BAB I

INTRODUCTION
1.1 Backround
Diarrhea or gastroenteritis disease is an important disease around people who are still
the main cause of morbidity and mortality someone, especially in children. This reflected a
lot of people who suffer from diarrhea or gastroenteritis coming out of hospital. As a result of
many factors, including diarrheal diseases environmental health, higene individual,
nutritional status, socioeconomic factors, determine diarrheal disease, many cases of diarrhea
sufferers who experience severe dehydration and many die if not done the right actions.
Society in general has always considered it a case of diarrhea is trivial, whereas if you
know what happened was a lot of diarrhea patients who experienced death. Gastrointeritis
disease is a disease that must be addressed because glass of ra can lead to severe dehydration
and hypovolemic shock experienced
roblems on gastrointeritis or diarrhea illness that can lead to other complications
such as death and other problems related to diarrhea has not been fully addressed ade!uately,
but a variety of roles in order to prevent complications and death in the form of other issues
such as health care and well met,in preventing diarrheal disease by providing health
education to all citi"ens of gastroenteriritis disease and the role of families and the
surrounding community is very encouraging decline in the occurrence of gastroenteritis
because of the families that formed a pattern of life. #ith a healthy lifestyle and clean to
prevent the occurrence of disease gastrointeritis.
Thus it appears that the idea does not appear to reduce the gastroenteritis patients by
providing health education to the general public and from the background of the case as the
authors take medical$surgical nursing preparation of paper with the title of gastroenteritis.
1.2 Purpose
A. General urpose
Students can be understand the nursing process of gastroenteritis.
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%. Spesific urpose
&. Gastroenteritis 'verview
(. Gastroenteritis )auses
*. Gastroenteritis Symptoms
+. Gastroenteritis Diagnosis
,. Gastroenteritis Treatment
6. Gastroenteritis Self-Care and Home Remedies
-. Gastroenteritis .edical Treatment
/. Gastroenteritis .edications
0. Gastroenteritis revention
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BAB II
EXPLANATION
2.1 Gastroenterts O!er!e"
Diarrhea or gastroenteritis 1G23 is an increase in fre!uency and decrease in stool
consistency expenditures than individuals with normal bowel condition 1Dipiro et.al., (44,3.
Acute gastroenteritis or diarrhea is the fre!uency and dilution %A% where fre!uency
is more than * times per day and the number is more than (44$(,4 grams 1Syaiful 5oer,
&0063.
Gastroenteritis is a condition that causes irritation and inflammation of the stomach
and intestines 1the gastrointestinal tract3.
The most common symptoms of gastroenteritis are
diarrhea ,
nausea, and
crampy abdominal pain,
vomiting.
.any people also refer to gastroenteritis as 7stomach flu.7 This can sometimes be confusing
because influen"a 1flu3 symptoms include.
headache,
muscle aches and pains, and
respiratory symptoms, but influen"a does not involve the gastrointestinal tract.
The term stomach flu presumes a viral infection, even though there may be other
causes of infection. 8iral infections are the most common cause of gastroenteritis9 but
bacteria, parasites, and food$borne illnesses 1such as from shellfish that has been
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contaminated by sewage or from eating raw or undercooked shellfish from contaminated
water3 can also be the offending agents. .any people who experience vomiting
and diarrhea that develops from these types of infections or irritations think they have
7food poisoning,7 when they actually may have a food$borne illness.
Travelers to foreign countries may experience 7traveler:s diarrhea7 from contaminated
food and unclean water. The severity of infectious gastroenteritis depends on the immune
system:s ability to resist the infection. 2lectrolytes 1these include essential elements of
sodium and potassium3 may be lost as the affected individual vomits and experiences
diarrhea.
.ost people recover easily from a short episode of vomiting and diarrhea by drinking
fluids and gradually progressing to a normal diet. %ut for others, such as infants and the
elderly, the loss of bodily fluid with gastroenteritis can causedehydration, which is a life$
threatening illness unless the condition is treated and fluids are restored.
