University of Makati

College of Allied Health Studies

J.P. Rizal Extension West Rembo, Makati City

ACUTE GASTROENTERITIS

A Case Study
Presented to Prof. Noel A. Dichosa ,RN,MAN
Instructor, College of Allied Health Studies, AY 2010-2011

Presented by:
II-AN
Agne, Yuki L.
Aldevera, Kaira R.
Almara, Edrianne Paul A.
Alsol, Lawrenz H.
Arizo, Jamil Carlo G.
Awit, Rendel Mark M.
Barranda, Florabel V.
Benavides, Rogienette A.
Bon, Bernard M.
Bustalinio, Mariane Jhenica I.
Bustillo, Ann Marie Carmela R.
Coronado, Jordan O.
May 13, 2011

Table of Contents
I.

INTRODUCTION

II.

OBJECTIVES

III.

BIOGRAPHICAL DATA

IV.

CHIEF COMPLAINT

V.

HISTORY OF PRESENT ILLNESS

VI.

PAST MEDICAL HISTORY

VII.

FAMILY MEDICAL HISTORY

VIII.

PERSONAL AND SOCIAL HISTORY

IX.

COURSE IN THE WARD

X.

REVIEW OF SYSTEMS

XI.

PHYSICAL ASSESSMENT

XII.

DIAGNOSIS

XIII.

DIFFERENTIAL DIAGNOSIS

XIV.

ANATOMY AND PHYSIOLOGY

XV.

PATHOPHYSIOLOGY

XVI. LABORATORY RESULT

XVII. NURSING CARE PLAN
XVIII. DRUG STUDY
XIX. DISCHARGE PLANNING

I. Introduction
Gastroenteritis is the infection or irritation of the digestive tract, particularly the
stomach and the intestines. It is also known as gastric flu/ stomach flu, although it is not
related to influenza. It is usually consist of mild to severe diarrhea that may be
accompanied by loss of appetite, nausea, vomiting, cramps and discomfort in the
abdomen. Although Gastroenteritis usually is not serious for healthy adults, it can cause
life-threatening dehydration and electrolyte imbalance in very ill, the very young and the
very old. (Merck Manual)
Gastroenteritis is a very common disease; most people are at some risk to
encounter the wide-spread causes (mainly viral and bacterial). This risk is due to poor
hygiene of a few people with the disease that may be encountered frequently in daily
living (for example, infants, children, or some food handlers). Some people have higher
risk for infection; for example, individuals on cruise ships or those that live or work in
crowded conditions like child care centers, dorms, or barracks, because of the higher
chance that an infected person will come in contact with many other people, and rapidly
spread the causative agent. (www.medicinenet.com)
According to the then NSO survey, 572, 259 infants, young and old were affected
by diarrheal diseases during 2006. Because of severe dehydration and diarrhea, 914 case
of Acute Gastroenteritis specifically infants hospitalize and eventually die. ) 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. Acute gastroenteritis is a human enteric (intestinal) disease primarily
caused

by ingestion

(www.census.gov.ph)

of

spoiled

or

bacterial

contaminated

water

or

food.

II. Objectives
A. General Objectives
To understand the underlying disease of the patient and identify the significant
physiological, psychological and socioeconomic needs to provide appropriate care.
B. Specific Objectives
1. To know the anatomy of the G.I. tract and pathophysiology of Acute
Gastroenteritis.
2. To learn about the major etiologic agent of AGE.
3. To determine the previous and present medical history of the patient.
4. To perform physical assessment with special attention on the systems focus.
5. To show the laboratory examination results with the corresponding normal
values, actual result from the patient, and its interpretation
6. To learn the basic principle of medical management of AGE.
7. To gain information through Nurse-Patient interaction, identify problems
from the client and provide the appropriate nursing care plan.
8. To understand the pharmacological management set on the client and
provide nursing interventions.
9. To identify the discharge plan for the patients rehabilitation to conduct an
evaluation of the clients condition from admission to present.

III. Biographical Data

Patients Name

SMP

Age

1 year old

Gender

Male

Status

Single

Date of Birth

May 9, 2010

Place of Birth

La Union (lying-in)

Nationality

Filipino

Religion

Roman Catholic

Address

Makati City

Date of Admission :

April 25, 2011 (11:12AM)

Hospital

Ospital ng Makati

Informant

Mother

Percentage of Reliability: 80%

IV. Chief Complaint

Masyado na kasing liquid yung tae na lumalabas sa colostomy bag niya as verbalized
by the mother

V. History of Present Illness

The patient is a known case of intussusception, s/p exploratory laparotomy, ileal
resection with ileostomy, appendectomy. (December 19, 2010)

History revealed that 10 days prior to admission, patient was discharge for acute
gastroenteritis. Prior to discharge, the consistency of the stool was soft, non-bloody, and
the patient was active, no fever and vomiting.
On the 9th day until the 2nd day prior to admission, the patient didnt experience
any signs of further symptoms of acute gastroenteritis.
One day prior to admission, patient had loose watery yellowish stools via
ileostomy bag. He had fever of 39oC, 3-4 episodes of vomiting of milk amounted 2-3 tbs.
Symptoms persisted until few hours prior to admission; patient was noted to be
irritable. Thus patient brought to Ospital ng Makati for re-admission.

