Introduction: Acute Gastroenteritis is a common infection of the stomach and intestines usually causing diarrhea (increased amount and

number of watery bowel movements). It is an inflammation of the gastrointestinal tract, (the pathway responsible for digestion that includes the mouth, esophagus, stomach and intestines). AGE is quite common among children, though it is certainly possible for adults to suffer from it as well while most cases of gastroenteritis last a few days, acute gastroenteritis can last for weeks and months. AGE is also known as stomach flu which may be caused by viruses, which include rotavirus, adenovirus, calicivirus, astrovirus, Norwalk virus, and norovirus. The common bacteria associated with bacterial gastroenteritis are salmonella, shigella, staphylococcus, clostridium, and E. coli. AGE can be spread by handling food products with contaminated hands. Acute gastroenteritis remains a serious health issue and is responsible for over 50,000 hospitalizations of children in the US each year. In developing countries, AGE is the leading cause of death for infants. It should thus be taken seriously, and people should nit hesitate to seek medical treatment for especially seniors and children who have been ill for more than a day.

Statistics: Acute Gastroenteritis is a common cause of morbidity and mortality worldwide. Conservative estimates put diarrhea in the top 5 causes of deaths worldwide with most occurring in young children in non industrialized countries; diarrhea diseases are a significant cause for morbidity across all age groups. In the US, each year more than 3.5million infants develop acute gastroenteritis resulting in more than 500,000 office visits, 55,000 hospitalizations and 30 deaths. Statistics on sporadic cases of adult

viral gastroenteritis are not known; food and water borne epidemics of viral gastroenteritis are monitored by the US centers for disease control and prevention surveillance programs. The CDC estimates that viruses cause 9.2million (out of a total of 13.8million from all causes) cases of food related illness each year. Noroviruses causes approximately 23million cases of AGE each year and are the leading cause of outbreaks of gastroenteritis. They are responsible for 68-0% of all outbreaks in industrialized countries. The genus Norovirus was formerly called the Norwalk-like virus. The genus is in the family caliciviridae. Noroviruses were attributed to 9 out of the 21 outbreaks of acute gastroenteritis on cruise ships reported to the CDCs vessel sanitation program from January 1, 2002 to December 2, 2002, frequency is seasonal. The highest incidence of rotavirus cases occurs during the months from November to April. Cruise ship outbreaks of noroviruses are more common during summer months. Internationally, AGE is a leading cause of infant mortality

throughout the world. By age 3 years, virtually all children become infected with the most common agents. Rotavirus causes 2million hospitalizations and 600,00 875,000 deaths per year.

Current Trends Pedialyte, Gatorade equally effective in alleviating effects of AGE. A double-bind trial of oral rehydration solutions for children with diarrhea and vomiting related to AGE found that Gatorade is as effective as pedialyte in correction dehydration and improving bowel symptoms. Satish S.C. Rao, MD, PhD, FACG, of the university of Iowa and College of Osmania Medical College in Hyderabad, India will present the study at the 70th annual scientific meeting of the American College of Gastroenterology. This study randomized 73 children in India with viral gastroenteritis

to receive Gatorade, pedialyte or a new oral rehydration solution with carbohydrates, sodium, and potassium for 48 hours. The children also received a diet of yogurt and rice of the GI children between ages 5 and 12 who completed the study, stool frequency, stool consistency and body weight improved in children taking all three of the solutions and there was no difference among solutions. The researchers found that all three solution were safe, when asked to rate the taste, the patients rated Gatorade and the new solution higher than pedialyte. The study was supported by a grant from the Gatorade sports science institute. A potassium deficiency, known as hypokalemia, persisted in a new patient receiving Gatorade after 48 hours. Patients who experienced hyponatremia, of patients an electrolyte dehydration disturbance may have experienced significant persisting electrolyte symptoms for all three solutions. According to Dr. Rao, a small number with disturbance. As they continue to rehydrate with oral rehydration solutions, a portion may continue to experience electrolyte imbalances and additional treatment may necessary. AGE, an inflammation of the gastrointestinal tract, is an illness of feverm diarrhea and vomiting caused by an infectious virus. It usually is of acute onset, normally lasting less than 10 days and self-limiting. It is often referred to as the Stomach Flu even though it is not related to influenza.
B. Reason for choosing such for case presentation

The group first exposure in the hospital is in the Jose B. Lingad (JBL), 3rd floor ; Pediatric ward, the subgroup 2 of the group 80 of the BSN 3-20 encountered different cases of patients. And they observed that most common admitting diagnosis are Pneumonia, CNS Infection and Acute Gastroenteritis (AGE). The group chose the topic of Acute Gastroenteritis for their case because this disease is very common in the children. And there are many cases of this disease one of this is eating foods or drinking liquids contaminated with bacteria or parasites, and most worse is having contact with the fecal matter or a person with the condition and then improperly

washing or not washing of hands causes Acute Gastroenteritis (AGE). The children are much more affected of this disease because they are prone in the streets such as fishball, isaw, barbeque etc. which are not safe to eat because they are exposed in open environment. And as a student nurses, they want to impart their knowledge in preventing this disease and provide management in occurring of this disease. In this case study, they knew that they will learn a lot, with his diagnosis, complication that may occur, signs and symptoms, the medication/drugs, diagnostic procedure and their nursing intervention and nursing care plan needed as they contribute on his improvement regarding to his health

II. Nursing Assessment 1. PERSONAL DATA Informant: Mrs. Queen (Mother) This is the case of patient Baby Prince, 3 months old, male and natural born Filipino. He is affiliated as Roman Catholic. His parents are Mr. King and Mrs. Queen which were currently residing in a Barangay. He was born on May 4, 2007 at Macabebe District Hospital. He was brought to Jose B. Lingad Memorial General Hospital and admitted last July 23, 2007 with a diagnosis of Acute Gastroenteritis with moderate dehydration. He was discharged last July 27, 2007.

2. PERTINENT FAMILY HISTORY

a. Size of Family On the paternal side, it was stated that Princes

grandfather and grandmother have hypertension. Both of them are still alive and currently residing on one house together with the Rich Family in a Barangay. His father, Mr. King, didnt have past history of illness. On the maternal side, his grandmother has hypertension and his uncle has anemia. His mother, Mrs. Queen, didnt have past history of illness. The Rich family is characterized as an extended family

which

consists of a grandmother, grandfather, father, mother

and a baby living together in a single house. b. Obstetrical History The obstetrical history of Mrs. Queen is G1P1T1P0A0L1. Mrs. Queen gave birth for the first time (primipara) via normal spontaneous delivery. c. Family Living Condition The head of the family, Mr. King works as a laborer. He is an elementary undergraduate and his income is P250.00 a day/P1,500 a week/P6,500/month. While Mrs. Queen works as a maid. She is elementary graduate. Her monthly income is P2,500 a month. The monthly income of both the father and mother is P9000, which is spent mostly for food and the milk of their baby. Their house is made up of wood, consisting of five members, their house is elevated, and according to them the space is just sufficient to accommodate five people. With regards to their food preparation for Baby Prince, they boil his bottles, but not the water that he drinks in preparing for his milk formula, according to his mother they used distilled water for the preparation of Baby Princes milk, later on when he was hospitalized, the mother learned to boil the water for milk formula and no longer used distilled water, because according to her, it is more safe to used boiled water. d. Cultural Factors Affecting the Health of the Family The family is affiliated with the Roman Catholic. They believed in manghihilot whom they seek whenever a member

of their family is sick. They also used herbal medicines such as guava and lagundi to treat their illness. They do not immediately go to the hospital if their disease is still tolerable, they only go to the hospital if their condition become worsen and cannot treat by self-medication. 3. PERSONAL HISTORY a. Pre-natal According to Mrs. Queen, she visited the health center two times for her check-up; the first visit was on her second trimester and the last visit for the third trimester. She has long hours of sleep during the day and she loves to walk. According to her, she is not choosy in the food that she eats. b. Birth- duration and circumstances of labor, home or hospital delivery, type, complication, birth weight, and age of gestation According to Mrs. Queen she had undergone labor for one hour. She delivered Baby Prince via normal spontaneous delivery at Macabebe District Hospital last May 4, 2007. He was a full term baby, and had a birth weight of 6.6lbs. Her age of gestation is 37 weeks and 5 days. Upon giving birth and after birth, Mrs. Queen doesnt experience any complications.