The most recent data from the )D), show that deaths from gastroenteritis have
increased dramatically. ;n (44-, &-,444 people died from gastroenteritis, overwhelmingly,
these people were older and the most common infections were Clostridium
difficile and norovirus.
2.2 Gastroenterts Causes
Gastroenteritis has many causes. 8iruses and bacteria are the most common. 8iruses
and bacteria are very contagious and can spread through the consumption contaminated food
or water. ;n up to ,4< of diarrheal outbreaks, no specific agent is found. The infection can
spread from person to person because of improper handwashing following a bowel movement
or handling a soiled diaper. Gastroenteritis caused by viruses may last one to two days.
=owever, some bacterial cases can continue for a longer period of time.
#ruses $Norovirus% Rota!rus% Adeno!ruses% Par!o!ruses% and Astro!ruses&
Noro!rus $ >ifty to seventy percent of cases of gastroenteritis in adults are caused by
noroviruses 1genus Norovirus, familyCaliciviridae). This virus is highly contagious
and spreads rapidly. 5orovirus is the most common cause of gastroenteritis in the
?nited States.
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5oroviruses can be transmitted by
o consuming contaminated food and li!uids,
o touching ob@ects contaminated with norovirus and then placing the hands or
fingers in the mouth,
o direct contact with an infected individual 1for example, exposure to
norovirus when caring for or sharing foods, drinks, eating utensils with an
affected individual, and
o exposure to infected individuals and ob@ects in daycare centers and nursing
homes.
5orovirus is often in the news when cruise ship passengers contract the virus causing
gastroenteritis.
Rota!rus $ According to the )D), 7Aotaviruswas also the leading cause of severe
diarrhea in ?.S. infants and young children before rotavirus vaccine was introduced
for (446. rior to that, almost all children in the ?nited States were infected with
rotavirus before their ,th birthday. 2ach year in the ?nited States in the pre$vaccine
period, rotavirus was responsible for more than +44,444 doctor visits9 more than
(44,444 emergency room visits9 ,,,444 to -4,444 hospitali"ations9 and (4 to 64
deaths in children younger than , years of age.7
Adeno!ruses $ This virus most commonly causes respiratory illness9 however, other
illnesses may be caused by adenoviruses such as gastroenteritis, bladder infections,
and rashillnesses.
Par!o!ruses ' The human bocavirus 1=%o83, which can cause gastroenteritis
belongs to the family arvoviridae.
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Astro!ruses $ Astrovirus infection is the third most fre!uent cause of gastroenteritis
in infants.
Bactera $Clostridium difficile%Salmonella, Shigella, and E coli&
%acteria may cause gastroenteritis directly by infecting the lining of the stomach and
intestine. Some bacteria such as Staphylococcus aureus produce a toxin that is the cause of
the symptoms. Staph is a common type of food poisoning.
2scherichia coli infection can cause significant complications. 2. coliBCiD '&,-E=-
1one type of the bacteria3 can cause complications in approximately &4< of affected
individuals 1for example, kidney failure in children 1hemolytic$uremic syndrome or
=?S3, bloody diarrhea, and thrombotic thrombocytopenic purpura 1TT3 in the
elderly
Salmonella, Shigella and )ampylobacter.
Salmonella, Shigella and )ampylobacter are also common causes of illness.
)lostridium difficile 1) difficile3 bacteria may overgrow in the large intestine after a
person has been on antibiotics for an infection. The most common antibiotics that
pose a potential risk
Parastes and Proto(oans $Garda% Cr)ptospordu*&
These tiny organisms are less fre!uently responsible for intestinal irritation. A person
may become infected by one of these by drinking contaminated water. Swimming pool sare
common places to come in contact with these parasites. )ommon parasites include
Giardia is the most fre!uent cause of waterborne diarrhea, causing giardiasis. 'ften,
people become infected after swallowing water that has been contaminated by animal
feces 1poop3. This may occur by drinking infected water from river or lakes but
giardia may also be found in swimming pools, wells and cisterns.