VI. Past Medical History

The patient was delivered NSD at one of the lying-in at La Union and was fully
immunized. He had previous case of intussusceptions, s/p exploratory laparotomy, ileal
resection with ileostomy, appendectomy last December 19, 2010.
VACCINE

Age of Vaccination

BCG

At birth

Hepa B

At birth

Vit. K

At birth

DPT

6 weeks

OPV

6weeks

AMV

9 months

VII. Family Medical History

No significant family medical history.

VIII. Personal and Social History

A. Health Perception and Health Management Pattern
The mother considers the patients health so important. She assures that
the patient receives enough nutrition and is alert to any abnormal condition his
son is experiencing. Whenever her son has cough, she gives him home remedies
in which if does not alleviate makes her decide to bring him on private clinics.
She ensures that she is focused on the patients health.
B. Nutritional and Metabolic Pattern
Patient SMP is exclusively breastfed from birth up to 6 months old. When
he is 6 months old, he started to eat solid foods like rice and biscuits such as
wafer, eggnog, breadstick and bravo. His appetite is good. He is not eating salty
foods yet fond of eating fruits like orange and banana. Her mother then gave him
formula milk and its brand is Pediasure. He drinks a lot of water. When he was
hospitalized, this routine was changed since hes no longer fond of eating fruits
and drinking water but is still given formula milk.
C. Elimination pattern
The mother changes his diaper three times a day. According to the mother,
the patient defecates three times a day with yellow colored stool. The consistency
of his stool is condensed, soft and slightly formed. When he was hospitalized, her
mother then changes his diaper two times a day and his stool is watery.
D. Activity and Exercise Pattern
According to the mother, he wants to walk but needs assistance. He plays
many toys but he loses eagerness and gets easily tired and plays another toy.
E. Sleep and Rest Pattern
He sleeps in the morning up to lunch, two naps in the afternoon and sleeps
in the whole night. When he was hospitalized, his sleep pattern changed. He
sleeps on and off for about every two hours at night and just take naps if not
disturbed.
F. Cognitive and Perceptual Pattern

The patient is active and is oriented with the people around him. He could
recognize his mother and father.

G. Role and Relationship Pattern

According to the mother, he is a very active child and does not cry easily.
He recognizes the people around him and play with them. He has one elder
brother and they kept on playing with each other when he was around. He can
cope easily with other person.
H. Sexuality and Reproductive Pattern
Not applicable to age
I. Coping and Stress Tolerance
Patient SMP copes up to his condition very well. He is not easily irritated
and is even a jolly kid. He is fond of playing with people around him. He reduces
his stress by entertaining himself with the different things around him. He has also
good appetite despite of his condition.
J. Value and Belief Pattern
Their religion is Roman Catholic.
K. Self-Perception and Self-Concept Pattern
Not applicable to age

IX. Course in the Ward

DATE &TIME
Monday-May 9, 2011
8:00 am

DATA
Seen patient
sleeping on bed
with his mother
on the bedside.

8:30 am

11:00 am

12:00 noon

The ileostomy
bag of the
patients is
about twothirds.

ACTION

RESPONSE / RESULT

Vital signs taken and

recorded.

Temp: 36.5oC
CR: 130cpm
RR: 34bpm

Provided with bedside care.

Nurse-patient interaction,
done.

Established rapport.

Assisted the mother in

emptying the ileostomy bag.
Noted the appearance of the
stoma.
Noted the consistency, and
odor of the effluent.
Vital signs taken and
recorded.
Intake and Output was
documented.

Beefy red stoma.

Fluid condense-like effluent.
Temp: 36.5oC
CR: 135cpm
RR: 30bpm
Intake: Breast feeding and 120 ml
of water
Output: 90 ml ( 1 diaper changed)

Tuesday- May 10,

2011
8:00 am

Seen patient
awake and
playing with
her mother.

Due medications are given.

Temp: 36.5oC
CR: 135ccpm
RR: 30bpm
Ferrous sulfate 150mg/10.6
ml/2ml, PO, OD
Probiotics plus prebiotics 1
sachet, OD

Provided with bedside care

and done with nurse-patient
interaction.
Physical assessment done.

9:00 am
11:00 am

Vital signs taken and

recorded.

Scheduled time
for ileostomy
bag emptying.

12:00 noon

Assisted the mother in

ileostomy bag emptying.
Noted the appearance of the
stoma.
Vital signs taken and
recorded.

Fluid condense-like effluent

Documented the intake and

output.

Temp: 36.5oC
CR: 134 cpm
RR: 30 bpm
Intake: Breast feeding and 60 ml
of water
Output: 90 ml (1 diaper change)

Vital signs taken and

Temp: 36.5oC

Wednesday- May 11,

2011
8:00 am

Seen patient

eating cerelac
for breakfast,
with his mother
feeding his son.

recorded.

Due medications given.

Bedside care done, nursepatient interaction done.
9:00 am
11:00 am

CBG monitored.
With beefy red
stoma on the
lower right
quadrant of the
abdomen.
Scheduled time
for ileostomy
bag emptying.

12:00 noon

CR: 136 cpm

RR: 30 bpm
Ferrous sulfate 150mg/10.6
ml/2ml, PO, OD
Probiotics plus prebiotics 1
sachet, OD
68 mg/dl

Assisted the mother in

ileostomy bag emptying.

Fluid condense-like effluent

Vital signs taken and

recorded.

