molecules across the intestinal wall.

The digestive system consist of the digestive tract, a tube extending from the mouth to
the anus, plus the associated organs, which secrete fluids into the digestive tract. The digestive
tract is consist of the oral cavity, pharynx, esophagus, stomach, small intestine, and large
intestine. The various parts of the digestive tract are specialized for different functions, but nearly
all parts consists of four layers of tunics: the mucosa, sub mucosa, mucularis and serosa.

Oral Cavity, Pharynx and Esophagus

The oral cavity or the mouth, is the first part of the digestive tract. It is bounded by the
lips and cheeks and contains the teeth and tongue which help in breaking down of foods. The
pharynx, or throat, which connects the mouth with the esopagus. Esophagus transport foods from
the pharynx to the stomach.

Mouth is used for taking in food. Lips, which form the mouth's muscular opening, are an
especially familiar part of the body for humans. Lips help hold food in the mouth. Lips are darker
than the surrounding skin because of the many extremely small blood vessels, called capillaries,
that show through the skin.

The cheeks form the sides of the mouth. They are composed of muscle tissue that is
covered on the outside by skin. Like the lips, the cheeks help hold food.

Inside the mouth is the large, muscular tongue. This extremely flexible muscle is used for
eating and swallowing. It is attached to the floor, or bottom, of the mouth. Its upper surface is
covered with tiny projections, called papillae, that give the tongue a somewhat rough texture. The
papillae contain tiny pores that are the site of taste buds, the receptor cells responsible for our
sense of taste. There are four kinds of taste buds that are grouped together on certain areas of the
tongue’s surface—those that are sensitive to sweet, salty, sour, and bitter flavors.

The roof, or top, of the mouth is called the palate. It separates the mouth from the nasal
passages above it. The front part of the palate—the part closer to the lips—is made of bone
covered with moist tissue, called mucous membrane. This part of the mouth is known as the hard
palate. Behind the hard palate is the soft palate, a
small area composed mainly of muscle tissue.
During swallowing, the soft palate presses
against the back of the throat, preventing food or
liquid from moving upward into the nasal
passages.

Teeth are used for biting into and

chewing food. The number of permanent teeth is 32. The crown, or top, of each tooth is covered
with enamel, the hardest substance in the human body.

The mouth also contains three pairs of salivary glands. These glands secrete a watery
fluid called saliva, which moistens food and the tissues of the mouth. Saliva contains amylase, a
digestive enzyme that starts to break down carbohydrates in food even before it is swallowed.
Saliva also contains a specialized protein, or enzyme, called lysozyme, which fights bacteria.

Stomach
The stomach is a muscular organ that is located in the central/upper left hand region of
the abdominal cavity. The function of the stomach is to break down food items. The stomach
secretes digestive juices, such as hydrochloric acid and pepsin, to aid in this process. Its muscular
walls churn the food until it is in a semi-liquid form.

Small Intestines

The small intestines digest and absorb many of the foods we eat. In addition to secreting
a strong mucus membrane to protect its walls from the strong acid food mixture that passes into it
from the stomach, the small intestines (along with the liver and pancreas) secrete enzymes that
help to digest proteins and carbohydrates and break them down into their simplest form. Once
digested, nutrients are extracted and are absorbed by the body.
Duodenum

A hollow jointed tube about 25-30

cm long connecting the stomach to the
jejunum. It is the first and shortest part
of the small intestine and it is where most chemical digestion takes place. The duodenum is
largely responsible for the breakdown of food in the small intestine. Brunner's glands, which
secrete mucus, are found in the duodenum. It also regulates the rate of emptying of the stomach
via hormonal pathways. Secretin and cholecystokinin are released from cells in the duodenal
epithelium in response to acidic and fatty stimuli present there when the pyloris opens and
releases gastric chyme into the duodenum for further digestion