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Cryptosporidium 1)rypto3 is a parasite that lives in the intestine of affected
individuals or animals. The infected individual or animal sheds
the Cryptosporidium parasite in the stool. )rypto may also be found in food, water,
soil, or contaminated surfaces 1swallowing contaminated water, beverages, uncooked
food, unwashed fruits and vegetables, touching contaminated surfaces such as
bathroom fixtures, toys, diaper pails, changing tables, changing diapers, caring for an
infected individual or handling an infected cow or calf3. Those at risk for serious
disease are individuals with weakened immune systems.
2.3 Gastroenterts +)*pto*s
%y definition, gastroenteritis affects both the stomach and the intestines, resulting in
vomiting and diarrhea.
)ommon gastroenteritis symptoms
Fow grade fever to &44 > 1*-.- )3
5ausea with or without vomiting
.ild$to$moderate diarrhea
)rampy painful abdominal bloating 1The cramps may come in cycles, increasing in
severity until a loose bowel movement occurs and the pain resolves somewhat.3
.ore serious symptoms of gastroenteritis
%lood in vomit or stool 1blood in vomit or stool is never normal and the affected
individual should call or a visit a health care professional.3
8omiting more than +/ hours
>ever higher than &4& > 1+4 )3
Swollen abdomen or abdominal pain
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Dehydration $ weakness, lightheadedness, decreased urination, dry skin, dry mouth
and lack of sweat and tears are characteristic signs and symptoms.
2.4 Gastroenterts Da,noss
Gastroenteritis is often self$limiting, and the care is supportive designed to control
symptoms and prevent dehydration. Tests may not be needed. ;f the symptoms persist for a
prolonged period of time, the health care professional may consider blood and stool tests to
determine the cause of the vomiting and diarrhea.
Patent -stor) and P.)sca/ E0a*naton
Taking a thorough history and physical examination is very helpful in accessing the
diagnosis.
Guestions asked by the health care professional may includeE
&. =ave any other family members or friends had similar exposure or symptomsH
(. #hat is the duration, fre!uency, and description of the patient:s bowel movements,
and is vomiting presentH
*. )an the patient tolerate any fluids by mouthH
These !uestions help determine the potential risk of dehydration and may also include
asking !uestions about the amount and fre!uency of urination, weight loss, lightheadedness,
andfainting 1syncope3.
'ther information in the medical history that may be helpful in the diagnosis of
gastroenteritis includeE
Tra!e/ .stor)1 Travel may suggest E. colibacterial infection or a parasite infection
ac!uired from something the patient ate or drank. 5orovirus infections tend to occur
when many people are confined to a close space 1for example, cruise ship3.
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E0posure to posons or ot.er rrtants1Swimming in contaminated water or
drinking from suspicious fresh water such as mountain streams or wells may indicate
infection with Giardia $ an organism found in water.
Det c.an,e% 2ood preparaton .a3ts% and stora,e1 #hen the disease occurs
following exposure to undercooked or improperly stored or prepared food 1for
example foods at picnics and %%Gs that should be refrigerated to avoid
contamination3, food poisoning must be considered. ;n general, symptoms caused by
bacteria or their toxins will become apparent after the following amount of timeE
o Staphylococcus aureus in ( to 6 hours
o Clostridium / to &4 hours
o Salmonella in &( to -( hours
4edcatons1 ;f the patient has used antibiotics recently, they may have antibiotic$
associated irritation of the gastrointestinal tract, caused byclostridium
difficile infection.
hysical examination will explore the reasons for symptoms that may not be related to
infection. ;f there are specific tender areas in the abdomen, the health care practitioner may
wanttodetermineif the patient, has appendicitis, gallbladderdisease, pancreatitis, diverticulitis,
or other conditions that maybe the cause of the patient:s symptoms.
'ther noninfectious gastrointestinal diseases such as )rohn:s disease, ulcerative
colitis, or microscopic colitis also must be considered. The health care practitioner will feel
the abdomen for masses. A rectal examination may be considered, in which the physician
inspects the anus for any abnormalities and then inserts a finger in the rectum to feel for any
masses. Stool obtained during this test may be tested for the presence of blood.