Temp: 36.5oC
CR: 136 cpm
RR: 30 bpm
Intake: Breastfeeding and 60 ml
of water
Output: 90 ml ( 1 diaper change)

Documented the intake and

output.
Thursday-May 12,
2011
8:00 am

Seen patient

Vital signs taken and

Temp: 36.5oC

sleeping with
his parents on
the bedside.

recorded

CR: 136 cpm

RR: 30 bpm

.
Bedside care done, with
nurse-patient interaction.

11:00 am

12:00 noon

With beefy red

stoma on the
lower right
quadrant of the
abdomen.
Scheduled time
for ileostomy
bag emptying.
Scheduled time
for ileostomy
care.

Assisted the mother in

ileostomy bag emptying.

Fluid condense-like effluent

Assisted the mother in

providing ileostomy care.

Vital signs taken and

recorded.
Documented the intake and
output

Temp: 36.5oC
CR: 134 cpm
RR: 30 bpm
Intake: Breastfeeding and 50 ml
of water
Output: 90 ml ( 1 diaper change)

X. Review of Systems
General
(+) altered sleeping pattern
Integumentary System
(+) pruritus around the skin barrier of ileostomy bag
Gastrointestinal System
Stool from ileostomy bag was yellowish in colour, ~ half of plastic cup as amount and drain
twice a day
XI. Physical Assessment (MAY 10, 2011)
GENERAL APPEARANCE

Awake, conscious, active and looks as an

infant (1 yr old).

CEPHALOCAUDAL EXAMINATION

Anthropometric
measurement

Initial Vital Signs

Findings
Height : 69 cm
Weight : 8.5 kg
Weight Percentile Rank: 9%
Height Percentile Rank: <5%

Reference Value
Height : 71 -81 cm
Weight : 8.6-12.2kg
Weight percentile Rank : 5%-95%
Height percentile Rank : 5%-95%

Head circumference : 46 cm
Chest Circumference : 44 cm
Abdomen circumference : 45
cm

Chest Circumference generally < 2

cm than Head circumference.

Heart rate : 130 bpm

Respiratory rate : 34 cpm
Temperature : 36.5 C

Heart rate : 120-160 bpm

Respiratory rate : 20-40 cpm
Temperature : 36.5-37.5C

Abdomen circumference :
protuberant abdomen

Organ/
system

Techniques of
physical
examination
Head (Facial Inspection
features )

Findings
(-) lesions
(-) areas of deformity
Symmetric facial
features

Palpation

Hair

Eyes

Inspection

Inspection

Eyebrows
symmetrically aligned
Eyelashes equally
distributed
(+) Sunken eyes
Anecteric sclera
White sclera
Pinkish Conjunctivae
Dark brown iris
(+) PERRLA (2-3
mm diameter of iris
(-) discharge

Symmetrically aligned
Intact tymphanic
membrane
(-) masses
(-) discharge
(-) lesions

(-) lesions
(-) areas of deformity
Symmetric facial
features

(-) palpable masses or

lesions
(+) temporal pulse

(-) palpable masses or

lesions
(+) temporal pulse

Inspection

Evenly distributed
black hair
(-) infestations
normal texture

Ears

Reference findings

Evenly distributed
black hair
(-) infestations
normal texture
Eyebrows
symmetrically aligned
Eyelashes equally
distributed
(-) Sunken eyes
Anecteric sclera
White sclera
Pinkish Conjunctivae
Black iris
(+) PERRLA (2-3 mm
diameter of iris)
(-) discharge

Symmetrically aligned
Intact tymphanic
membrane
(-) masses
(-) discharge
(-) lesions

Pinna immediately
recoil after it is folded

Pinna immediately
recoil after it is folded

Pink nasal mucosa

(-) nose flaring

Pink nasal mucosa

Palpation

Nose

Inspection

Mouth and
Throat

Neck

Inspection

Inspection

Teeth (+) central and

lateral incisor on
upper and lower
Gums and Mucosa
(-) swelling
(-) bleeding
(-) infection
(-) white patches
Gums are pink
normal Pharynx and
Tonsillar Fossa
Pink and moist oral
mucosa
(-) swelling and
lesions
(-) lips are pinkish
and moist
Tongue is pink, moist
and at midline
position
(-) lesions

Supple
(-) vein engorgement

Thyroid: non-palpable
lymph nodes
(-) postauricular
(-) occipital
(-) superficial cervical
(-) posterior cervical
(-) tonsilar
(-) anterior cervical
(-) supraclavicular
(-) preaucular
(-) submental
(-) submaxillary
(-) masses or lesions
present
Suprasternal Notch:
(-) pulsation

Palpation

(-) nose flaring

Teeth (+) central and

lateral incisor on upper
and lower
Gums and Mucosa
(-) swelling
(-) bleeding
(-) infection
(-) white patches
Gums are pink
normal Pharynx and
Tonsillar Fossa
Pink and moist oral
mucosa
(-) swelling and
lesions
(+) lips are pinkish and
moist
Tongue is pink, moist
and at midline position
(-) lesions

Supple
(-) vein engorgement

Thyroid: non-palpable
lymph nodes
(-) postauricular
(-) occipital
(-) superficial cervical
(-) posterior cervical
(-) tonsilar
(-) anterior cervical
(-) supraclavicular
(-) preaucular
(-) submental
(-) submaxillary
(-) masses or lesions
present
Suprasternal Notch:
(-) pulsation

