1.

Definition

ACUTE GASTROENTERITIS (AGE)

Acute gastroenteritis, commonly known as AGE is a sudden onset

of vomiting, diarrhea, fever and stomach cramps. AGE can be
caused by viral or bacterial infections. Sources of the illness are
usually unknown. A p atient can have one or all symptoms.

When vomiting, a patient can become dehydrated and lose

electrolytes. Electrolytes help our bodies function, so it is very
important to stop the vomiting as soon as possible. If excessive
vomiting occurs, a patient usually complains of weakness,
dizziness and body aches.

Diarrhea is also a symptom of AGE. Diarrhea is the way the body gets rid of the virus
or bacteria. Contamination from the diarrhea is usually how AGE is passed from one
person to the next. Good hand washing after each bowel movement is strongly
recommended. Over the counter medication such as Imodium AD can help with
symptoms, but is not a substitute for change in diet.

Though often considered a benign disease, acute gastroenteritis remains a leading

cause of pediatric morbidity and mortality around the world, accounting for 520,000
deaths annually in children younger than 5 years.

Viruses remain by far the most common cause of acute gastroenteritis in children,
both in high-resource and low-resource settings, though several bacterial species also
play an important role in acute gastroenteritis in low-resource settings. The 2 primary
mechanisms responsible for acute gastroenteritis are as follows:

Damage to the villous brush border of the intestine, causing malabsorption of

intestinal contents and leading to osmotic diarrhea
Release of toxins that bind to specific enterocyte receptors and cause the release
of chloride ions into the intestinal lumen, leading to secretory diarrhea

Signs and symptoms

Diarrhea
Vomiting
Increase or decrease in urinary frequency
Abdominal pain
 Signs and symptoms of infection - Presence of fever,
chills, myalgias, rash, rhinorrhea, sore throat, cough;
these may be evidence of systemic infection or sepsis
Changes in appearance and behavior - Including
weight loss and increased malaise, lethargy, or
irritability, as well as changes in the amount and
frequency of feeding and in the childs level of thirst
History of recent antibiotic use - Increases the
likelihood of Clostridium difficile
History of travel to endemic areas

Assessment of dehydration

According to the World Health Organization (WHO), a patient exhibiting 2 of the

following signs can be considered to have some amount of dehydration:

Restless, irritable
Sunken eyes
Thirsty, drinks eagerly
Skin pinch goes back slowly

According to the WHO, a patient exhibiting 2 of the following signs can be considered
to have severe dehydration:

Lethargic or unconscious
Sunken eyes
Not able to drink or drinking poorly
Skin pinch goes back very slowly

2. Medical Management

a. Diagnostic Tests

Workup in pediatric gastroenteritis can include the following:

Baseline electrolytes, bicarbonate, and urea/creatinine - In any child being

treated with intravenous fluids for severe dehydration
Fecal leukocytes and stool culture - May be helpful in children presenting with
dysentery
Stool analysis for C difficile toxins - In children older than 12 months with a
recent history of antibiotic use
Stool analysis for ova and parasites - In patients with a history of prolonged
watery diarrhea (>14 days) or travel to an endemic area
 Complete blood count (CBC) and blood cultures - Any child with evidence of
systemic infection

If indicated, urine cultures, chest radiography, and/or lumbar puncture should be

performed. Several studies have found that combinations of clinical signs and
symptoms may have better sensitivity and specificity for detecting dehydration in
children than do individual signs or symptoms.

b. Drugs x 2-3

3. 5 Nursing Responsibilities

Educate the patient about perianal care after each bowel movement. The anal
area should be gently clean properly after a bowel movement to prevent skin
irritation and transmission of microorganism.
Encourage the patient to eat foods rich in potassium. When a patient
experience diarrhea, the stomach contents which is high in potassium get
flushed out of the gastrointestinal tract into the stool and out of the body,
resulting in hypokalemia.
Assess the patients skin turgor and mucous membranes for signs of
dehydration. A loss of interstitial fluid causes the loss of skin turgor. Skin
turgor assessed over the sternum in the forehead is best. Several longitudinal
furrows and coating may be noted along the tongue.
Encourage increase oral fluid intake. Increased fluid intake replaces fluid lost
in the liquid stool. Being creative in selecting fluid sources (e.g., flavored
gelatin, frozen juice bars, sports drink) can facilitate fluid replacement. Oral
hydrating solutions (e.g., Rehydrate) can be considered as needed.
Monitor intake and output, and weight. This will accurately monitor the
response to therapy.

4. Prognosis

Acute gastroenteritis is usually self-limiting, but if untreated it can result in morbidity