The health care practitioner may perform other laboratory tests, including complete
blood count 1)%)3, electrolytes, and kidney function tests. Stool samples may be collected
and tested for blood or different types of infection.
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2.5 Gastroenterts Treat*ent
Treatment of gastroenteritis include self$care and home remedies that are aimed at
keeping the patient well hydrated to avoid dehydration. .edical treatment may be necessary
if the patient becomes dehydrated and needs hospitali"ation to rehydrate via an ;8 solution.
Some medications may be prescribed to treat some infections 1for example, ). diff3, to stop
vomiting, and antidiarrheal medication to treat diarrhea 1either over$the$counter or
prescription3, depending upon the condition of the patient and cause of gastroenteritis.
2.5 Gastroenterts +e/2'Care and -o*e Re*edes
The treatment of gastroenteritis is aimed at hydration and home remedies that address
keeping fluid in the body are key to recovery.Since most causes of gastroenteritis are due to
viruses, replacing the fluid lost because of vomiting and diarrhea allows the body to
recuperate and fight the infection.
Dehydration can also intensify the symptoms of nausea and vomiting. The critical
step is replacing fluids when the affected individual is nauseous and doesn:t want to drink
1hydrate3. This is especially difficult with infants and children. Small fre!uent offerings of
clear fluids, sometimes only a mouthful at a time, may be enough to replenish the body:s fluid
stores and prevent an admission to the hospital for intravenous 1;83 fluid administration.
;n general, clear fluids 1anything you can see through3, may be tolerated in small
amounts. Think of it as adding @ust an ounce or less to the saliva that the patient is already
swallowing. =owever, giving too much fluid at one time may cause increased nausea due to a
distended stomach, which causes additional irritation.
)lear fluids do not include carbonated beverages but colas or ginger ale with the fi""
gone are often well tolerated. )oke syrup may also be helpful in settling the stomach.
Iello and popsicles may be 7solid food7 alternatives to clear fluids in children who aren:t
interested in clear fluids.
De.)draton n c./dren
'ral rehydration therapy using balanced electrolyte solutions such as edialyte or
GatoradeCowerade may be all that is needed to replenish the fluid supply in an infant or
child. lain water is not recommended because it can dilute the electrolytes in the body and
cause complications such as sei"ures due to low sodium.
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The key to oral rehydration is small fre!uent feedings. ;f offered free access to a
bottle, infants especially may drink !uickly to !uench their thirst and then vomit. ;nstead it
may be best to limit the amount of fluid given at one time. There are a variety of regimens
that are used and they follow a basic formatE
'ffer &C* of an ounce 1, to &4 cc3 of fluid at one time. #ait , to &4 minutes then
repeat.
;f this amount is tolerated without vomiting, increase the amount of fluid to (C* of an
ounce 1&4 to (4 cc3. #ait and repeat.
;f tolerated, increase the fluid offered to & ounce 1*4 cc3 at a time.
;f vomiting occurs, go back to the &C* of an ounce 1, to &4 cc3 and restart.
'nce the child is tolerating significant fluids by mouth, a more solid diet can be
offered.
The important thing to remember is that the goal is to provide fluid to the child and
not necessarily calories. ;n the short term, hydration is more important than nutrition.
>or infants and children, fluid status can be monitored by
whether they are urinating,
if they have saliva in their mouths,
tears in their eyes, and
sweat in their armpits or groin.
;f the child:s baseline weight is known, dehydration can be measured by comparing
weight. .edical care should be accessed immediately, if the child is listless, floppy or does
not seem to be acting normal.
De.)draton n adu/ts
Although adults and adolescents have a larger electrolyte reserve than children, electrolyte
imbalance and dehydration may still occur as fluid is lost through vomiting and diarrhea.
Severe symptoms and dehydration usually develop as complications of medication use or
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chronic diseases such as diabetes or kidney failure9 however, symptoms may occur in healthy
people.