Thorax and
Lungs

Inspection

(+) symmetrical
expansion with
respiration

(+) symmetrical
expansion with
respiration

Palpation

(+) Tactile fremitus

(+) Tactile fremitus

Percussion

(+) resonant sound

(+) resonant sound

Auscultation

(+) normal vesicular

breathing sounds
(-) added or
adventitious sound
(+) not visible PMI

(+) normal vesicular

breathing sounds
(-) added or
adventitious sound
(+) not visible PMI

(+) regular rhythm

Precordium:
(-) parasternal
impulse
(-) thrills
PMI- palpable in 5th
ICS, apical area

S1- heard best at

apex, normal intensity
S2- heard best at
base,
Extra Sounds- (+) S3,
S4
(-)murmurs
(+) protuberant
(-) scars, striae
(+) Ileostomy on
Right lower Quadrant
(+) beefy red
(+) moist
(+) redness around
the skin barrier

Heart

Inspection

Palpation

Auscultation

Abdomen

Inspection

Auscultation
Palpation

(+) pinging sounds

(bowel sounds) 5-10
secs.
(-) bruit

(+) regular rhythm

Precordium:
(-) parasternal
impulse
(-) thrills
PMI- palpable in 5th
ICS, apical area
S1- heard best at apex,
normal intensity
S2- heard best at base,
Extra Sounds- (+) S3,
S4
(-)murmurs
(+) protuberant
(-) scars, striae
(-) Intact on Right
lower Quadrant
Ileostomy should:
(+) beefy red
(+) moist
(-) redness around the
skin barrier
(+) pinging sounds 510 secs.
(-) bruit

Extremities

Inspection

Palpation

Inspection

Palpation

Umbilicus
Facial ring ~2cm
(-) hernia
Right & left Kidney:
(+) palpable as size as
walnut
Upper extremities:

Umbilicus
Facial ring ~2cm
(-) hernia
Right & left Kidney:
(+) palpable as size as
walnut
Upper extremities:

(-) pallor
(+) slightly cyanosis
(-) rashes
(+) 3 major creases on
the palms
(+) pink nails

(-) pallor
(-) cyanosis
(-) rashes
(+) 3 major creases on
the palms
(+) pink nails

(+) hard masses on the

right antecubital area
and carpal region
Palms normal in texture
(-) nails are hard and
clubbing
(-) warm to touch
(-) slightly moist
(+) skin pinch goes back
rapidly
Radial pulse normal and
symmetric
(+) capillary refill

(-) masses

Lower Extremities
(bilaterally):
(-) pallor
(-) cyanosis
(-) rashes
(-) edema
(+) nails are convex
(-) nails cyanosis and
Clubbing
Pulse of Dorsalis pedis
and Posterior tibia was
normal and symmetric
(-) palpable popliteal
nodes

Palms normal in texture

(+) smooth and convex
(-) warm to touch
(-) slightly moist
(+) skin pinch goes back
rapidly
Radial pulse normal and
symmetric
(+) capillary refill

(-) pallor
(-) cyanosis
(-) rashes
(-) edema
(+) nails are convex
(-) nails cyanosis and
clubbing
Pulse of Dorsalis pedis
and Posterior tibia was
normal and symmetric
(-) palpable popliteal

(+) capillary refill

within 2 secs. (-) cold
and clammy extremities
Genitalia

Inspection

Inspection and
palpation

Penis:
(+) Uncircumcised
(-) lesions and
deformities

nodes
(+) capillary refill within
2 secs. (-) cold and
clammy extremities
Penis:
(+) Uncircumcised
normal for his age
(-) lesions and
deformities

Urethral meatus:
(-) discharge
(+) slit like and
centered at penis tip

Urethral meatus:
(-) discharge
(+) slit like and
centered at penis tip

Scrotum & testes :

(+) normal size for
his age
(+) left testes was
slightly lower
than right
Inguinal area:
(-) bulging
(-) palpable Femoral
Lymph nodes

Scrotum & testes :

(+) normal size for his
age
(+) left testes was
slightly lower than right
Inguinal area:
(-) bulging
(-) palpable Femoral
Lymph nodes

XII. Diagnosis
Acute Gastroenteritis with some signs of dehydration

XIII. Differential Diagnosis

XIV. Anatomy and Physiology
The Gastrointestinal System
If a human adults digestive tract were stretched out, it would be
6 to 9 m (20 to 30 ft) long. In humans, digestion begins in the mouth,
where both mechanical and chemical digestion occurs. The mouth
quickly converts food into a soft, moist mass. The muscular tongue
pushes the food against the teeth, which cut, chop, and grind the

food. Glands in the cheek linings secrete

mucus, which lubricates the food, making
it easier to chew and swallow. Three pairs
of glands empty saliva into the mouth
through ducts to moisten the food. Saliva
contains the enzyme ptyalin, which
begins to hydrolyze (break down) starch
a carbohydrate manufactured by green
plants. Once food has been reduced to a
soft mass, it is ready to be swallowed.
The tongue pushes this masscalled a bolusto the back of the
mouth and into the pharynx. This cavity between the mouth and
windpipe serves as a passageway both for food on its way down the
alimentary canal and for air passing into the windpipe. The
epiglottis, a flap of cartilage, covers the trachea (windpipe) when a
person swallows. This action of the epiglottis prevents choking by
directing food from the windpipe and toward the stomach.
Esophagus

The presence of food in the pharynx stimulates swallowing, which squeezes the
food into the esophagus. The esophagus, a muscular tube about 25 cm (10 in) long,
passes behind the trachea and heart and penetrates the diaphragm (muscular wall
between the chest and abdomen) before reaching the stomach. Food advances through
the alimentary canal by means of rhythmic muscle contractions (tightenings) known as
peristalsis. The process begins when circular muscles in the esophagus wall contract
and relax (widen) one after the other, squeezing food downward toward the stomach.
Food travels the length of the esophagus in two to three seconds.

