INTRODUCTION

Acute Gastroenteritis

Acute Gastroenteritis is an 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. At
least 50% of cases of gastroenteritis as foodborne illness are due to norovirus. Another
20% of cases, and the majority of severe cases in children, are due to rotavirus. Other
significant viral agents include adenovirus and astrovirus.

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe

drinking water, or contaminated food—conditions common in developing nations.
Natural or man-made disasters can make underlying problems in sanitation and food
safety worse. In developed nations, the modern food production system potentially
exposes millions of people to disease-causing bacteria through its intensive production
and distribution methods. Common types of bacterial gastroenteritis can be linked to
Salmonella and Campylobacter bacteria; however, Escherichia coli 0157 and Listeria
monocytogenes are creating increased concern in developed nations.

Acute gastroenteritis 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.

Locally, In July 22, 2004, the Department of Health (DOH), Philippines declared
an epidemic (outbreak) of a water/food-borne disease called acute gastroenteritis in 45
towns in Central Pangasinan.

According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the
said intestinal infection were recorded in just 45 days (from May 31 to July16, 2004).
From the studies on the medical diagnoses of 81 cases, Dayrit concluded that infectious
(transmittable) cholera disease was the main cause of the epidemic.

In Tagum City, at Davao Regional Hospital pediatric department, acute

gastroenteritis was considered number 3 among the most common pediatric cases. It is
common in this area because some of the people are not aware regarding the proper
handling and preparation of food.

In the Philippine Health Statistic, gastroenteritis range as number 10 in the ten

leading causes of infant mortality, with the rate of 0.5 and percentage of 4.1 cases in the
Philippines by the year 2004 this was updated last February 12, 2008.
Causes and symptoms

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food that
has spoiled may also cause illness. Certain medications and excessive alcohol can irritate the
digestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptoms of
gastroenteritis include diarrhea, nausea and vomiting, and abdominal pain and cramps. Sufferers
may also experience bloating, low fever, and overall tiredness. Typically, the symptoms last only
two to three days, but some viruses may last up to a week.

A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medical
treatment is essential if symptoms worsen or if there are complications. Infants, young children,
the elderly, and persons with underlying disease require special attention in this regard.
The greatest danger presented by gastroenteritis is dehydration. The loss of fluids through
diarrhea and vomiting can upset the body's electrolyte balance, leading to potentially life-
threatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydration
increases as symptoms are prolonged. Dehydration should be suspected if a dry mouth, increased
or excessive thirst, or scanty urination is experienced.

If symptoms do not resolve within a week, an infection or disorder more serious than
gastroenteritis may be involved. Symptoms of great concern include a high fever (102 ° F [38.9
°C] or above), blood or mucus in the diarrhea, blood in the vomit, and severe abdominal pain or
swelling. These symptoms require prompt medical attention.
 LABORATORY EXAMINATION

PATIENT’S NAME: Purita Advincula

AGE: 85 years old GENDER: Female CIVIL STATUS: Widowed

URINALYSIS

Result Interpretation

Color Yellow Normal

Appearance Clear Normal

Specific Gravity 1.015

pH 5.0

Protein Negative

Glucose Negative

RBC >0.1

WBC

Amorphous Few

Epithelial Cells Rare

Bacteria Rare
COMPLETE BLOOD COUNT

Normal Values Result Interpretation Significant

Findings
Hemoglobin Male: 14-18 mg/dl 14.2mg/dl Normal
Female: 12-
16mg/dl

Hematocrit Male: 41-53% 41.0% Normal

Female: 36-48%

RBC Male: 4.7-6.1

Female: 4.2- 4.25 Normal
5.4x1012/L

WBC 4,800-10,800/cu 6,800/cu mm

mm Normal

BLOOD TYPE

Platelet Count 140,00-440,000/ 229,000/cu.mm

cu. mm Normal

DIFFERENTIAL
COUNT

Segmenter 51

Lymphocytes 39

Monocytes 0

Eosinophils 10

Basophils 0
 GORDON’S FUNCTIONAL HEALTH PATTERNS

CLIENT PROFILE:

Patient name is Purita Lagahit Advincula, 85 years old. She is widowed and is a mother
of four. She is recently residing in Crossing Poblacion, Consolacion, Cebu and is living only
with her grandson. Upon admission, she complains frequent watery stools and abdominal pain.
Admitting diagnosis is Acute Gastroenteritis.

HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN

Before her hospitalization, patient perceives health in a way that she is not suffering from
any disease. She eats vegetables for her to improve her health and to protect her from acquiring
any disease.

During her hospitalization, patient feels so unhealthy. She follows and takes every
medications and treatments given to her. She expects to recover from the illness immediately
which largely depends on the medications given by the doctor. Present medications include the
following: Metoclopramide 1 amp IVTT q 8 PRN, Ranitidine 50mg IVTT q 8,

NUTRITIONAL – METABOLIC PATTERN

Before her hospitalization, patient takes her meal more than three times a day without any
restrictions. According to her, she has food preferences on sweets like ice cream and chocolates.
She drinks 4-5 glasses of water each day. She loves to eat vegetables and fish.

During her hospitalization, her appetite decreased. But her fluid intake increased for
about 7-9 glasses of water each day. She does not have difficulty in swallowing and masticating.
Her vital signs are: T- 38.1 C, P- 72bpm, R- 20cpm, BP- 110/70 mmHg. Her weight is 51.1kg
compare to 52.3kg six months ago.

ELIMINATION PATTERN

Before her hospitalization, patient used to eliminate once a day, most often every
morning, with a semi-solid consistency and is brownish in color. She usually urinates five times
a day with light yellow in color and is usually in large amount,

During her hospitalization, patient’s stool is watery with a yellowish color. She urinates
five times a day still with large in quantity (120mL every urination). After the shift, patient’s
total intake is 500ml and output is 720mL.

ACTIVITY – EXERCISE PATTERN

 Before her hospitalization, she does not exercise regularly. Instead, she is so busy doing
the household chores in which she thinks is an alternative to exercise. She makes it sure that the
house is clean all the time.

During her hospitalization, most of her time is spent for resting and sleeping. She does
nothing but lying on the bed and talking with the people inside the ward.

SLEEP – REST PATTERN

Before her hospitalization, she usually sleeps 5-7 hours. She is fond of playing with cards
“baraha” before going to sleep.

During her hospitalization, patient sleeps early but has sleep disturbances whenever the
nurse takes her vital signs, administers medications and feels hot.

COGNITIVE – PERCEPTION PATTERN

Before her hospitalization, patient is able to remember her birthday and what she did
during her birthday. She has problem with her hearing senses.

During her hospitalization, patient is alert and active. Her response to my questions is
very accurate.

SELF – PERCEPTION / SELF – CONCEPT PATTERN

According to her, she is really old and at this age she should be resting but she cannot
because she really wants to work for her grandson’s benefit.

ROLE – RELATIONSHIP PATTERN

Patient has a close relationship with her family but as of the moment she is the only one
living here in Cebu because most of her children were living in Manila. Few days ago, her
daughter called up and told her that she should leave Cebu and be with them in Manila so that
they can take good care of her. But she insisted not to. After her husband died, she is already the
head of the family. She did everything to provide the needs of her four children.

SEXUAL – REPRODUCTIVE PATTERN

Prior to her age already, she was not into any sexual matters anymore. She had her first
menstrual period when she was 15 years old then. At her age, she is already menopausal.

COPING STRESS – TOLERANCE PATTERN

 According to her, whenever she has problems she makes it sure that it will be solved
immediately. During her hospitalization, she feels safe with the staff. Whenever she has a
problem, she immediately consults her eldest daughter and tells her the problem.

GENOGRAM

LEGEND:

VALUES – BELIEF PATTERN

She is a Roman Catholic. She only watches mass every Sunday on the television because
she can no longer walk in a long distance. But she really does believe in the power of God.
ANATOMY AND PHYSIOLOGY

DIGESTIVE SYSTEM

The human digestive system is a complex series of organs and glands that processes food.
In order to use the food we eat, our body has to break the food down into smaller molecules that
it can process; it also has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-like and contain
the food as it makes its way through the body. The digestive system is essentially a long, twisting
tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas)
that produce or store digestive chemicals.

THE DIGESTIVE PROCESS

The start of the process: the mouth – The digestive process begins in the mouth. Food is partly
broken down by the process of chewing and by the chemical action of salivary enzymes (these
enzymes are produced by the salivary glands and break down starches into smaller pieces).

On the way to the stomach: the esophagus – After being chewed and swallowed, the food
enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It
uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into
the stomach. This muscle movement gives us the ability to eat or drink when we are upside-
down.