c. Feeding Baby Prince did not experience to be breast fed because her mother preferred to be bottle fed. Thats why he was given milk formula for feeding. d. Growth and Development

Erik Erikson (Psychosocial development) Under psychosocial development, Baby Prince is under Trust vs. Mistrust, wherein he learns to love and be loved, the significant person he can lean on is his mother. In this stage, Baby Prince is aware of new environment and less crying and smiles at significant others. Baby Prince has achieved this stage because he was seen crying when he was not cuddled by his mother. Jean Piaget (Cognitive development) As to cognitive development, Baby Prince begins to coordinate responses to different stimuli, he make noises when spoken to his father. The second sub-stage of sensorimotor stage, the primary circular reaction phase occurs from first to fourth months, hand-mouth and ear-eye coordination develop. Infants spend much time looking at objects and separating self from them. Beginning intention of behavior is present. Enjoyable activity for these periods: A rattle or parents voice tape, colourful musical hanging objects over the crib. Sigmund Freud (Psychosexual development) As to psychosexual development, baby Prince seek for enjoyment, as well as for nourishment by means of sucking because he was bottle fed. In this oral stage, mouth is the center of pleasure (major source of gratification and exploration). This was started at birth up to one and one-half year. Anna Freud (Structural Model of Personality) The id is the only component of personality that is present from birth. This aspect of personality is entirely unconscious and includes of the instinctive and primitive behaviors. According to

Freud, the id is the source of all psychic energy, making it the primary component of personality. The id is driven by the pleasure principle, which strives for immediate gratification f all desires, wants and needs. If these needs are not satisfied immediately, the result is a state anxiety or tension. For example, an increase in hunger or thirst should produce an immediate attempt to eat or drink. The id is very important early in life, because it ensures that an infants needs are met. If the infant is hungry or uncomfortable, he or she will cry until the demands of the id are met. This was manifested by baby Prince. e. Immunization status As to immunization status, Baby Prince is incompletely immunized because he just received one dos of BCG and doesnt receive DPT, Hepa B, and OPV.

4. HISTORY OF PAST ILLNESS According to his grandmother, Baby Prince was hospitalized a month ago prior to admission to the same institution, for the same diagnosis AGE, he just experienced relapsed to the disease. It was on June 20, 2007, he stayed in the hospital for seven days. The medicines that he had taken are ampicillin, amikacin, and furosemide. 5. HISTORY OF PRESENT ILLNESS Two days prior to admission, Baby Prince experienced, (+) loose watery, (-) bloody greenish foul smelling x 10 episodes, (-) vomiting, with good skin turgor, (-) fever. One day prior to admission, he experiences persistent of signs

and symptoms which admitted to OPD hospital.

6. PHYSICAL EXAMINATION Physician on Dutys physical examination upon admission (July 23, 2007, 9:15 am) Medicare Chief complaint: loose stools Condition on Admission: CR: 159, Temp- 37.2 Skin: poor skin turgor/acyanotic Head- EENT: enteric (+) slightly pink p/p conjunctiva, 2.0 mm ppb Lymph nodes: (-) CLAD Chest: SLE Lungs: CBS Cardiovascular: AP, tachypnea Abdomen: globular, bowel sound Rectum: patent non- blood First Student Nurse- Patient Interaction (July 26, 2007) General Survey: Patient was seen cuddled by his mother, awake, irritable, and crying at times. Vital signs: Temp- 38C PR- 113 bpm RR- 49 bpm Head:

Hair and scalp: Short- length hair and equally distributed on scalp area. No infestation noted.

Skull and face: Rounded, smooth skull shape and symmetrical facial

feature, with no masses noted. Nose:

symmetrical, absence of lesion upon inspection, and absence of inflammation upon palpation, with clear nasal discharge in minimal amount Eyes and vision:

(-) sunken eyeballs, (+) tears noted during crying, symmetrical eye features with hair evenly distributed, (+) pupillary reflex on both eyes, Baby Prince blinks when his cornea touched, with the used of penlight, and approaching from the side, shine a light on the pupil, shine the light on the pupil again Baby Prince respond with his illuminated pupil constricts and non-illuminated pupil constricts.

Reaction to accommodation- Baby Prince pupil constricts when looking at near objects, dilates at far objects; converge when object is moved toward his nose. Ear and hearing:

Symmetrical ear features, absence of lesions and discharges. Mouth:

(+) drying of lips and oral mucosa, pink colored lips, absence of lesions. Neck:

no swelling and masses noted upon palpation Thorax and lungs:

(-) fast breathing pattern, no presence of adventitious breath sounds upon auscultation Heart:

normal rhythm and rate noted auscultation Abdomen:

without any pulsations, no masses noted, increased bowel sounds, absence of bruit, no rebound and tenderness. Rectum:

patent anus Upper extremities

good skin turgor, intact fingernail beds, good capillary refill test Lower extremities:

good skin turgor, intact toenail beds, good capillary refill test Skin: 1 (-) dry skin, presence of rashes at the sacral area

Reflexes

Sucking reflex: A feeding reflex that occurs when the infants lips are touched. The reflex persists throughout infancy. Assessment: Baby Prince can able to do sucking reflex because he was bottle fed.

Rooting reflex: A feeding reflex elicited by touching the babys cheek, causing the babys head to turn o the side that was touched. This reflex usually disappears after 4 mos. Assessment: Baby Prince achieved rooting reflex because the student nurse place her finger to baby Princes face/cheek and he turned his head.

Moro reflex: Often assessed to estimate the maturity of the CNS. A loud noise, a sudden change in position, or an abrupt jarring of the crib elicits this reflex. The infant reacts by extending both arms and legs outward with the fingers spread, then suddenly retracting he limbs. Often the infant cries at the same time. This reflex disappears after 4 mos. Assessment: Baby Prince can able to extend his both arms and legs

outward with his fingers spread then suddenly retracting his limbs, when he heard a loud noise.

Palmar grasp reflex: Occurs when a small object is placed against the palm of the hand causing the fingers to curl around it. His reflex disappears after 3 mos. Assessment: The student nurse put her finger to Baby Princes palm and he grasps it.

Plantar reflex: Similar to the palmar grasp reflex, an object placed just beneath the toes causes them to curl around it. This reflex disappears after 8 mos. Assessment: The student nurse placed the bandage scissor beneath the toes of Baby Prince that caused him to curl around it.

Tonic neck reflex or fencing reflex: A postural reflex. When a baby who is lying on its back turns its head to he right side. This reflex disappears after 4 mos. Assessment: Baby Prince can able to do the tonic reflex because he was able to turn his head to the right when the student nurse holds his head.

