A CASE STUDY ON

ACUTE
GASTROENTERITIS
By: Marco Ray V. Vela, SN
Acute Gastroenteritis
Acute Gastroenteritis is the 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 infection with certain viruses,

less often by bacteria or their toxins, parasites, or adverse reaction to something
in the diet or medication.
Acute Gastroenteritis
Different species of bacteria can cause gastroenteritis, including
Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium,
Escherichia coli, Yersinia, and others
Each organism causes slightly different symptom but all result in diarrhea.
Colitis, inflammation of the large intestine, may also be present.
Diarrhea
Diarrhea is loose, watery stools. A person with diarrhea typically passes
stool more than three times a day. People with diarrhea may pass more than a
quart of stool a day.

Acute diarrhea is a common problem that usually lasts 1 or 2 days and

goes away on its own without special treatment.
Objectives
The ability to utilize the skills, knowledge and attitude obtained during the
clinical exposure and to further understand the necessary nursing care intended for
clients with AGE and/or dehydration.
Specific Objectives:
Skills:
1. To perform correctly and appropriately the roles and duty of nurse in the
nursing ward.
2. Able to observe and classify the type of stool in order to proceed medication as
needed.
3. Able to tend to the patient’s needs and comfort while maintaining appropriate
nursing interventions needed.
4. Able to perform the nursing management and actions to attend to patients
diagnosed with Acute Gastroenteritis.
Specific Objectives:
Knowledge:
1. Enhance the use of interpersonal communication skills and ethics specific to the
care of the patient.
2. To fully understand the process on how AGE progresses and apply the needed
nursing interventions accordingly to clinical manifestations.
Specific Objectives:
Attitude:
1.Utilization of nursing care knowledge and empathy into betterment of the
patient’s health.
2. Create a rapport with the client and have a positive nurse-patient interaction.
3. Build a cooperative and collaborative environment with the staff nurse, patient,
and family to provide the best nursing care.
Vital Information
Name: D, P. M.
Time of Admission: 4:36 AM
Age: 2
Current Address: Cala-an, Panitan Capiz
Sex: Female
Highest Educational Attainment: N/A
Religion: Roman Catholic
Final Diagnosis: AGE, Moderate Dehydration, with
Civil Status: Single LBM
Nationality: Filipino Attending Physician: Dr. S.
Date of Birth: Feb. 19, 2018 Bed number: GW
Place of Birth: Cala-an, Panitan Capiz Source of Info: Patient’s chart
Date of Admission: Feb. 23, 2020
Anatomy and Physiology
Gastroenteritis is defined as vomiting or diarrhea due to inflammation of
the small or large bowel, often due to infection.
In children, rotavirus is the most common cause of severe disease. In
adults, norovirus and Campylobacter are common causes.
Clinical Assessment
CHIEF COMPLAINT:
Complaints of frequent passing of bowel, LBM with wet watery stool.

HISTORY OF PRESENT ILLNESS:

Days prior to admission, client was positive of several episodes of LBM, yellowish
in color. No associated fever, cough and colds. Admitting vital signs of Temp - 36.8
Celsius, CR- 124bpm, RR- 27bpm, with pulse oximeter reading of 96% O2
saturation.
Clinical Assessment
Vital Signs
During Admission
Baseline Normal Values (Feb. 24, 2020)

8AM 12AM
36.5oC - 37.5oC Temperature 36.5 oC 36.6 oC
80-120bpm Cardiac Rate 120bpm 120bpm
20-30 breaths/min Respiratory Rate 28 27
S/U 1/D 0/D
Clinical Assessment
Clinical Manifestations
FROM THE TEXTBOOK MANIFESTED BY THE CLIENT RATIONALE

Nausea and Vomiting Due to irritation in the gastrointestinal tract caused by the infection

Abdominal pain & cramping Due to infection and therefore irritation in the digestive tract

Mild fever and chills Due to an infection viral, bacterial or protozoal in nature

Loss of appetite Due to loss of body fluids caused by vomiting and diarrhea

Headache and muscle aches Due to loss of body fluids caused by vomiting and diarrhea