Jejunum

the central of the three divisions of the small intestine and lies between the duodenum
and ileum. The inner surface of the jejunum, its mucous membrane, is covered in projections
called villi, which increase the surface area of tissue available to absorb nutrients from the gut
contents. The epithelial cells, which line these villi, possess even larger numbers of microvilli.
The transport of nutrients across epithelial cells through the jejunum and ileum includes the
passive transport of sugar fructose and the active transport of amino acids, small peptides,
vitamins, and most glucose. The villi in the jejunum are much longer than in the duodenum or
ileum.
Ileum
Is the final section of the small
intestine. It is about 2-4 m long in humans,
follows the duodenum and jejunum. The
pH in the ileum is usually between 7 and
8 (neutral or slightly alkaline). Its function is
mainly to absorb vitamin B12 and bile salts
and whatever products of digestion that
were not absorbed by the jejunum. The
wall itself is made up of folds, each of which has many tiny finger-like projections known as villi,
on its surface. In turn, the epithelial cells which line these villi possess even larger numbers of
microvilli.
Large Intestines
The large intestine is responsible for the elimination of food materials that cannot be
digested and assimilated by the body. It is also
responsible for the re-absorption of water used
during the digestive process. As food materials
pass through the large intestine, friendly
bacteria that live in the colon act upon this
waste, producing vitamin K and some of the
B-vitamins.
IV. The Patient and His Illness

Synthesis of the Disease (Book-based)

a. Definition of the Disease

Gastroenteritis (also known as gastro, gastric flu, tummy bug in some countries,
and stomach flu, although unrelated to influenza) 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 an infection from certain viruses or less often by bacteria,
their toxins, parasites, or an adverse reaction to something in the diet or medication. These agents
cause diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin
production. These mechanisms result in increased fluid secretion and/or decreased absorption.
This produces an increased luminal fluid content that cannot be adequately reabsorbed, leading to
diarrhea. The epithelium of the digestive tube is protected from insult by a number of
mechanisms constituting the gastrointestinal barrier, but like many barriers, it can be breached.
Disruption of the epithelium of the intestine due to microbial pathogens is a very common cause
of diarrhea in all species. Destruction of the epithelium results not only in exudation of serum and
blood into the lumen but often is associated with widespread destruction of absorptive epithelium.
In such cases, absorption of water occurs very inefficiently and diarrhea results. Aside from that a
large volumes of water are normally secreted into the small intestinal lumen, but a large majority
of this water is efficiently absorbed before reaching the large intestine. Diarrhea occurs when
secretion of water into the intestinal lumen exceeds absorption.
 This infectious agent also triggers the body to release chemical mediator which serves as
the guard system of the body. These chemical mediator releases endogenous pyrogens that
stimulate the hypothalamus, which is the heat regulator of the brain to reset the body temperature
resulting to an increased in body temperature.
A child with gastroenteritis experiences not only decreased absorption of water but also nutrients
needed by the body, a condition resulting to weakness and pallor. Since the disease condition
mainly involves the inflammation of the gastrointestinal tract, certain gastrointestinal
disturbances are manifested by the patient, this include: nausea, vomiting, loss of appetite,
abdominal cramps and abdominal pain. The child may be lethargic, suffer lack of sleep, or run a
high fever and have signs of dehydration, which include dry mucous membranes, reduced skin
turgor, sunken fontanelles and sunken eyeballs, poor perfusion resulting to pallor.

At least 50% of cases of gastroenteritis due to foodborne illness are caused by 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. Some
sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and
bakery products. Each organism causes slightly different symptoms but all result in diarrhea.

Risk factors include consumption of improperly prepared foods or contaminated water and travel
or residence in areas of poor sanitation. It is also common for river swimmers to become infected
during times of rain as a result of contaminated runoff water.