Babinski reflex: When the sole of the foot is stroked, the big toe rises and other toes fan out. A newborn baby has a positive babinski. After age 1, the infant exhibits a negative babinski; that is, the toes curl downward. A positive babinski after age 1 indicates brain damage. Assessment: Baby Prince can able to respond to this reflex when the student nurse stroked his sole of the foot, then his toes fan out. DIAGNOSTIC AND LABORATORY PROCEDURES

DIAGNOSTI C/ LABORATO RY PROCEDUR E COMPLETE BLOOD COUNT (CBC)

DATE ORDERED / DATE RESULT

INDICATIO N(S) OR PURPOSE (S)

RESULT (1ST, 2ND, 3RD )

NORMAL VALUES

ANALYSIS AND INTERPRETA TION OF RESULT

DO: 07-23- >a 07 complete blood DR: 07-23- count 07 gives important informatio n about the kinds and number of cells in the blood, especially RBC, WBC and Platelets. >a CBC helps the health profession al checks any symptoms, such as weakness, fatigue or bruising. It is useful in indicating such as anemia, infection and many other disorder.

HEMOGLO BIN (Hgb)

DO: 07-23- >to 07 evaluate the oxygen DR: 07-23- carrying

73

125 -175 g/L

*if the hemoglobin is low it indicates

07 HEMATOC RIT (Hct)

capacity of the blood 0.22 0.38 0.48

anemia *if the hematocrit is low it indicates anemia

DO: 07-23- >to 07 determine ratio and DR: 07-23- fluid to the 07 plasma level in the blood >to evaluate the hydration status

WHITE BLOOD CELL (WBC)

DO: 07-23- >to assess 11.3 07 the ability of the body DR: 07-23- to respond 07 to and eliminate infection

5-10 X109

*it indicates of the presence of bacterial infection

NURSING RESPONSIBILITIES

PRE PROCEDURE 1 Check the physicians request 2 Check the name of the patient, identification and band 3 Explain to the S.O the purpose and procedure 4 Inform the S.O that the test requires blood sample, tell who will do the test and when 5 Inform the S.O that foods and fluids need to be restricted before the test 6 Explain to the S.O that patient may feel slightly discomfort from the tourniquet pressure and the needle puncture

INTRA PROCEDURE 1 Wrap an elastic band around the upper arm to stop the flow of

blood. This makes vein below the band larger so it is easier to put needle into the vein 2 Clean the needle site with alcohol 3 Instruct the S.O patient not to move the arm and remain still upon the insertion of needle 4 Remove the band from your arm when enough blood is collected 5 Apply a cotton ball over the needle site as the needle removed

POST PROCEDURE 1 Apply pressure to the puncture site 2 Observe the vein puncture site for bleeding 3 Explain to the S.O that he might experience at the site some bruising or swelling. Instruct to apply warm soaks compress 4 Send the specimen immediately to the laboratory

DIAGNOSTI C/ LABORATO RY PROCEDUR E URINALYSI S

DATE ORDERED / DATE RESULT

INDICATIO N(S) OR PURPOSE (S)

RESULT (1ST, 2ND, 3RD )

NORMAL VALUES

ANALYSIS AND INTERPRETA TION OF RESULT *Normal color of urine *Normal result of sugar in urine *Normal result of protein in urine *Normal value of specific

DO: 07-23- >urinalysis 07 is performed DR: 07-23- to screen 07 for kidney disorder and other medical condition that produces changes in the urine

Color: Yellow Sugar: Negative Albumin: Negative Specific Gravity: 1.015 Pus Cells: 0.2

Color: Yellow / Clear Sugar: Negative Albumin: Negative Specific Gravity: 1.010 1.029 Pus Cells: up to 10

gravity *Normal value of pus cells

NURSING RESPONSIBILTIES

PRE PROCEDURE 1 Check the physicians request 2 Check the name of the patient 3 Explain the procedure and the purpose of the test 4 Tell the S.O of the patient he need not to restrict any foods or fluids 5 Prepare the laboratory request and Inform laboratory 6 Obtain laboratory specimen container 7 Instruct the proper perineal hygiene and hand washing 8 Instruct the S.O in collecting a sample of urine using mid stream clean catch method 9 The urine specimen must not be contaminated by toilet paper, toilet water, feces or secretion

INTRA PROCEDURE 1 Provide privacy 2 Have the client urinate into a bed pan or toilet 3 Correctly position a sterile urine container, into which the patient voids 3-4 ounces of urine. Cover the container and allow patient to finish voiding 4 If urine sample is accidentally contaminated with feces, discard entire specimen and wait for the next voiding

POST PROCEDURE 1 Label the container with the patient name, time and date of the

possible voiding 2 Bring the specimen to the laboratory 3 Obtain result and secure it to the patients chart 4 Obtain necessary results and refer to the physician

DIAGNOSTI C/ LABORATO RY PROCEDUR E FECALYSIS

DATE ORDERED / DATE RESULT

INDICATIO N(S) OR PURPOSE (S)

RESULT (1ST, 2ND, 3RD )

NORMAL VALUES

ANALYSIS AND INTERPRETA TION OF RESULT *Normal colo of stool *Sign of diarrhea

DO: 07-23- >to check 07 and differentiat DR: 07-23- e between 07 discolorati on on stool >to detect if the patient has bacterial invasion, infection or parasite infection in the stool

Color: Yellow

Color: Yellow / Golden Consistenc Brown y: Watery Consistenc y: Semisolid

NURSING RESPONSIBILTIES

PRE PROCEDURE

1 Check the physicians request 2 Check the name of the patient 3 Explain the procedure and purpose of the test 4 Instruct the patient to avoid dark colored foods and eat a high fiber diet for 48 -72 hours before the collection of the stool specimen

5 Instruct the correct fecal collection procedure. One method is to place a loose firm of plastic wrap across the toilet bowl

INTRA PROCEDURE 1 Provide privacy

POST PROCEDURE 2 Label the container with patients name, time and dte 3 Bring the specimen to the laboratory 4 Obtain results and secure it to the patients chart Obtain necessary results and refer to the physician

Anatomy & Physiology: Digestive System Purpose The digestive system prepares food for use by hundreds of millions of body cells. Food when eaten cannot reach cells (because it cannot pass through the intestinal walls to the bloodstream and, if it could not be in a useful chemical state. The gut modifies food physically and chemically and disposes of unusable waste. Physical and chemical modification (digestion) depends on exocrine and endocrine secretions and controlled movement of food through the digestive tract. Mouth Mouth Food enters the digestive system via the mouth or oral cavity, mucous membrane lined. The lips (labia) protect its outer opening, cheeks form lateral walls, hard palate and soft palate form anterior/posterior roof. Communication with nasal cavity behind soft palate. Floor is muscular tongue. Tongue has bony attachments (styloid process, hyoid bone) attached to floor of mouth by frenulum. Posterior exit from mouth guarded by a ring of palatine/lingual tonsils. Enlargement = sore throat, tonsillitis.