)lear fluids are appropriate for the first (+ hours to maintain ade!uate hydration.
After (+ hours of fluid without vomiting, begin a soft$bland solid diet such as the
%AAT diet 1bananas, rice, apples, toast3 and then progress the diet to other foods as
tolerated.
2.6 Gastroenterts 4edca/ Treat*ent
?pon seeking medical attention, if the patient cannot take fluids by mouth because of
vomiting, the health care practitioner may insert an ;8 to replace fluids back into the body
1rehydration3.
;n infants, depending upon the level of dehydration, intravenous fluids may be
delayed in order to attempt oral rehydration therapy. >re!uent feedings, as small as a &C6
ounce 1, cc3 at a time, may be used to restore hydration.
2.7 Gastroenterts 4edcaton
Antibiotics are usually not prescribed until a bacteria or parasite has been identified as
the cause of the infection. Antibiotics may be given for certain bacteria,
specifically )ampylobacter,Shigella, and 8ibrio cholerae, if properly identified through
laboratory tests. 'therwise, using any antibiotic or the wrong antibiotic can worsen some
infections or make them last longer.
Antibiotics are not used to treat virus infection.Some infections, such as salmonella,
are not treated with antibiotics. #ith supportive carecomprising of fluids and rest, the body is
able to fight and resolve the infection without antibiotics.
>or adults, the health care practitioner may prescribe medications to stop the vomiting
1antiemetics3 such as prometha"ine1henergan, Anergan3, prochlorpera"ine1)ompa"ine3,
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or ondansetron 1Jofran3. Sometimes these medications are prescribed as a suppository.
Doctors usually do not recommend antiemetics for infants, but depending upon the situation,
older children may be prescribed an antiemetic 1antinausea3 medication in a lower dosage.
Antidiarrhea medications are not usually recommended if the infection is associated
with a toxin that causes the diarrhea. The most common antidiarrheal agents for people older
than * years of age include over$the$counter 1'T)3 medications such as
diphenoxylateatropine 1Fomotil, Fofene, Fonox3 or loperamidehydrochloride 1;modium3.
2.8 Gastroenterts Pre!enton
#ith most infections, the key is to block the spread of the organism.
Always wash your hands.
2at properly prepared and stored food.
%leach soiled laundry.
8accinations for 8ibrio cholerae, and rotavirus have been developed. Aotavirus
vaccination is recommended for infants in the ?.S. 8accines for 8. cholerae may be
administered to individuals traveling to at$risk areas.
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BAB III
END
9.1 Conc/uson
Diarrhea or gastroenteritis disease is an important disease around people who are still
the main cause of morbidity and mortality someone, especially in children. This reflected a
lot of people who suffer from diarrhea or gastroenteritis coming out of hospital. As a result of
many factors, including diarrheal diseases environmental health, higene individual,
nutritional status, socioeconomic factors, determine diarrheal disease, many cases of diarrhea
sufferers who experience severe dehydration and many die if not done the right actions.
9.2 +u,,eston
%ased on the results of this paper mainly kepeda author expects readers and especially
students ST;Kes )eria %uana gastroenteritisl order to add knowledge about the 2nglish
language courses.
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RE:ERENCE+
#ebb, A9 Starr, . 1(44, Apr3. 7Acute gastroenteritis in children.7. Australian family
physician 9; 1+3E ((-L*&.
.an S. 1December (4&&3. 7The clinical importance of emerging )ampylobacter
species7.Nature Reviews. Gastroenterology & epatology 7 1&(3E 660L/,.
2ckardt AI, %aumgart D) 1Ianuary (4&&3. 78iral gastroenteritis in adults7.Recent !atents on
Anti"infective #rug #iscovery 5 1&3E ,+L6*.
S"a@ewska, =9 D"iechciar", 1(4&4 Ian3. 7Gastrointestinal infections in the pediatric
population.7. Current opinion in gastroenterology 25 1&3E *6L++.
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