Classification

Bacterial gastroenteritis

Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with
antibiotics. If gastroenteritis in a child is severe enough to require admission to a hospital, then it
is important to distinguish between bacterial and viral infections. Bacteria, Shigella and
Campylobacter, for example, and parasites like Giardia can be treated with antibiotics. Traveler's
diarrhea is usually a type of bacterial gastroenteritis.
 Viral gastroenteritis

Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus. Viruses do
not respond to antibiotics and infected children usually make a full recovery after a few
days.Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to
gather surveillance data relevant to the epidemiological effects of rotavirus vaccination
programs.These children are routinely tested also for norovirus, which is extraordinarily
infectious and requires special isolation procedures to avoid transmission to other patients. Other
methods, electron microscopy and polyacrylamide gel electrophoresis, are used in research
laboratories.

B. Modifiable and Non-Modifiable factors

NON-MODIFIABLE FACTORS
o Age- Infants are more likely to acquire Gastroenteritis because their intestinal flora has
not yet fully developed. Lactose intolerance also aggravates the problem.
MODIFIABLE FACTORS
o Poor Environmental Sanitation-The environment plays a vital role in our health. An
unhygienic or poor environmental condition may lead to acquiring such disease.
o Poor Hygienic Practices – one does not performed proper hand washing technique
after defecation and before handling food.
o Intake of Drugs
o Intake of food allergens
o Nutrient Deficiencies – poor immune system
o Contaminated Food-A person who frequently eats street foods and junk foods is at risk
of having Gastroenteritis.
o Low socio-economic status-Due to low income, the tendency is that the foods that being
bought is less nutritious, hence, not being cautious with the food being consumed.

C. Signs and Symptoms

The condition is usually of acute onset, normally lasting 1–6 days, and is self-limiting.

o Nausea and vomiting- stimulation of CTZ

 o Diarrhea- this is due to increased luminal fluid content that cannot be adequately
reabsorbed, leading to diarrhea. Destruction of the epithelium results not only in
exudation of serum and blood into the lumen but often is associated with widespread
destruction of absorptive epithelium thus leading to decreased absorption of water. This
manifestation can also be linked to secretion of water into the intestinal lumen which
exceeds the absorption.
o Loss of appetite- Gastrointestinal disturbances are due to the alteration on the function of
the intestinal epithelium that occurred because of the inflammation of the gastrointestinal
tract.
o Fever- inflammatory process
o Abdominal pain- changes in the intestinal lumen or intestinal epithelium led to intestinal
spasm leading to a painful stimulation felt by the patient.
o Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella,
Shigella or some pathogenic strains of Escherichia coli)
o Fainting and Weakness- another manifestation that occurred due to prolonged
decreased absorption of nutrients needed by the body for energy reserve.
o Signs of dehydration (which include dry mucous membranes), tachycardia, reduced skin
turgor, skin color discoloration, sunken fontanels, sunken eyeballs, darkened eye circles,
glassy eyes, poor perfusion and ultimately shock.

o Poor feeding- occurs because of the disturbance of gastrointestinal function.

Viral diarrhea usually causes frequent watery stools, whereas blood stained diarrhea may be
indicative of bacterial colitis. In some cases, even when the stomach is empty, bile can be
vomited up.
 Pathophysiology Book Centered
Modifiable Factors
• Poor Hygienic Practices
• Low Socio Economic Status
• Intake of Drugs
Non-Modifiable • Intake of food allergens
Factors • Nutrient Deficiencies
• Age • Poor Environmental Solution

Entrance of Microorganisms in the digestive tract via oral route

Mucosal Invasion

Endotoxin Production

Attachment to the villi

Toxins/Viruses/bacteria/ Destruction of Parietal Triggers the immune response of Malabsorption of

the body
parasites enter the Cells Nutrients
intestinal epithelium

Decreased production of Inflammatory Process Utilization of body’s

intrinsic factor
Destruction of the absorptive CHO, Fats ,CHON
epithelium
Release of Chemical
Decreased absorption of intrinsic Mediators
factor
Malnutrition