A circular muscle called the esophageal sphincter separates the esophagus and
the stomach. As food is swallowed, this muscle relaxes, forming an opening through
which the food can pass into the stomach. Then the muscle contracts, closing the
opening to prevent food from moving back into the esophagus. The esophageal
sphincter is the first of several such muscles along the alimentary canal. These muscles
act as valves to regulate the passage of food and keep it from moving backward.
Stomach
The stomach, located in the upper abdomen just below the diaphragm, is a
saclike structure with strong, muscular walls. The stomach can expand significantly to
store all the food from a meal for both mechanical and chemical processing. The
stomach contracts about three times per minute, churning the food and mixing it with
gastric juice. This fluid, secreted by thousands of gastric glands in the lining of the
stomach, consists of water, hydrochloric acid, an enzyme called pepsin, and mucin (the
main component of mucus). Hydrochloric acid creates the acidic environment that
pepsin needs to begin breaking down proteins. It also kills microorganisms that may
have been ingested in the food. Mucin coats the stomach, protecting it from the effects
of the acid and pepsin. About four hours or less after a meal, food processed by the
stomach, called chyme, begins passing a little at a time through the pyloric sphincter
into the duodenum, the first portion of the small intestine.
Small Intestine
Most digestion, as well as absorption of digested food, occurs in the small
intestine. This narrow, twisting tube, about 2.5 cm (1 in) in diameter, fills most of the
lower abdomen, extending about 6 m (20 ft) in length. Over a period of three to six

hours, peristalsis moves chyme through the duodenum into the next portion of the
small intestine, the jejunum, and finally into the ileum, the last section of the small
intestine. During this time, the liver secretes bile into the small intestine through the
bile duct. Bile breaks large fat globules into small droplets, which enzymes in the
small intestine can act upon. Pancreatic juice, secreted by the pancreas, enters the
small intestine through the pancreatic duct. Pancreatic juice contains enzymes that
break down sugars and starches into simple sugars, fats into fatty acids and glycerol,
and proteins into amino acids. Glands in the intestinal walls secrete additional
enzymes that break down starches and complex sugars into nutrients that the intestine
absorbs. Structures called Brunners glands secrete mucus to protect the intestinal
walls from the acid effects of digestive juices.
The small intestines capacity for absorption is increased by millions of
fingerlike projections called villi, which line the inner walls of the small intestine.
Each villus is about 0.5 to 1.5 mm (0.02 to 0.06 in) long and covered with a single
layer of cells. Even tinier fingerlike projections called microvilli cover the cell
surfaces. This combination of villi and microvilli increases the surface area of the
small intestines lining by about 150 times, multiplying its capacity for absorption.
Beneath the villis single layer of cells arecapillaries (tiny vessels) of the bloodstream
and the lymphatic system. These capillaries allow nutrients produced by digestion to
travel to the cells of the body. Simple sugars and amino acids pass through the
capillaries to enter the bloodstream. Fatty acids and glycerol pass through to the
lymphatic system.
Large Intestine
A watery residue of indigestible food and digestive juices remains unabsorbed.
This residue leaves the ileum of the small intestine and moves by peristalsis into the

large intestine, where it spends 12 to 24 hours. The large intestine forms an inverted U
over the coils of the small intestine. It starts on the lower right-hand side of the body
and ends on the lower left-hand side. The large intestine is 1.5 to 1.8 m (5 to 6 ft) long
and about 6 cm (2.5 in) in diameter.
The large intestine serves several important functions. It absorbs water about
6 liters (1.6 gallons) dailyas well as dissolved salts from the residue passed on by
the small intestine. In addition, bacteria in the large intestine promote the breakdown
of undigested materials and make several vitamins, notably vitamin K, which the body
needs for blood clotting. The large intestine moves its remaining contents toward the
rectum, which makes up the final 15 to 20 cm (6 to 8 in) of the alimentary canal. The
rectum stores the feceswaste material that consists largely of undigested food,
digestive juices, bacteria, and mucusuntil elimination. Then, muscle contractions in
the walls of the rectum push the feces toward the anus. When sphincters between the
rectum and anus relax, the feces pass out of the body.