Food is first processed (bitten off) by teeth, especially the anterior incisors. Suitably sized portions then retained in closed mouth and chewed or masticated (especially by cheek teeth, premolars, molars) aided by saliva Ducted salivary glands open at various points into mouth. This process involves teeth (muscles of mastication move jaws) and tongue (extrinsic and intrinsic muscles). Mechanical breakdown, plus some chemical (ptyalin, enzyme in saliva). Taste buds allow appreciation, also sample potential hazards (chemicals, toxins) Swallowing In leaving the mouth a bolus of food must cross the respiratory tract (trachea is anterior to oesophagus) by a complicated mechanism known as swallowing or deglutination which empties the mouth and ensures that food does not enter the windpipe. Swallowing involves co-ordinated activity of tongue, soft palate pharynx and oesophagus. The first (buccal) phase is voluntary, food being forced into the pharynx by the tongue. After this the process is reflex. The tongue blocks the mouth, soft palate closes off the nose and the larynx rises so that the epiglottis closes off the trachea. Food thus moves into the pharynx and onwards by peristalsis aided by gravity. If we try to talk whilst swallowing food may enter the respiratory passages and a cough reflex expels the bolus. Oesophagus The oesophagus (about 10") is the first part of the digestive tract proper and shares its distinctive structure. Basic tissue layers of the gut are 1. mucosa. Innermost, moist lining membrane. Epithelium (friction resistant stratified squamous in oesophagus, simple beyond) plus a little connective tissue and smooth muscle. 2. submucosa. Soft connective tissue layer, blood vessels, nerves, lymphatics 3. muscularis externa. Typically circular inner layer, longitudinal outer

layer

of

smooth

muscle

4. serosal fluid producing single layer. Stomach C shaped, left side abdominal cavity (because liver is on right). Cardioesophageal sphincter guarding entrance from oesophagus is of doubtful anatomical integrity (though functionally the diaphragmatic pinch cock serves). Pyloric sphincter guarding the outlet is much better defined. Fundus, body and pylorus recognised as distinct regions. Stomach secretes both acid and mucus (for self protection). Surface area increased by rugae. Serves as a temporary store for food which is also churned by muscular layers (three here) to form chyme, creamy substance voided via pyloric sphincter to duodenum. Duodenum First part of small intestine. C shaped 10" long and curves around head of pancreas and entry of common bile duct (accessory organs of digestion, pancreas, liver see below). Chemical degradation of small controlled amounts of food controlled by pyloric sphincter begins here, enzymes secreted by pancreas and duodenum itself aided by emulsifying bile (which also lowers pH). Duodenal ulcers caused by squirting of acid stomach contents into duodenal wall opposite sphincter. Small Intestine Jejunum (8 feet) and ileum (12 feet) continue degenerative process. Surface area increased by plica circulares (circular folds) carrying villi: cells of villi carry microvilli. Each villus has a capillary and a lacteal (lymphatic capillary) Absorption of digested foodstuffs is via these to the rich venous and capillary drainage of the gut. Towards the end of the small intestine accumulations of lymphoid tissue (Peyer's patches) more common. Undigested residue of food is rich in bacteria. Large Intestine Jejunum terminates at caecum. Caecum is small saclike

evagination,

important

in

some

animals

as

repository

for

bacteria/other organisms able to digest cellulose. A blind ending appendix may give trouble (appendicitis) if infected. The large intestine has three longitudinal muscle bands (taenia coli) with bulges in the wall (haustra) between them. These may evaginate in the elderly to become diverticuli and infected in diverticulitis. The large intestine resorbs water then eliminates drier residues as faeces. Regions recognised are the ascending colon, from appendix in right groin up to a flexure at the liver, transverse colon, liver to spleen, descending colon, spleen to left groin, then sigmoid (S-shaped) colon back to midline and anus. Anus has voluntary and involuntary sphincter and ability to distinguish whether contents are gas or solid. No villi in large intestine, but many goblet cells secreting lubricative mucus. Accessory digestive organs Salivary glands Three pairs, parotid, submandibular, sublingual. Mumps begins as infective parotitis in the parotid glands in the cheek. The others open into the floor of the mouth. Saliva is a mixture of mucus and serous fluids, each produced to various extents in various glands. Also contains salivary amylase, (starts to break down starch) lysozyme (antibacterial) and IgA antibodies. In some mammals (and snakes!) saliva may be poisonous, quietening down living prey. Pancreas Endocrine and exocrine gland. Exocrine part produces many enzymes which enter the duodenum via the pancreatic duct. Endocrine part produces insulin, blood sugar regulator. Liver and gallbladder Bile, a watery greenish fluid is produced by the liver and secreted via the hepatic duct and cystic duct to the gall bladder for storage, and thence on demand via the common bile duct to an opening near the

pancreatic duct in the duodenum. It contains bile salts, bile pigments (mainly bilerubin, essentially the non-iron part of haemoglobin) cholesterol and phospholipids. Bile salts and phospholipds emulsify fats, the rest are just being excreted. Gallstones are usually cholesterol based, may block the hepatic or common bile ducts causing pain, jaundice. Liver Multifunctional: important in this context since the capillaries of the small intestine drain fat and other nutrient rich lymph into it via the hepatic portal system. The digestive system is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Inside this tube is a lining called the mucosa. In the mouth, stomach, and small intestine, the mucosa contains tiny glands that produce juices to help digest food. Two solid organs, the liver and the pancreas, produce digestive juices that reach the intestine through small tubes. In addition, parts of other organ systems (for instance, nerves and blood) play a major role in the digestive system. Why is digestion important? When we eat such things as bread, meat, and vegetables, they are not in a form that the body can use as nourishment. Our food and drink must be changed into smaller molecules of nutrients before they can be absorbed into the blood and carried to cells throughout the body. Digestion is the process by which food and drink are broken down into their smallest parts so that the body can use them to build and nourish cells and to provide energy. How is food digested? Digestion involves the mixing of food, its movement through the digestive tract, and the chemical breakdown of the large molecules of food into smaller molecules. Digestion begins in the mouth, when we chew and swallow, and is completed in the small intestine. The

chemical process varies somewhat for different kinds of food. Movement of Food Through the System The large, hollow organs of the digestive system contain muscle that enables their walls to move. The movement of organ walls can propel food and liquid and also can mix the contents within each organ. Typical movement of the esophagus, stomach, and intestine is called peristalsis. The action of peristalsis looks like an ocean wave moving through the muscle. The muscle of the organ produces a narrowing and then propels the narrowed portion slowly down the length of the organ. These waves of narrowing push the food and fluid in front of them through each hollow organ. The first major muscle movement occurs when food or liquid is swallowed. Although we are able to start swallowing by choice, once the swallow begins, it becomes involuntary and proceeds under the control of the nerves. The esophagus is the organ into which the swallowed food is pushed. It connects the throat above with the stomach below. At the junction of the esophagus and stomach, there is a ringlike valve closing the passage between the two organs. However, as the food approaches the closed ring, the surrounding muscles relax and allow the food to pass. The food then enters the stomach, which has three mechanical tasks to do. First, the stomach must store the swallowed food and liquid. This requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material. The second job is to mix up the food, liquid, and digestive juice produced by the stomach. The lower part of the stomach mixes these materials by its muscle action. The third task of the stomach is to empty its contents slowly into the small intestine. Several factors affect emptying of the stomach, including the nature of the food (mainly its fat and protein content) and the degree

of muscle action of the emptying stomach and the next organ to receive the contents (the small intestine). As the food is digested in the small intestine and dissolved into the juices from the pancreas, liver, and intestine, the contents of the intestine are mixed and pushed forward to allow further digestion. Finally, all of the digested nutrients are absorbed through the intestinal walls. The waste products of this process include undigested parts of the food, known as fiber, and older cells that have been shed from the mucosa. These materials are propelled into the colon, where they remain, usually for a day or two, until the feces are expelled by a bowel movement. Production of Digestive Juices The glands that act first are in the mouththe salivary glands. Saliva produced by these glands contains an enzyme that begins to digest the starch from food into smaller molecules. The next set of digestive glands is in the stomach lining. They produce stomach acid and an enzyme that digests protein. One of the unsolved puzzles of the digestive system is why the acid juice of the stomach does not dissolve the tissue of the stomach itself. In most people, the stomach mucosa is able to resist the juice, although food and other tissues of the body cannot. After the stomach empties the food and juice mixture into the small intestine, the juices of two other digestive organs mix with the food to continue the process of digestion. One of these organs is the pancreas. It produces a juice that contains a wide array of enzymes to break down the carbohydrate, fat, and protein in food. Other enzymes that are active in the process come from glands in the wall of the intestine or even a part of that wall. The liver produces yet another digestive juicebile. The bile is stored between meals in the gallbladder. At mealtime, it is squeezed out of the gallbladder into the bile ducts to reach the intestine and mix