Tiredness and general body ✔ Due to loss of body fluids caused by vomiting and diarrhea
weakness

Incontinence (loss of control ✔ Due to the weakening of the muscles of the rectum and intestines
over bowel motions) stretch and eventually weaken, allowing watery stool from farther up
the digestive tract to move around the impacted stool and leak out
Pathophysiology
Gastroenteritis is an inflammation of the lining of the
stomach and intestine accompanied by fever, nausea, vomiting,
watery diarrhea, and abdominal cramping.
Incubation is 12 to 72 hours, with a duration of 12-60 hours.
Viruses act by invading and killing cells of the
intestinal villi, disturbing the structural integrity of the region
so that foods cannot be completely digested.
Normally, the host’s immune system quickly responds,
and because the lifetime of mature intestinal cells is only about
3 to 5 days, the illness is usually self-limiting.
Physical Assessment Pt.1
Area Assessed Technique Actual Findings Evaluation

Skin appears warm to touch and no presence of

Skin Inspection rashes. No lesions or excoriations noted. Normal

Hair Inspection Hair is black, curly and clean Normal

Head is normocephalic
Inspection/
Head and symmetrical. Normal
Palpation
No presence of lesions
Inspection & Nails are trimmed and pinkish in color.
Nails Normal
Palpation Smooth and intact with epidermis
Both eyes are dark brown in color.
Eyes are in good alignment. May be a sign of
Eyes Inspection
dehydration
Eyes slightly sunken

Both ears are symmetrical.

Ears Inspection Normal
No discharge to the opening of the ear canal.
Nose Inspection Oval, symmetric and without discharge Normal
Lips are pinkish in color.
Mouth Inspection Normal
Tongue is pink and no presence of sores.
Physical Assessment Pt.2
Inspection/ Nipples are brown in color with no presence of
Breast Normal
Palpation lumps, masses and tenderness.
Inspection/ Neck is symmetrical and no swelling and lymph
Neck Normal
Palpation nodes enlargement.
Inspection/ Normal symmetry and deviation of the spinal
Back Palpation column. Normal
No presence of lesions.
Inspection, Skin of abdomen is free of striae, scars, lesions
Abdomen Palpation, or rashes. Abdomen is flat and symmetric with Normal
Auscultation no bulges or lumps.
Respiratory System Auscultation Clear breath sounds Normal
No presence of heart murmur. Steady, S1 S2
Cardiovascular System Auscultation Normal
sounds
Warm to touch. Normal palmar crease. There is
Upper Extremities Inspection/
no presence of lumps, discharges or lesions. No Normal
Palpation
presence of swelling and edema.
Inspection/
Lower Extremities Palpation No presence of swelling and edema. Normal
Physical Assessment Pt.3
GENERAL APPRAISAL:
• SPEECH: Babbles, says only a few words
• HEARING: Both ears can hear clearly.
• MENTAL STATUS: Mentally stable.
• EMOTIONAL STATUS: Can express emotionally, needs parents to calm down
each visit.
LABORATORY AND DIAGNOSIS
Diagnosis is based on clinical history and presentation. Stool cultures are
obtained for white blood cells, ova, and parasite culture for specific bacteria.
Fecalysis Result:

Physical Examination

Stool Color Yellow

Consistency Loose

Microscopic Examination

Bacteria Many
Others No Parasite Seen
TEXBOOK DISCUSSION (A.G.E.)
DEFINITION OF GASTROENTERITIS:
Gastroenteritis is a catchall term for infection or irritation of the digestive
tract, particularly the stomach and intestine.
It is frequently referred to as the stomach or intestinal flu, although the
influenza virus is not associated with this illness.
Gastroenteritis arises from ingestion of viruses, certain bacteria, or
parasites.
Gastroenteritis is a self-limiting illness which will resolve
by itself. However, for comfort and convenience, a person may use over-the-counter
medications such as Pepto Bismol to relieve the symptoms.
TEXBOOK DISCUSSION (A.G.E.)
CAUSES:
The most common cause of gastroenteritis is a viral or bacterial infection,
and less commonly parasitic infection.
• Parasitic gastroenteritis is usually caused by Giardia.
• Viral gastroenteritis is the most frequent cause of gastroenteritis
outbreaks, which occur when groups of people are affected at the same time and
place.
Norovirus outbreaks can affect both children and adults, while rotavirus mainly
affects infants and children.
TEXBOOK DISCUSSION (A.G.E.)
SIGNS AND SYMPTOMS:
The main symptom of gastroenteritis is diarrhea, which is the unusual elimination of frequent
loose, watery stools.
Additional symptoms and signs of gastroenteritis may include:
• Nausea and vomiting
• Abdominal pain and cramping
• Mild fever and chills
• Loss of appetite
• Headache and muscle aches
• Tiredness and general body weakness
• Incontinence (loss of control over bowel motions)
• Poor feeding in infants
TEXBOOK DISCUSSION (A.G.E.)
DIAGNOSIS :
It is important to establish the cause, as different types of gastroenteritis respond to
different treatments. Diagnostic methods may include:
• Medical history
• Physical examination
• Blood and stool tests
TEXBOOK DISCUSSION (A.G.E.)
TREATMENT:
Treatment depends on the cause, but may include:
• Plenty of fluids
• Oral rehydration drinks, available from your pharmacist
• Admission to hospital and intravenous fluid replacement, in severe cases
• Antibiotics, if bacteria are the cause
• Anthelmintic drugs
• Avoiding anti-vomiting or anti-diarrhea drugs unless prescribed or recommended by the
physician
TEXBOOK DISCUSSION (Dehydration)
DEFINITION OF DEHYDRATION:
Dehydration, a well-known nutritional problem, can be defined as depletion in total
body water content due to pathologic fluid losses, diminished fluid intake, or a combination of
both and poses particularly acute dangers.
This occurs when more water and fluids leave the body than enter it. Even low levels of
dehydration can cause headaches, lethargy, and constipation.
TEXBOOK DISCUSSION (Dehydration)
CAUSES:
Dehydration is most often caused by fever, diarrhea, vomiting, and a decreased ability
to drink or eat associated with a viral infection.
Common viral infections that cause vomiting or diarrhea include rotavirus, Norwalk
virus, and adenovirus.
Infants and small children are much more likely to become dehydrated than older
children or adults, because they can lose relatively more fluid quickly.
TEXBOOK DISCUSSION (Dehydration)
SIGNS AND SYMPTOMS:
Dehydration can arise from the excessive loss of fluid from the body, which can occur quickly with
gastroenteritis. The signs and symptoms of dehydration include:
• Extreme thirst
• Not having urinated in the past eight hours or passing only a small volume of urine
• Urine that is dark in color and smelly
• Dry lips and mouth, and a lack of tears
• Cold hands and feet
• Sunken cheeks or eyes
• Dizziness, lethargy, floppiness
• In infants, dry nappies (for longer than 4-6 hours) and/or a sunken fontanelle (the soft spot on the top of
a baby’s head)
• Skin that ‘tents up’ when pinched.
TEXBOOK DISCUSSION (Dehydration)
DIAGNOSIS OF DEHYDRATION:
Dehydration is commonly diagnosed on the basis of physical signs and symptoms.
To help confirm the diagnosis and pinpoint the degree of dehydration, you may have
other tests, such as:
• Blood tests. Blood samples may be used to check for a number of factors, such as the
levels of your electrolytes — especially sodium and potassium — and how well your kidneys
are working.
• Urinalysis. Tests done on your urine can help show whether you're dehydrated and to
what degree. They also can check for signs of a bladder infection.
TEXBOOK DISCUSSION (Dehydration)
TREATMENT:
The only effective treatment for dehydration is to replace lost fluids and lost
electrolytes. The best approach to dehydration treatment depends on age, the severity of
dehydration and its cause.
Most adults with mild to moderate dehydration from diarrhea, vomiting or fever can
improve their condition by drinking more water or other liquids.
MEDICATIONS:
Drug
Generic Name: Levocetirizine
Brand Name: Xyzal
Classification: Antihistamine
Dosage:
 Adults, Elderly, Children 12yrs
and Older = 5mg once daily in
the evening
 Children 6yrs up to 11yrs =
2.5mg once daily in the evening
 Children 6mo up to 5yrs =
1.25mg once daily in the
evening
Route: PO
Action Indication/Contraindication Nursing Responsibilities
Mechanism of Action: Indication:  Baseline Assessment – Assess severity
 Competes with histamine for H1-receptor sites on effector  Drug - May increase ritonavir, of rhinitis, urticaria, other symptoms.
cells in GI tract, blood vessels, respiratory tract. theophylline concentrations Obtain baseline renal function tests
 Relieves allergic response (sneezing, rhinorrhea, postnasal  Herbal – None Significant  Intervention/Evaluation – For upper
discharge, nasal pruritus, ocular pruritus, tearing), allergic respiratory allergies, increase fluids to
 Food – None Known
rhinitis (hay fever), mediated by histamine (urticaria, maintain thin secretions and offset
pruritis) thirst. Monitor symptoms for
Contraindication: None Significant therapeutic response
 Patient/Family Teaching – Avoid tasks
Side Effects:
that require alertness, motor skills
Adults until response to drug is established.
 Occasional – Drowsiness, nasopharyngitis, fatigue Avoid alcohol during antihistamine
 Rare – Dry mouth, pharyngitis therapy
Children 6yrs – 12yrs
 Rare – Fever, cough, fatigue, epistaxis
Adverse Reactions: None Significant
NURSING CARE PLAN:
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation Nursing Theories