Destroyed intestinal epithelium Dehydration

are replaced with immature cells Muscle Wasting
Anemia

Release of Cytokines Release of Endogenous

Disruption on the
Deficient brush border enzyme Pyrogens
absorption of water
and transporter
Stimulates secretions
Deficient brush border enzyme Body increase heat
Decreased absorption of and transporter Large amount of water production and decrease
water secreted in the lumen heat loss

Water secreted exceeds water Fever

absorption of the lumen
Fainting and Diarrhea
Weakness

Fluid and Electrolyte

Gastrointestinal imbalance
Intestinal spasm
disturbances

Dry mucous membrane, tachycardia,

2. Synthesis
Nausea, of the Disease (Client-based) poor skin turgor, sunken fontanels
Vomiting, loss and eyeballs, poor perfusion
Abdominal Abdominal
of appetite Pain Cramps Shock / Death
 a. Definition of the Disease (Client-based)

The patient was admitted to the emergency room of Ospital Ning Angeles last
April 15, 2010 at 3:00 pm, with a chief complaint of dizziness and vomiting. He was
subjected to series of laboratory tests such as complete blood count (CBC) and Fecal
analysis. In addition, an IV line of D5 0.3 NaCl was started with a regulation of 50
µgtts/min.. After seen by ROD, orders are made and carried out, the doctors order are
as follows;
o Ampicillin 100 mg q6 (-) ANST SIVP
o Cefuroxime 150 mg q8 (-) ANST
o Paracetamol drops 0.5 ml q4
o Hidrosec sachet tid
o D5 0.3 NaCl 1 L X 50 µgtts/min.

b. Modifiable and Non-modifiable Factors (Client-based)

NON-MODIFIABLE FACTORS
o Age- Infants are more likely to acquire Gastroenteritis because their intestinal flora has
not yet fully developed. Lactose intolerance also aggravates the problem.

MODIFIABLE FACTORS
o Poor Environmental Sanitation-The environment plays a vital role in our health. An
unhygienic or poor environmental condition may lead to acquiring such disease.
o Poor Hygienic Practices – one does not performed proper hand washing technique
after defecation and before handling food.
o Low socio-economic status-Due to low income, the tendency is that the foods that being
bought is less nutritious, hence, not being cautious with the food being consumed.

Signs and Symptoms (Client-based)

• Nausea and vomiting- stimulation of CTZ

• Fever- inflammatory process

 • Dizziness- defined as disorientation in space; a sense of unsteadiness;
a feeling of movement within the head such as giddiness or a
swimming sensation; lightheadedness; or a whirling sensation.
• Hyper active bowels sounds- the patient had 40 bowels sounds
compared to the normal which is 20.

4. Health Promotion and Preventive Aspects

Health promotion actions for avoiding such GI infections involve instructing clients
about (1) good handwashing technique after defacation and before handling food and (2)
obtaining available vaccinations against bacterial and viral gastroenteritis. Encourage cleanliness
and sanitation as well as proper food handling, preparation and storage techniques, such as
cooking meats to 150°F, cooking chicken to 170°F, and not allowing food to sit at room
temperature for long periods. In developing countries, safe food practices must be done such as
avoiding tap water, ice cubes, milk products, raw meat or seafood, salads and foods that cannot
be cooked or peeled

CLIENT BASED PATHOPHYSIOLOGY Modifiable Factors

• Poor Environmental
Sanitation
Non-Modifiable • Poor hygienic Practices
Factors • Low socio-economic
• Age status

Destroyed intestinal
Toxins/Viruses/bacteria/ Entrance of Microorganisms in the digestive tract via oral route
epithelium
parasitesare replaced
enter
Destruction of the
the Triggers theChemical
Release of immune
with immature
intestinal cells
epithelium
absorptive epithelium Attachment
Endotoxin
Mucosal Invasionresponse
Production of theProcess
to theInflammatory
villi Mediators body
 Release of Endogenous
Pyrogens

Body increase heat

Gastrointestinal
production and decrease
disturbances
heat loss

Fever & dizziness 04-15

Vomiting Hyperactive & 16-10
04-15-10 bowel sounds
04-15-10