with the fat in our food. The bile acids dissolve the fat into the watery contents of the intestine, much like detergents that dissolve grease from a frying pan. After the fat is dissolved, it is digested by enzymes from the pancreas and the lining of the intestine. Absorption and Transport of Nutrients Digested molecules of food, as well as water and minerals from the diet, are absorbed from the cavity of the upper small intestine. Most absorbed materials cross the mucosa into the blood and are carried off in the bloodstream to other parts of the body for storage or further chemical change. As already noted, this part of the process varies with different types of nutrients. Carbohydrates It is recommended that about 55 to 60 percent of total daily calories be from carbohydrates. Some of our most common foods contain mostly carbohydrates. Examples are bread, potatoes, legumes, rice, spaghetti, fruits, and vegetables. Many of these foods contain both starch and fiber. The digestible carbohydrates are broken into simpler molecules by enzymes in the saliva, in juice produced by the pancreas, and in the lining of the small intestine. Starch is digested in two steps: First, an enzyme in the saliva and pancreatic juice breaks the starch into molecules called maltose; then an enzyme in the lining of the small intestine (maltase) splits the maltose into glucose molecules that can be absorbed into the blood. Glucose is carried through the bloodstream to the liver, where it is stored or used to provide energy for the work of the body. Table sugar is another carbohydrate that must be digested to be useful. An enzyme in the lining of the small intestine digests table sugar into glucose and fructose, each of which can be absorbed from the intestinal cavity into the blood. Milk contains yet another type of sugar, lactose, which is changed into absorbable molecules by an

enzyme called lactase, also found in the intestinal lining. Protein Foods such as meat, eggs, and beans consist of giant molecules of protein that must be digested by enzymes before they can be used to build and repair body tissues. An enzyme in the juice of the stomach starts the digestion of swallowed protein. Further digestion of the protein is completed in the small intestine. Here, several enzymes from the pancreatic juice and the lining of the intestine carry out the breakdown of huge protein molecules into small molecules called amino acids. These small molecules can be absorbed from the hollow of the small intestine into the blood and then be carried to all parts of the body to build the walls and other parts of cells. Fats Fat molecules are a rich source of energy for the body. The first step in digestion of a fat such as butter is to dissolve it into the watery content of the intestinal cavity. The bile acids produced by the liver act as natural detergents to dissolve fat in water and allow the enzymes to break the large fat molecules into smaller molecules, some of which are fatty acids and cholesterol. The bile acids combine with the fatty acids and cholesterol and help these molecules to move into the cells of the mucosa. In these cells the small molecules are formed back into large molecules, most of which pass into vessels (called lymphatics) near the intestine. These small vessels carry the reformed fat to the veins of the chest, and the blood carries the fat to storage depots in different parts of the body. Vitamins Another vital part of our food that is absorbed from the small intestine is the class of chemicals we call vitamins. The two different types of vitamins are classified by the fluid in which they can be dissolved: water-soluble vitamins (all the B vitamins and vitamin C) and fat-soluble vitamins (vitamins A, D, and K).

Water and salt Most of the material absorbed from the cavity of the small intestine is water in which salt is dissolved. The salt and water come from the food and liquid we swallow and the juices secreted by the many digestive glands. How is the digestive process controlled? Hormone Regulators A fascinating feature of the digestive system is that it contains its own regulators. The major hormones that control the functions of the digestive system are produced and released by cells in the mucosa of the stomach and small intestine. These hormones are released into the blood of the digestive tract, travel back to the heart and through the arteries, and return to the digestive system, where they stimulate digestive juices and cause organ movement.

The hormones that control digestion are gastrin, secretin, and cholecystokinin (CCK):

Gastrin causes the stomach to produce an acid for dissolving and digesting some foods. It is also necessary for the normal growth of the lining of the stomach, small intestine, and colon.

Secretin causes the pancreas to send out a digestive juice that is rich in bicarbonate. It stimulates the stomach to produce pepsin, an enzyme that digests protein, and it also stimulates the liver to produce bile.

CCK causes the pancreas to grow and to produce the enzymes of pancreatic juice, and it causes the gallbladder to empty. Additional hormones in the digestive system regulate appetite:

Ghrelin is produced in the stomach and upper intestine in the absence of food in the digestive system and stimulates appetite.

Peptide YY is produced in the GI tract in response to a meal in the

system and inhibits appetite. Both of these hormones work on the brain to help regulate the intake of food for energy. Nerve Regulators Two types of nerves help to control the action of the digestive system. Extrinsic (outside) nerves come to the digestive organs from the unconscious part of the brain or from the spinal cord. They release a chemical called acetylcholine and another called adrenaline. Acetylcholine causes the muscle of the digestive organs to squeeze with more force and increase the "push" of food and juice through the digestive tract. Acetylcholine also causes the stomach and pancreas to produce more digestive juice. Adrenaline relaxes the muscle of the stomach and intestine and decreases the flow of blood to these organs. Even more important, though, are the intrinsic (inside) nerves, which make up a very dense network embedded in the walls of the esophagus, stomach, small intestine, and colon. The intrinsic nerves are triggered to act when the walls of the hollow organs are stretched by food. They release many different substances that speed up or delay the movement of food and the production of juices by the digestive organs.

Pathophysiology (Book Based) Normally, human intestinal flora protects the bowel from

colonization of pathogens; however, the intestinal flora can be (1) disrupted by harmful bacteria and viruses that cause tissue damage and inflammation or (2) depressed by antibiotic therapy, administered either orally or parentally. Antibiotics most often implicated in the depression of normal flora are clindamycin, penicillins, cephalosporin and aminoglycosides. Pathogens cause tissue damage and inflammation by releasing endotoxins that stimulates the mucosal lining of the intestine, resulting

in greater secretion of water and electrolytes into the intestinal lumen. The active secretion of chloride and bicarbonate ions in the small bowel leads to inhibition of sodium reabsorption. To balance the excess sodium, large amounts of protein- rich fluids are secreted in the bowels ability to reabsorb the fluid and leading to diarrhea. Pathogens also cause damage and inflammation by invading and destroying the mucosal lining of the bowel, resulting in blleding and ulceration. When the integrity of the GI tract is impaired, its ability to carry out digestive and absorptive functions can be affected (Joyce M. Black, 7th edition).
PATHOPHYSIOLOGY BOOK BASED

Human Intestinal Flora protect bowel from pathogens

Can be malfunction of: disrupted by harmful viruses and depressed by antibiotic therapy

Pathogens cause tissue damage because of endotoxins

Endotoxins stimulate intestine which cause the greater secretion of water in the intestinal lumen

Chloride and bicarbonate ions in small intestine cause sodium reabsorption

To balance excess sodium, protein rich fluid and secreted in bowels ability to reabsorb fluid which cause the diarrhea

Pathogens can also cause inflammation by destroying mucosal lining in bowel which result bleeding and ulceration