In the stomach – The stomach is a large sack-like organ that churns the food and bathes it in a
very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with
stomach acids called chyme.
In the small intestine – After being in the stomach, food enters the duodenum, the first part of
the small intestine. It then enters the jejunum and then the ileum (the final part of the small
intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),
pancreatic enzymes and other digestive enzymes produced by the inner wall of the small
intestine help in the breakdown of food.

In the large intestine – After passing through the small intestine, food passes into the large
intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are
removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus,
Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part
of the large intestine is called the cecum (the appendix is connected to the cecum). Food then
travels upward in the ascending colon. The food travels across the abdomen in the transverse
colon, goes back down the other side of the body in the desceneding colon, and then through the
sigmoid colon.

The end of the process – Solid waste is then stored in the rectum until it is excreted via the
anus.

Digestive System Glossary:

anus - the opening at the end of the digestive system from which feces (waste) exits the body.
appendix - a small sac located on the cecum.
ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted
into the small intestine.
cecum - the first part of the large intestine; the appendix is connected to the cecum.
chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes
on to the small intestine for further digestion.
descending colon - the part of the large intestine that run downwards after the transverse colon
and before the sigmoid colon.
duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the
jejunum.
epiglottis - the flap at the back of the tongue that keeps chewed food from going down the
windpipe to the lungs. When you swallow, the epiglottis automatically closes. When you
breathe, the epiglottis opens so that air can go in and out of the windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle
movements (called peristalsis) to force food from the throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a
digestive chemical which is produced in the liver) into the small intestine.
ileum - the last part of the small intestine before the large intestine begins.
jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the
ileum.
liver - a large organ located above and in front of the stomach. It filters toxins from the blood,
and makes bile (which breaks down fats) and some blood proteins.
mouth - the first part of the digestive system, where food enters the body. Chewing and salivary
enzymes in the mouth are the beginning of the digestive process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above the intestines.
Enzymes from the pancreas help in the digestion of carbohydrates, fats and proteins in the small
intestine.
peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into
the stomach. Peristalsis is involuntary - you cannot control it. It is also what allows you to eat
and drink while upside-down.
rectum - the lower part of the large intestine, where feces are stored before they are excreted.
salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that
break down carbohydrates (starch) into smaller molecules.
sigmoid colon - the part of the large intestine between the descending colon and the rectum.
stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and
mechanical digestion takes place in the stomach. When food enters the stomach, it is churned in
a bath of acids and enzymes.
transverse colon - the part of the large intestine that runs horizontally across the abdomen.
DISCHARGE PLAN

Clients with Acute Gastroenteritis, significant others are instructed to take the following
plan for discharge:

M- Medications should be taken regularly as prescribed, on exact dosage, time, & frequency,
making sure that the purpose of medications is fully disclosed by the health care provider.

E- Exercise should be promoted in a way by stretching hand and feet every morning

T- Treatment after discharge is expected for patients and SOs with Acute Gastroenteritis to
fully participate in continuous treatment.

H- Hygiene must be maintained for patients with Acute Gastroenteritis. Promotion of

personal hygiene should be encouraged such as, daily bathing and changing of diapers
when soiled.

O- OPD such as regular follow-up check-ups should be greatly encouraged to client’s water
with Acute Gastroenteritis as ordered by physician to ensure the continuing management
and treatment.

D- Diet should be promoted, since, during admission, the patient was on NPO. Proper
selection of nutritious food that is suitable for her age will help protect from any illness.
 PATIENT’S PROFILE

Name of the patient: Advincula, Purita

Date Admitted: November 8, 2009

Age: 85 years old

Civil Status: Widowed

Address: Crossing Poblacion, Consolacion, Cebu

Religion: Roman Catholic

Nationality: Filipino

Dialect: Cebuano and Tagalog

Date of Admission: November 8, 2009

Chief Complaint: Severe diarrhea, vomiting and abdominal pain

Admitting Diagnosis: Acute Gastroenteritis

PHYSICAL ASSESSMENT

General survey:
November 8, 2009 / 4pm
Examined lying on bed, awake, conscious, and responsive with no IVF and with the following
V/S of:

BP=110/70
T=39.0 C
P=65 bpm
R=16 cpm

SKIN: skin is moist, warm to touch with good mobility and turgor with dark brown complexion.
Convex nails with intact surrounding epidermis. Fingernails and toenails were unclean.
HEAD: head is normocephalic with symmetrical facial features. Unevenly distributed of hair,
presence of scalp, no parasite infestations, no lesion, no masses and no tenderness upon
palpation.
EYES: evenly distributed eyebrows, eyes were constricted with reddish palpebral conjunctiva
with no discharges. Able to read nameplate.
EARS: symmetrical, pinna is in line with outer canthus of the eyes, no lesions, no discharges,
presence of cerumin, no swelling no tenderness and able to follow the 6 ocular movements.
NOSE: nasal septum at midline with no discharges, both nose can pass air, no sinus and no
mucus.
MOUTH: Lips are pale and dry, tongue is pale, moist and rests at the floor of the mouth gums
are pinkish, incomplete teeth both palate are pinkish.
NECK: Neck is symmetrical, trachea at midline, no tenderness,swelling and Wide ROM and
able to swallow.
THORAX and LUNGS: no lesions, no visible deformities, with equal chest expansion, clear
breath sounds,99 presence of vibration
HEART: S1 and S2 distinct
ABDOMEN: flabby with umbilicus at midline
GUT: no lesions, no discharges as claimed, no reports of difficulty in voiding
EXTREMETIES
Left Upper: good muscle strength,brachial and radial pulses are palpable, wide ROM
Right Upper: good muscle strength, brachial and radial pulses are palpable,wide ROM
Both lower Extremeties: popliteal, posterior tibial and dorsalis pedis are palpable
NEUROLOGIC ASSESSMENT
Mental: oriented to time and place, inyact short term but not long term memory, intact clear and
logical thought process and speech, mood and affect congruent.
CEREBELLAR: able to do finger to nose test.
SENSORY: able to feel light touch and can discriminate sharp from dull objects stereognosis
and graphesthesia present bilaterally, he has intact pain sensations.
CN1: able to discriminate the scent of alcohol
CN2: able to read student’s nameplate at 4 ft. distance
CN3: able to look up and down and do the 6 ocular movements, PERRLA
CN4: (+) PERRLA and (+) CARDINAL GAZE
CN5: able to swallow
CN6: able to perform peripheral vision (Cardinal Gaze) (+) PERRLA
CN7: Symmetrical facial expressions can raise eyebrow, intact light touch sensation.
CN8: able to hear whisper at a foot distance
CN9: able to swallow without difficulty
CN10: (+) gag reflex
CN11: can shrug shoulders with or without resistance
CN12: tongue at midline upon protrusion; able to move tongue to sides without difficulty.

PATHOPHYSIOLOGY

HOST AGENT ENVIRONMENT

Escherichia coli Man Hygiene

Salmonella
Campylobacter
 Ingestion of Escherichia coli

Invasion of gastric
mucosa

Penetration of Gastric
mucosa

Signs & Symptoms:

Toxins producing pathogens Watery stool

cause watery, large volume Fever
Dizziness
diarrhea

Signs & Symptoms:

Irritation of the Gastric
Lining Vomiting
Abdominal Pain
Abdominal Cramps

Signs & Symptoms:

Fluid and Electrolyte imbalance too much Na+ and
H2O are expelled from the body Thirst

Loss of Appetite

Increased fluid loss Dry Skin

Skin Flushing
Too much Dehydration
Dark Colored Urine

Dry Mouth

Fatique or Weakness
DEATH
Chills

Head Rushes

University of San Jose Recoletos

Cebu City, Philippines
Case Study on Acute Gastroenteritis Presented to the nursing faculty in
the partial fulfillment of requirements at the Medical Ward rotation

Puza, Jeremie M.

BSN-3 BLK.7

Lavinia Caballero, RN

Clinical Instructor

TABLE OF CONTENTS

I. Introduction …………………………………………………………1
 II. Anatomy and Physiology…………………………………………….3

III. Pathophysiology………………………………………………………6

IV. Patient’s Profile……………………………………………………….7

V. Patient’s Laboratory Examination…………………………………….8

VI. Patient’s Assessment…………………………………………………10

 Physical Assessment
 Gordons Functional Health Pattern

VII. Nursing Care Plan…………………………………………….……..15

VIII. Drug Study………………………………………………..………….24

IX. Discharge Plan……………………………………………………….26