FLUIDS & ELECTROLYTES

Electrolytes are minerals in your body that have an electric charge. They are in
your blood, urine and body fluids. Maintaining the right balance of electrolytes helps
your body's blood chemistry, muscle action and other processes. Sodium, calcium,
potassium, chlorine, phosphate and magnesium are all electrolytes. You get them from
the foods you eat and the fluids you drink.
Levels of electrolytes in your body can become too low or too high. That can
happen when the amount of water in your body changes. Causes include some

medicines, vomiting, diarrhea, sweating or kidney problems. Problems most often

occur with levels of sodium, potassium or calcium.
XV. Pathophysiology
XVI. Laboratory Result
MAY 8, 2011
Hematology
Component
Hgb
Hct
WBC Count
RBC Count
Different Count
Eosinophils
Neutrophil
Segmenters
Lymphocytes
Monocytes
Platelet Count

Result
11.3
0.35
18.6
4.3

Normal Values
14-18g/L
0.40-0.54
4-11x109/L
5.0-6.4

0.02

0.02-0.04

0.49
0.48
0.01

0.50-0.70
0.20-0.40
0.02-0.05

288

150-450x

Remarks: Pricked

MAY 4, 2011
Macroscopic Examination
Examination
Color
Consistency

Result
Dark Yellow
Watery

Interpretation
Normal
Increased peristaltic
movement

Occult Blood
Examination
WBC
RBC

Result
None
None

Interpretation
Normal
Normal

I
Iron D
Iron D
Infecti
Iron D
Normal

Infecti
Release
the bloo
Normal

*No intestinal parasite seen

MAY 4, 2011
Chemical Chemistry Section

Test Name
Total

SI

Unit

Range

Cony

Unit

Result
2.01

mmol/L

2.12-

Result
8.04

Range
8.50-

2.52

mg/dL

10.10

Calcium

Interpretation
Vitamin D
deficiency,
over
consumption

Sodium

139

mmol/L

136-145

139.00

of phosphates
136-145 Normal

Potassium

3.6

mmol/L

3.5-5.1

meq/L
3.60

3.5-5.1

Normal

98-107

meq/L
103.00

98-107

Normal

Chloride

103

mmol/L

meq/L
APRIL 30, 2011
Component
Hgb
Hct
WBC Count
RBC Count
Different Count
Eosinophils
Neutrophil
Stab Cells
Segmenters
Lymphocytes
Monocytes
Platelet Count

Result
10.4
0.32
8.3
3.9

Normal Values
14-18g/L
0.40-0.54
4-11x109/L
5.0-6.4

Interpretation
Iron Deficiency
Iron Deficiency
Normal
Iron Deficiency

0.01

0.02-0.04

Normal

0.01
0.42
0.52
0.04
262

0.50-0.70
0.20-0.40
0.02-0.05
150-450x

Infection
Normal
Normal

APRIL 28, 2011

Specimen Blood Right Arm
Initial result: No growth after 2 days of incubation

APRIL 27, 2011

Macroscopic Exam
Examination
Color

Results
White

Interpretation
Lack of bile, problem in biliary

Consistency

Watery

tract or liver
Increased peristaltic movement

Occult Blood
Examination
WBC
RBC

Results
0-1
None

Interpretation
Normal
Normal

Remarks
*No intestinal parasite seen
Examination
Yeast Cells

Results
Occasional

Interpretation
Infection

APRIL 27, 2011

Chemical Chemistry Section

Test Name
Total Calcium

SI Result
2.40

Unit
mmol/L

Range
2.12-2.52

Cony Result
8.04 mg/dL

Unit Range
8.50-10.10

Sodium

133

mmol/L

136-145

139.00 meq/L

136-145

Potassium
Chloride

4.2
90

mmol/L
mmol/L

3.5-5.1
98-107

3.60 meq/L
103.00 meq/L

3.5-5.1
98-107

Remarks: Pre- extracted; Ionized Calcium: Not available

APRIL 25, 2011

Macroscopic Examination
Examination
Color
Transparency
Sugar
Protein
pH
S.G.

Results
Light Yellow
Clear
(-)
(-)
6.0
1.020

Interpretation
Normal
Normal
Normal
Normal
Normal
Normal

Microscopic Examination
Examination
WBC
RBC
Epithelial Cells
Crystals
Amorphous Urates/Phosphates
Others
Bacteria

Result
o-1/HPF
0-1/HPF
Occasional

Interpretation
Normal

Few

Normal

Few

Infection

APRIL 25, 2011

Component
Hgb
Hct

Result
11.2
0.34

Normal Values
14-18g/L
0.40-0.54

Interpretat
Iron Defic
Iron Defic

WBC Count
RBC Count
Different Count
Neutrophil
Segmenters
Lymphocytes
Monocytes
Platelet Count

17.6
4.2

4-11x109/L
5.0-6.4

0.51
0.46
0.03
428

0.50-0.70
0.20-0.40
0.02-0.05
150-450x

Infection
Iron Defic
Normal
Normal
Normal

APRIL 25, 2011

Chemical Chemistry Section

Test Name
Total Calcium
Sodium

Potassium
Chloride

SI Result
2.34

Cony Result
8.04 mg/dL

Unit Range
8.50-10.10

mmol/L

Range
2.12-2.52

121

Unit
mmol/L

2.9
79

mmol/L
mmol/L

3.5-5.1
98-107

3.60 meq/L
103.00
meq/L

3.5-5.1
98-107

136-145

139.00
meq/L

136-145

APRIL 24, 2011

Chemical Chemistry Section

Test Name
Total Calcium
Sodium

Potassium

SI Result
2.23
132

Unit
mmol/L
mmol/L

Range
2.12-2.52
136-145

Cony Result
8.04 mg/dL
139.00 meq/L

Unit Range
8.50-10.10
136-145

2.9

mmol/L

3.5-5.1

3.60 meq/L

3.5-5.1

Chloride

97

mmol/L

GLUCOSE MONITORING SHEET

APRIL 25, 2011
12pm
8pm
APRIL 26, 2011
4am
12pm
8pm
APRIL 27, 2011
4am
12pm
8pm
APRIL 28, 2011
4am
12pm
8pm
APRIL 29, 2011
4am
12pm
APRIL 30, 2011
4am
12pm
8pm
MAY 1, 2011
4am
12pm
8pm
MAY 2, 2011
4am
12pm
8pm
MAY 3, 2011
4am
12pm
8pm
MAY 4, 2011
4am
12pm
8pm
MAY 5, 2011