Impaired GI tract can affect the ability of digestion and absorption

Patients Illness A. Synthesis of the Disease A.1. Definition of the Disease Acute Gastroenteritis is an inflammation of the bowel (intestines) that causes diarrhea and sometimes vomiting. It is common in infants and children. It is more serious in infants and young children than it is in adults. Diarrhea and vomiting can cause the loss of important fluids and minerals quicker than adults. Since water makes up most of an infants or children weight this can lead to serious illness and require hospitalization. Gastroenteritis in young children is most often due to viral infections. There are many viruses that can produce diarrhea, with or without vomiting: these include the rotaviruses, which we usually see in the wintertime, the enteroviruses, which are common during summer, and adenoviruses, which can occur year-round but usually cause respiratory problems, although they can cause diarrhea in babies. Generally, once a particular virus infects, the person arent likely to get it again; but there are many viruses around and it takes a while for a person to have all of them. Also viruses can mutate (change some of their characteristics) and may be able to infect people who are immune to the original form. This kind of change is the reason we need influenza vaccine every year. There are also bacteria that cause gastroenteritis. It is seen frequently where sanitation is not goodespecially anywhere, where drinking water may have been tainted by human or animal waste. Bacterial gastroenteritis can also come from contaminated food, like undercooked meat. Bacterial gastroenteritis is rare than viral, but

sometime wont go away without antibiotics. A.2. Predisposing/ Precipitating Factors Even through causes for AGE vary, methods of transmission from one person to another usually remain the same. Thats why the group tried to trace back the possible factors that may predispose the condition of baby Prince. This includes: improper milk formula preparation, water contamination, bacterial, viral and/or parasitic infections, and other factors which may also have predisposed the occurrence of AGE includes the age of the patient ,3 months, because at the age of baby Prince his immune system is not that fully develop. Thats why he has decrease capacity to fully protect himself from possible illness. Gender is also one of the contributing factors in acquiring AGE, like to the case of baby Prince, male has a great chance of having the said disease because males are more active compared to females. In additional to this, environmental factors play a vital role in the development of such disease. Like for example cleanliness in a household and sanitary ways of food preparation can eliminate possible illness and will help the childs immune system fight against pathogens. In the case of baby Prince, the leaving condition and lack of knowledge of the parents regarding this matter and prevention of disease has led baby Prince to have AGE. One way of avoiding this disease is by proper hand washing for the one who prepares the milk formula of baby Prince, because AGE could also acquire through fecaloral route.

A.3. Signs and Symptoms Before the admission of baby Prince to JBL, he has been experiencing nausea and vomiting, diarrhea because there is increase in peristaltic movement, abdominal pain because of gastric irritation,

dehydration because there is loss of fluids and electrolytes specifically sodium because of diarrhea, and poor skin turgor and dry mucous membranes because of dehydration.

A.4. Health Promotion and Preventive Aspects of the Disease 1 Good hand-washing technique after defecation and before handling food 2 Obtaining available vaccinations against bacterial and viral gastroenteritis 3 Encourage cleanliness and sanitation as well as proper food handling, preparation and storage techniques 4 Proper hand-washing by the whole family is the best way to prevent the spread of disease 5 When a family member is sick, extra care should be taken to wash hands often. 6 Proper hygiene and a good and balanced diet. 7 Breastfeeding among infants because mothers milk can boost the babys immune system to help to protect from infection. 8 Replacement of fluids and electrolytes that are lost because of the diarrhea and vomiting by drinking lots of fluids, especially Gatoradetype drinks, pedialyte, or a homemade rehydration drink and food that contain electrolytes and complex carbohydrates, such as potatoes, lean meats, whole grins and etc. 9 Hospitalization is required if symptoms is persist.

Medical Management
Drugs Date Route, Doses General Action and Indications Specific Action Frequency Clients Response Ordered: and

Date Taken and Given: Ampicillin (Ampicin, Principen, Polycillin, Totacillin) 150mg/IV Penicillin indicated for the patient was free patient because he is suffering from the signs and symptoms of GI evidence by patient stop crying after the drug was Amicakin (Amikin) 07/23/07 07/23/07 65mg/IV OD Anti-infective Inhibits protein synthesis by binding directly to 30S ribosomal subunit. Generally bactericidal. given. indicated for pts after all drugs with serious by sensitive strains of Pseudomonas aeruginosa, E. coli, Proteus, Serratia. Paracetamol 45mg/IV Anti-pyretic indicated for patients fever episodes. have been patient, the patient was free from bacterial infection as evidenced by patient is no longer defecating watery stools. the patient was free from fever. infections caused administered to the 07/23/07 every 8 hours Inhibits the cell 07/23/07 wall synthesis during bacterial multiplication

from GI infection. infection as

(acetaminophen) 07/23/07 every 4 hours Inhibition of PRN for hypothalamic heat 07/23/07 temperature regulating center. Furosemide (Furoside, Laxis) > 38 4mg after Diuretic Acts on the ascending loop of

indicated for edema in congestive heart

the patient was free from dehydration after

07/23/07 each BT 07/23/07

Henle in the kidney, failure, nephritic taking the entire syndrome, ascites drug due to inhibiting the reabsorption of the caused by hepatic balancing of the electrolytes Na and disease, hepatic electrolytes. Cl causing excretion cirrhosis. of Na, Ca, Mg, Cl, H2O, and some K.

Nursing Responsibilities:

 Ampicillin Instruct patient or the patients SO to time the doses evenly over a 24-h period. Inform patient or the patients SO that medication works best on an empty stomach, but may be taken with food if there is GI upset. Tell patient or the patients SO to increase fluid intake to 2,000 to 3,000 mL/day, unless contraindicated. Advise patient or the patients SO to refrigerate oral liquid preparations, and to discard unrefrigerated preparations that are more than 7?days old. Inform patient or the patients SO to notify health care provider immediately if rash develops or if having difficulty breathing. If therapy is changed because of allergic reaction, explain the significance of penicillin allergy and inform of potential sensitivity to cephalosporins. Amikacin Assess for any history of hypersensitivity to anti-infecitve drug. Weight client prior to administering medication to ensure correct calculation of dosage. Determine baseline renal and auditory function. Assess for any presence and possibly source of infection. Check doctors oder before administering the drug. Paracetamol Assess fever, not presence of associated signs. Advice the SO of the patient to check concentrations of liquid preparations. Errors may result in serious liver damage. Furosemide Assess fluid status during therapy. Monitor daily weight, intake and output, ratios, amount and location of edema, skin turgor and mucous membrane. Monitor blood pressure and pulse before and during administration of the drug. Diet Date General Indication Foods Clients Ordered: Date Taken and Given: NPO 07/23/07 to prevent to rest the GI tract 07/23/07 any infection in the GI tract patient longer experience GI problem because the GI tract the no Description Taken Response

was rested because patient eating nothing. Bottle 07/23/07 to provide to supply Milk and the nutrients Water 07/25/07 sufficient nutrients to and replace the liquid form Nursing Responsibilities: Check doctors order Explain the procedure to the patient or the patients SO why that specific diet is in use. Assess clients condition Explain foods to be taken and not to be taken Assess if the client has any allergic reactions to the food taken and if so, refer the patient to the physician.
Medication Date Ordered: General Indication Clients Response Date Taken and Description Given: IVF = PLRS 07/23/07 PLRS = isotonic fluid solution replacement the patient was crying when the IV insertion is performed on the left arm. 500cc 108cc x 07/23/07 fast drip to run for 1 then D5 0.3 NaCl 500cc 330cc x 8 at 41-42 mgtts/min

is

Feeding

patient was bottle feeding quietly and lying on the bed.

body fluid loss in in the body

D5 0.3 NaCl = fluid hypertonic maintenance solution which is to correct indicated for electrolyte those edematoes because it promotes imbalance

shrinking of cells, preventing fluid retention. prepare and transfuse 50cc PRBC after properly type and matched every 6 x 2 doses. 07/23/07 07/23/07 process of transferring blood or bloodbased products into the circulatory system of another to correct anemia and supply loss blood in the the patient was crying when receiving the blood transfusion.

from one person body.