Subjective Data:  Administer  To treat the Goal met as manifested by the  Virginia
 “Basa iya popo” Deficient Fluid Volume Within 2 days of medications as infection causing mother of the client stating Henderson 14
as verbalized by related to active fluid volume providing nursing care, ordered the illness “Wala naman siya ga LBM kag Basic Human
the mother loss will maintain fluid and ga popo gid” Needs
electrolytes volume at a and as evidenced by the client
Objective Data: Rationale: functional level as being able to eliminate semi-  Faye Glenn
 Loose, watery Acute Gastroenteritis is an evidenced by:  Encourage oral formed stool. Abdellah
stool, yellowish in inflammation on the stomach fluid intake Typology of 21
 For fluid
color & GI tract which is - elimination of semi- containing Nursing
replacement
 Sunken eyeballs manifested by diarrhea, formed stool at least 2 electrolyte Problems
noted abdominal pain associated times a day
with nausea, vomiting, fever,
and abdominal distention&  Educate the
excessive elimination of
client about the
waste caused electrolyte
importance of
proper hand  To prevent the
hygiene spread of infectious
diseases
NURSING CARE PLAN:
Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation Nursing Theories

Subjective Data:  Administer  To treat the Goal met as manifested by the  Virginia
 “Basa iya popo” Deficient Fluid Volume Within 2 days of medications as infection causing mother of the client stating Henderson 14
as verbalized by related to active fluid volume providing nursing care, ordered the illness “Wala naman siya ga LBM kag Basic Human
the mother loss will maintain fluid and ga popo gid” Needs
electrolytes volume at a and as evidenced by the client
Objective Data: Rationale: functional level as being able to eliminate semi-  Faye Glenn
 Loose, watery Acute Gastroenteritis is an evidenced by:  Encourage oral formed stool. Abdellah
stool, yellowish in inflammation on the stomach fluid intake Typology of 21
 For fluid
color & GI tract which is - elimination of semi- containing Nursing
replacement
 Sunken eyeballs manifested by diarrhea, formed stool at least 2 electrolyte Problems
noted abdominal pain associated times a day
with nausea, vomiting, fever,
and abdominal distention&  Educate the
excessive elimination of
client about the
waste caused electrolyte
importance of
proper hand  To prevent the
hygiene spread of infectious
diseases