342 mg/dL
123 mg/dL
126 mg/dL
101 mg/dL
96 mg/dL
110mg/dL
104mg/dL
110mg/dL
121mg/dL
96mg/dL
90mg/dL
102mg/dL
91 mg/dL
98 mg/dL
97 mg/dL
84 mg/dL
90 mg/dL
135 mg/dL
123 mg/dL
104 mg/dL
117 mg/dL
89 mg/dL
100 mg/dL
119 mg/dL
120 mg/dL
89 mg/dL
277 mg/dL
132 mg/dL

98-107

103.00 meq/L

98-107

4am
12pm
8pm
MAY 6, 2011
4am
12pm
8pm
MAY 7, 2011
4am
12pm
8pm
MAY 8, 2011
4am
12pm
8pm
MAY 9, 2011
4am
12pm
8pm
MAY 10, 2011
4pm

66 mg/dL
102 mg/dL
92 mg/dL
88 mg/dL
81 mg/dL
124 mg/dL
40 mg/dL
98 mg/dL
105 mg/dL
88 mg/dL
70 mg/dL
102 mg/dL
100 mg/dL
100 mg/dL
98 mg/dL
100 mg/dL

XVII. Nursing Care Plan

XVIII. Drug Study

DRUG NAME CLASSIFICATION

INDICATION

ACTION

Relief of mild to
moderate pain;
treatment of
fever.

Decreases
fever

DOSAGE /
ROUTE/
FREQUENCY

NURSING
CONSIDERATION

EVALUATION

Dosage: 7mg

-assess patients
fever or pain: type of
location, intensity,
duration,
temperature.

-The client
decreases the
fever.

Generic:
acetaminophe
n
paracetamol

Brand:

Analgesics /
anti-pyretics

Route: TIV
Inhibiting the
effects of
pyrogens on
the
hypothalamic
heat
regulating
center.
A
hypothalamic
action
Leads to
sweating and
vasodilation.

Frequency:
every 4 hours.

-assess allergic
reactions: rash,
urticaria; if these
occur drug may
have to discontinue
-check input and
output ratio:
decrease output
may indicate renal
failure
-inform the relatives
of the patient that
the urine may
become dark brown
as a result of
phenacetin
(metabolite of
acetaminophen)

-monitor liver and

renal functions.
AST, ALT, bilirubin,
BUN, CREA.
-tell the family of the
patient to avoid
taking more than
one product
containing
paracetamol at one
time; can cause
toxicity.
-teach the family of
the patient,
recognize of signs
of chronic overdose:
bleeding, bruising,
malaise, fever, sore
throat.
-tell parent to notify
prescriber for fever
lasting for more than
3 days.

DRUG
NAME

CLASSIFICATION

INDICATION

ACTION

Anti - infectives

Treatment of
respiratory tract
infection and soft
tissue infections,
bacteria,
meningitis,
septicaemia and
gonococcal
infections caused
by susceptible
microoorganisms
.

Interferes with
cell wall
synthesis of
susceptible
organisms.

DOSAGE /
ROUTE/
FREQUENCY

NURSING
CONSIDERATION

EVALUATION

Dosage: 170
mg

-obtain patient
history of infection
before and during
therapy to assess
response.

-control of
infection
manifested by
absence of
signs/
symptoms of
infection.

Generic:
ampicillin

Brand:

Preventing
bacterial
multiplication.
Renders the
cell wall
osmotically
unstable.
Burst due to
osmotic
pressure.
Deactivated
due by betalactamase, an
enzyme
produced by
resistant
bacteria.

Route: TIV
Frequency:
every 6 hours

-assess history of
previous sensitivity
reactions to
penicillins or other
cephalosporins.
-assess for allergic/
hypersensitivity
reactions: chills,
fever, joint pain
pruritus and rash.
-monitor renal
function: urine
output, urinalysis:
protein and blood,
BUN.
-assess for
overgrowth of
infection: perineal
itching, fever,

malaise, redness,
pain, swelling, rash
and diarrhea.
-instruct the family
of the patient to take
all medications
prescribed for the
length of time
period.
-instruct the family
of the patient to
monitor adverse
reactions.
-instruct the family
of the patient if
diarrhea with blood
or pus occur
immediately to the
notify physician.

DRUG
NAME

CLASSIFICATION

INDICATION

ACTION

DOSAGE /
ROUTE/
FREQUENCY

NURSING
CONSIDERATION

Anti-infectives

Short-term
treatment of
serious
infections
caused by
susceptible
strains of
microorganisms
especially gram
(-) bacteria.

Interferes
with the
protein
synthesis in
the bacterial
cell.

Dosage: 17 mg

- assess patient for

previous sensitivity
reaction.