Nursing Responsibilities IVF = PLRS 500cc and D5 0.3 NaCl Check doctors order Obtain equipment Inspect for sedimens in the IVF Inspect for expiration date Follow aseptic procedures in the IV replacement Explain the procedure to the pts SO Regulate the IVF drop PRBC 500cc Explain the procedure to the pts SO Check doctors order Obtain equipment Assess clients condition if capable of the procedure Match proper blood to be transfused Understand how to check the patients full name, hospital identification number and date

of birth on the above documentation with the labelling on the component pack and the attached blood bank label. Be able to select the correct blood component, in the appropriate order in the case of a multiple transfusion. Ensure that the door of the refrigerator is firmly closed. Sign their name in the blood bank register and record the date and time of removal. Confirm the time of removal from the blood bank refrigerator. Re-check that the appropriate pack has been collected. Visually inspect the component. Ensure that transfusion is commenced within 30 minutes of removal from refrigeration. Surgical Management: -pt did not under go any surgical procedure.

SOAPIE S> O> received patient cuddled by his mother with dislodged IVF, with skin warm to touch, increased body temperature above normal range, increased respiratory rate. Vital signs taken and recorded as follows: Temp- 38C, PR- 113 bpm, RR- 49 bpm.

A> Hyperthermia P> after four hours of nursing interventions the patient will maintain core temperature from 38C to 37C. I. Established rapport Monitored vital signs Assessed patient condition Provided TSB Maintained bed rest Provided cool environment E> Goal met, patient maintained core temperature from 38C to 37C.

SOAPIE S> O> received patient cuddled by his mother with dislodged IVF, with dry lips and oral mucosa. Vital signs taken and recorded as follows: Temp- 38C, PR- 113 bpm, RR- 49 bpm. A> Impaired oral mucous membrane P> after four hours of nursing interventions the patient will maintain a healthy oral mucosa I. Established rapport Monitored vital signs Assessed patient condition Bed side care done Encouraged SO to increase patient fluid intake Instructed parents in oral hygiene techniques E> Goal met, patient maintain healthy oral mucosa

SOAPIE S> O> received patient cuddled by his mother, with dislodged IVF, with clear nasal discharge in minimal amount. Vital signs taken and recorded as follows: Temp- 38C, PR- 113 bpm, RR- 49 bpm. A. Ineffective airway clearance related to retained secretions in the bronchi P. After four hours of nursing interventions patient will maintain airway patency as evidenced by absence of respiratory distress I. Established rapport Monitored vital signs Encouraged SO to increase patient fluid intake Encouraged SO of the patient that he must wear loose clothing Provided adequate rest and sleep Kept environment free from allergen Kept back dry E> Goal met, patient maintain airway patency as evidenced by absence of respiratory distress.

SOAPIE S> O> received patient cuddled by his mother, with dislodged IVF, (+) good skin turgor, patient appears irritable and crying at times, with yellow semi-formed stool for three episodes. Vital signs taken and recorded as follows: Temp- 38C, PR- 113 bpm, RR- 49 bpm.

A. Risk for deficient fluid volume related to frequent passage of semi-formed stool. P> after four hours of nursing interventions patient will be free from signs and symptoms of dehydration. I. Established rapport Monitored vital signs Assessed patient condition Provided health teachings such as proper hand washing, and proper handling of food Encouraged SO to increase patients fluid intake as tolerated E> Goal met, as evidenced by patient is free from signs and symptoms dehydration.

SOAPIE S> O> received patient cuddled by his mother, with dislodged IVF, with presence of rashes at the sacral area, with good skin turgor. Vital signs taken and recorded as follows: Temp- 38C, PR- 113 bpm, RR49 bpm. A. Impaired skin integrity as evidenced by presence of rashes at the sacral area P> after three to four hours of nursing interventions patient will display timely healing of skin lesions without signs of infection I. Established rapport Monitored vital signs Assessed patient condition

Bed side care done Instructed SO to change diaper frequently Stressed proper hand washing Instructed SO to do perineal care properly E> Goal met, as evidenced by patient display timely healing of skin lesions without signs of infection.

Problem # 1: Fluid Volume Deficit

Assessment Nursing S= O=Pt. May manifest: Decrease urine output Increase body temp. = Pt. Manifested: Poor skin turgor Pale nail beds and lips Dry mouth Capillary refill test greater than 3 secs. Scientific Planning Short Term: Interventions Rationale Monitor vital For baseline data To be able to monitor the prognosis of the client Infants and children have a relatively high percentage Evaluation Short Term: After 4 hours of NI the patient was able to maintained fluid volume at a functional level. Long Term: After 3 days of NI, the fluid volume of the Diagnosis Explanation Fluid Gastroenteritis is volume

an inflammation of After 2 hours of signs deficit r/t the stomach and NI, the pt. will Monitor I/O vomiting intestinal tract that maintain fluid and primarily affects Determine volume at a diarrhea the small bowel.

functional level the effects of The major clinical age Long Term: manifestations are Encourage diarrhea of varying After 3 days of SO increase NI, the fluid degrees and pts fluid volume of the abdominal pain intake client will be and cramping. maintained as Provide Mechanical environment evidence by inflammatory manifestations conducive for cause pain by rest of good skin stimulating the turgor, normal nerve endings or capillary refill the muscular or test. submucosal layers of the bowel wall. Mechanical factors cause pain by

of total body pt. had maintained as water and less are able evidence by manifestations to control their fluid intake To rehydrate the pt. To have fast of good skin turgor, normally capillary test.

With sunken eyeballs

stretching and distending the bowel; these actions then activate nerve endings. Biochemical mediators that are released during the inflammatory process cause pain by stimulating nerve endings.

recovery

PROBLEM # 2: IMPAIRED SKIN

Assessment Nursing S Scientific Explanation Planning Interventions Rationale Evaluation Diagnosis Impaired Scratching the pruritic SHORT TERM: >Establish After 3 hours rapport skin area causes the O: Patient of Nursing integrity inflamed cells and may Intervention >Monitor V/S manifest: the patient AEB nerve endings to >itching will display >Regulate >numbness presence release histamine, timely healing IVF of affected of skin lesion of rashes which produces or without sign of >Assess surrounding in the patient pruritus generating a infection area condition sacral viscous itch-scratch LONG TERM: area cycle. If the patient After 5 days of >Instruct the S.O to responds to an itch by Nursing change the scratching to an inch Intervention patient diaper by scratching the the patient frequently integrity of the skin may be altered and excoriation, redness, rashes area, infection or changes in pigmentation may result. will have a >Instruct the good skin AEB S.O to do no presence perineal care properly of rashes >Keep the area clean and dry carefully dress wound

>to gain SHORT TERM: the trust of the patient After 3 hours and S.O of Nursing Intervention >to have a the patient baseline shall display data timely healing of skin lesion >to note without sign of the infection prognosis of the LONG TERM: client After 5 days of condition Nursing >to Intervention prevent the patient infection shall have a >to protect good skin AEB from infection no presence of >assist the rashes bodys natural process of repair