EVALUATION

Generic:
Gentamicin

Brand:

binding to
ribosomal
unit.
Causing
misreading
of genetic
code.
Inaccurate
peptide
sequence
forms in
protein
chain.
Bacterial
death.

Route: TIV
Frequency:
every 8 hours

-assess for the

allergic reactions:
rash, urticaria,
pruritus, chills, fever.
Joint pain may
occur a few days
after therapy begins.
-identify urine
output; if
decreasing, notify
physician. Also
increased BUN,
creatinine, urine.
-monitor
electrolytes: patient
is in long-term
therapy.
-advise the patient
to to take drug
directly as exactlyas

-absence of signs
and symptoms of
infection
(WBC<10,000/mm
,
Absence of red,
draining wounds.

directed when
prescribed.
-advise the patients
to drink adequate
amounts of water
(2-3 L/day) unless
instructed to restrict
fuild intake.
-inform the family of
the patient might
experience of GI
upset, loss of
appetite.
-instruct the family
of the client
changes in urine
pattern and
respiratory difficulty.

DRUG
NAME

CLASSIFICATION

INDICATION

ACTION

Ophthalmic
preparations

Relief of eye
irritation, or
congestion
secondary to
eye strain,
exposure toto
smoke or air
pollutants.

Sympathomimeti
c w/ alpha
receptor activity.

DOSAGE /
NURSING
ROUTE/
CONSIDERATION
FREQUENCY

EVALUATION

Dosage: 1-2
drops

-patient
experiences
improvement of
vision w/
medication.

Generic:
Naphazoline/
Zinc drops

Brand:
VasoClearA

Route: eye
Causes
constriction of
blood vessels of
the eye and nasal
mucosa.

Frequency:
every 4 hours

-assess patients
condition before
therapy and
regularly thereafter
to monitor drug
effectiveness.
-assess patient for
narrow angle
glaucoma/
increased
intraocular pressure.

Decongestion
-monitor for possible
drug induced
adversed reactions:
Papillary dilatation,
increased
intraocular pressure.
-assess patients
and family
knowledge on drug
therapy.

DRUG
NAME

CLASSIFICATION

INDICATION

ACTION

DOSAGE /
ROUTE/
FREQUENCY

NURSING
CONSIDERATION

EVALUATION

Dietary/ nutritional
preparations

Prevention and
treatment of
iron-deficiency
anemia.

Provides/
replaces
elemental iron
essential
component in
formation of
haemoglobin
on RBC
development.

Dosage: 15mg/
10.6 ml/ 2ml

-obtain a baseline
assessment of iron
deficiency before
starting therapy.

-decreased of
feeling fatigue
and weakness.

Generic:
Ferrous
sulfate

Brand:

Contains 37%
elemental
iron. Ferrous
gluconate.
12%, ferrous
sulphate- 20%
ferrous
sulphate
dessicated30%

Route: Oral
Frequency:
once a day

-evaluate hgb, Hct,

and reticulocyte
count during
therapy.
-monitor adverse
reactions: nausea,
diarrhea.
-assess bowel
elimination, increase
water,bulk and
activity if
constipation occurs.
-assess diet and
nutrition: amount of
iron in diet.
-instruct the family
of the client not to
substituteone iron

-improvement in
results of Hct,
Hgb and
reticulocytes on
follow-up
examination.

salt for another

because they have
different elemental
iron content.
-remind the family of
the patient that
poisoning may
occur if increased
beyond
recommended level.
-instruct the family
of the client to
swallow the whole
tablet do not crush
or chew.

XIX. Discharge Planning

M- edications
Instruct the mother to administer the following medications to the client as
prescribed by the physician:
o
o
o
o

Zinc drops 1 ml OD x 14 days

Probiotics + Prebiotics 1 sachet OD to be mixed with milk
Paracetamo 170 mg q4 for fever 37
Ferrous Sulfate 2 ml OD

Inform the parents on the side effects of the following drugs given
Instruct the mother to properly comply on the following medications
Give emphasis on the right time and right dose of every drug to be given.
E- xercise
Inform the mother the need of the client to have a daily exercise
Encourage the mother to have some walk with her child especially early
morning.
If possible, advice the mother to let her child to play
Encourage to have a stretching of the hands and feet.
T- reatment
Advice the mother to visit their barangay health center for further
observations
Instruct the mother to routinely check the clients colostomy for signs of
infection
Instruct the mother to have a regular colostomy care to the client
Teach the mother to keep an eye on the appearance of the clients stool
H- ealth teaching
Teach the mother the proper hand washing as well as to the family and most
especially to the client
Instruct the SOs to observe proper hygiene such as taking a bath everyday
Teach the proper food handling

 Teach the family the susceptible microorganism that can cause diseases to the
GI tract including where, when and how to get these kinds of microorganism.
Teach the parents the best nutrition that fits to the clients needs at the same
time the appropriate time and number of hours for time and rest.
O- PD
Instruct the client to comply on the following scheduled check-ups to the OPD
Give emphasis on the need and the benefits to get when conforming to the
following check-ups.
D- iet

Follow the BRAT diet

Avoid eating street foods
Start eating cooked vegetables and fruits
Dairy products must not be taken
Increase fluid intake

S- piritual
Encourage the family as well as the patient to go to church every Sunday and
to keep on believing and praying.