>Provide optimum increase protein intake

>to provide a positive balance to aid in helping and to maintain good health

nutrition and nitrogen

PROBLEM #3 : HYPERTHERMIA
Assessment S= 0 O= Patient manifested: increased body temperature above normal range flushed skin: warm to touch increased respiratory rate Diagnosis Scientific Planning Intervention Rationale s 1. monitored 1.to evaluate Expected Outcome Short term:

Explanation Hyperthermi Gastroenteriti Short term: a s is an

After 4 hrs. effects/ degree After 4 hrs. of inflammation of nursing core of nursing of the temperature hyperthermia intervention intervention stomach and the patient 2. the patient 2. intestinal will maintain monitored hyperventilatio shall have tract that core respiration n may initially maintained primarily temperature 3. promote be present core affects the within temperature surface 3. heat loss by small bowel. normal range cooling by radiation and within normal The major range Long term: means of conduction clinical undressing Long term: manifestation After 4. heat loss by 4. provided convection After diarrhea of interventions cool 5. heat loss by Nursing environmen varying , the pt. will interventions, evaporation t and/or fan degrees and be free of and conduction the pt. shall be abdominal complication 5. provided free of 6. to control pain. s such as cool/TSB complications shivering and Associated viral and such as viral 6. seizures clinical bacterial and bacterial Administere manifestation infections 7. to reduce infections d s are nausea, metabolic medications vomiting that demands/ as ordered may occur oxygen 7. maintain consumption. from bedrest abdominal 8. to prevent distension. 8. Discuss dehydration s are Nursing Client may have fever, depending on causative organisms importance of adequate fluid intake

Problem # 5: Risk for Impaired Oral Mucous Membrane

Assessment S= 0 O= Patient may manifest: Dry oral mucosa Gingival or mucosal pallor diminished/ absent taste difficulty eating or swallowing Diagnosis Scientific Risk for Explanation Pathogens Planning Intervention Rationale Expected Outcome Short term: After 4 hrs. of nursing intervention the patient shall have maintained a healthy oral mucosa Long term:

1.to identify that cause GI After 4 hrs. Determine contributing factors oral disease are of nursing nutrition/flui 2. to correct mucous transmitted intervention d intake and identified/developin membran by the fecal- the patient reported g problems e oral route, will maintain changes 3. to prevent from person a healthy 2. Routinely dehydration to person, oral mucosa inspect oral impaired and through ingestion of fecally food and Long term: After cavity for sores, 4. when infection is present

s Short term: 1.

contaminated Nursing intervention water. It can s, the pt. also cause will tissue demonstrat damage and e a inflammation. decrease in One of the symptoms major clinical of impaired manifestation oral mucosa s is diarrhea which can cause dehydration that can lead to dry oral mucosa.

After lesions and 5. Encourages early Nursing or bleeding initiation of good oral health practices interventions, 3. the pt. shall encouraged and timely have intervention for SO to treatable problems demonstrated increase decrease in pts fluid 6. to prevent bottle symptoms of intake syndrome with impaired oral decaying of teeth. 4. mucosa Administer antibiotics, as ordered 5.Instruct parents in oral hygiene techniques 6. Stress importance of limiting nighttime regimen of bottle of

milk for infant in bed. Suggest pacifier or use of water during night

CLIENTS DAILY PROGRESS IN THE HOSPITAL (FROM ADMISSION TO DISCHARGE) DAYS NURSING PROBLEMS 1. Fluid volume deficit 2. Impaired skin integrity AEB presence of rashes at the sacral area 3. Hyperthermia 4. Ineffective airway clearance r/t retained secretion in bronchi 5. Risk for impaired oral mucus membrane VITAL SIGNS TEMPERATURE RESPIRATORY RATE PULSE RATE DIAGNOSTIC / LAB PROCEDURE JULY 23, 2007 (Admission) JULY 24, 2007 * * * * JULY 25, 2007 JULY 26, 2007 JULY 27, 2007 (Discharge)

* *

* * * 37.1 60 bpm 142 bpm COMPLETE BLOOD COUNT *Hemoglobin 73 *Hematocrit 0.22 *WBC 11.3 DIFFERENTIAL 37 72 bpm 80 bpm 36.8 69 bpm 92 bpm 38 36 bpm 88 bpm 37.2 52 bpm 72 bpm

COUNT *Neutrophil 60 *Lymphocytes 30 *Eusinophil 38 Urinalysis Fecalysis MEDICAL MANAGEMENT D5 0.3 NaCl 500 cc @ 40-41 gtss/min PLRS 50-108cc X fast drip to run for 1h DRUGS Ampicillin 150mg IV q 8h Amikacin 250mg IV q 12 Paracetamol 45mg PRN for fever 37.8 C Furosomide 4mg after each BT DIET NPO DISCHARGE PLANNING

* * * *

* * * *

* * * *

* * * * *

* *

a. GENERAL CONDITION OF CLIENT UPON DISCHARGE >Baby Prince signed a HAMA (Home against Medical Advice)

Conclusion: Treatment of acute diarrhea has relied upon simple and effective therapy of oral rehydration. The critical co-principle in case management of early resumption of feeding of children immediately upon rehydration has also gained wide acceptance. More recent advances in science of diarrhea treatment include recognition for the role of Zinc supplementation in reducing disease severity and occurrence and development of oral rehydration solution of lower as

molarity for global use. The combination of oral rehydration and early nutritional support promises to safely and effectively assist a patient through an episode of diarrhea. If the principles of therapy are accepted by all levels of the medical community and if education of parents includes teaching them to begin ORT at home, numerous deaths and unnecessary clinic visits and hospitalizations can be avoided. For many years, the treatment of acute diarrhea has proven that oral therapy, with a fluid electrolyte solution for rehydration and maintenance, is simple and effective. More recently, the importance co-principle in case management of early refeeding of children immediately upon rehydration and every nutritional support guides a patient through an episode of diarrhea safely and effectively. Improvement in rehydration and maintenance solution, vaccines, diapering practices and food safety are anticipated that may help combat one of the most common public health problems of children. Recommendation: Successful case management of children with diarrhea depends on the principles of appropriate fluid, electrolyte and nutritional therapy. Treatment of symptomatic and dehydrated children who seek medical evaluation should include two phases: rehydration and maintenance. In the rehydration phase, the fluid deficit should be replaced and clinical hydration attained. In the maintenance phase, adequate dietary and fluid intake should be maintained. Excess fluid losses must be replaced continuously.

Bibliography 1 Nanda, Nurses Pocket Guide edition 10 Authors:

Marilynn E. Doenges Mary Frances Moorhouse ALICE C. Murr 1 Mosbys Nursing PDQ 2 Fundamental of Nursing 7th edition Authors: Barbara Kozier Glenora Erb Audrey Berman Shirlee Snyder 1 Davis Drug Guide for Nurses 10th edition Authors: Judith Hopfer Dehlin April Hazard Vallerand 1 Bates Pocket Guide to Physical Examination and History Taking 4th edition by Lynn S. Bickley 2 Brunner and Suddarths Textbook of Medical Surgical Nursing 11th edition Authors: Suzanne C. Smeltzer Brenda G. Bane Janice L. Hinkle Kerry H. Cheener Websites: 1 http://psychology.about.com/od/theoriesofpersonality/a/perso nalityehem.htm 2 http://www.endonurse.com/hotnews/5ah261635288077.htm 3 http://www.emedicine.com/mod/topic856.htm