and mortality secondary to water loss, and electrolyte and acidbase disturbance.
Acute diarrhea causes 4 million deaths each year in children aged under 5 years in
Asia (excluding China), Africa, and Latin America, and more than 80% of deaths occur
in children under 2 years of age. Although death is uncommon in developed countries,
dehydration secondary to gastroenteritis is a significant cause of morbidity and
hospital admission.
Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp
Theofil amp
Classification: Antiasthmatic & COPD Preparations
Dosage: Initial: 225-450 mg twice daily, increased if needed. IV
Acute severe bronchospasm. Loading dose: 5 mg/kg (ideal body
wt). Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25
mg/min.
Indication: PO Chronic bronchospasm as hydrate
Action: Increases the level of cAMP resulting in bronchodilation
Adverse Reactions: Nausea, vomiting, abdominal pain, diarrhea,
headache, insomnia, dizziness, anxiety, restlessness; tremor,
palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias,
hypotension and sudden death after too rapid IV injection.
Nursing Measures:
Give immediate-release, liquid dosage forms with food if GI
effects occur.
Maintain adequate hydration.
Ensure that diazepam is readily available to treat seizures.
Take this drug exactly as prescribed; if a timed-release product is
prescribed, take this drug on an empty stomach, 1 hr before or 2 hr
after meals.
Avoid excessive intake of coffee, tea, cocoa, cola beverages,
Brand Names: Anespin amp Atropol amp Euro-Med Atropine
Sulfate amp Isopto Atropine eye drops Phil Pharmawealth/Atlantic
Atropine amp
Classification: Other Cardiovascular Drugs, Muscle Relaxants,
Mydriatic Drugs, Antidotes, Detoxifying Agents & Drugs Used in
Substance Dependence
Indication/Dosage: IV Bradycardia 500 mcg every 3-5 mins.
Total: 3 mg. IV/IM Organophosphorus poisoning 2 mg every 10-30
mins until muscarinic effects disappear or atropine toxicity appears.
IM/SC Premed in anesth 300-600 mcg 30-60 mins before anesth.
IV/IM/SC Overdosage w/ other compd having muscarinic actions
0.6-1 mg, repeat 2 hrly. Ophth Inflammatory eye disorders As 0.5-
1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1 drop
twice daily for 1-2 days before procedure.
Action: An anti-cholinergic that inhibits acetylcholine at the
parasympathetic neuroeffector junction, enhances the conduction of
AV node and increases heart rate
Adverse Reactions: Dry mouth, dysphagia, constipation, flushing
and dryness of skin, tachycardia, palpitations, arrhythmias,
mydriasis, photophobia, cycloplegia, raised intraocular pressure.
Toxic doses cause tachycardia, hyperpyrexia, restlessness,
confusion, excitement, hallucinations, delirium and may progress to
circulatory failure and respiratory depression. Potentially Fatal:
Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.
Nursing Measures:
Ensure adequate hydration; provide environmental control
(temperature) to prevent hyperpyrexia.
Have patient void before taking medication if urinary retention is
a problem.
Take as prescribed, 30 min before meals; avoid excessive dosage.
Avoid hot environments; you will be heat intolerant, and
dangerous reactions may occur.
Brand Names: Phil Pharmawealth/Harson Calcium Gluconate amp
Classification: Electrolytes
Indication/Dosage: PO Hypocalcaemia 10-50 mmol/day. IV
Hypocalcaemic tetany 2.25 mmol via slow inj , then 58-77 mL of
10% soln diluted and administered as a continuous IV infusion.
Antidote in severe hypermagnesaemia; Severe hyperkalaemia 10
mL of 10% soln, repeat every 10 mins if needed.
Action: replaces Calcium and maintains Calcium level
Adverse Reactions: GI irritation; soft-tissue calcification, skin
sloughing or necrosis after IM/SC inj. Hypercalcaemia characterised
by anorexia, nausea, vomiting, constipation, abdominal pain,
muscle weakness, mental disturbances, polydipsia, polyuria,
nephrocalcinosis, renal calculi; chalky taste, hot flushes and
peripheral vasodilation. Potentially Fatal: Cardiac arrhythmias and
coma.
Nursing Measures:
Make sure prescriber specifies form of calcium to be given; crash
carts may contain both calcium gluconate and calcium chloride.
Tell patient to take oral calcium 1 to 11/2 hours after meals if GI
upset occurs.
Give I.M. injection in gluteal region in adults and in lateral thigh in
infants. Use I.M. route only in emergencies when no I.V. route is
available bec. of irritation of tissue by calcium salts.
Tell patient to take oral calcium with a full glass of water.
Monitor calcium levels frequently. Hypercalcemia may result after
large doses in chronic renal failure. Report abnormalities.
Brand Names: Anoion tab Cordarone Cordarone inj Sandoz
Amiodarone HCl tab
Classification: Cardiac Drugs
Dosage: PO Initial: 200 mg 3 times/day for 1 wk, reduce to 200
mg twice daily for a further wk. Maintenance: 200 mg/day or lowest
effective dose. IV Initial: 5 mg/kg infusion via central venous
catheter. Max: 1.2 g/24 hr.
Indication: Ventricular and supraventricular arrhythmias.
Action: Blocks potassium chloride leading to prolongation of action
potential duration.
Adverse Reactions: Blue-grey discoloration of skin,
photosensitivity, peripheral neuropathy, paraesthesia, myopathy,
ataxia, tremor, hot flushes, sweating. Heart block, bradycardia,
sinus arrest, hepatotoxicity, heart failure. Potentially Fatal:
Pulmonary toxicity including pulmonary fibrosis and interstitial
pneumonitis, hepatotoxicity, thyrotoxicity. Ventricular arrhythmias,
pulmonary alveolitis, exacerbation of arrhythmias and rare serious
liver injury.
Nursing Measures:
Monitor cardiac rhythm continuously.
Give drug with meals to decrease GI problems.
Arrange for regular periodic blood tests for liver enzymes, thyroid
hormone levels.
Have regular medical follow-up, monitoring of cardiac rhythm,
Brand Names: Burinex amp Burinex tab
Classification: Sulfonamide Diuretics
Indication/Dosage: PO edema 1 mg once daily, 2nd dose 6-8 hr
later if needed. Refractory edema Initial: 5 mg/day, may increase
dose depending on response. Max: 10 mg/day. HTN 0.5-1 mg/day.
Max: 5 mg/day. IV Pulmonary edema 1-2 mg, repeat 20 mins. later
if needed. IV/IM Emergency edema 0.5-1 mg, then adjust according
to response.
Action: inhibits Sodium and Chloride reabsorption at the ascending
loop of Henle
Adverse Reactions: Muscle cramps, dizziness, hypotension,
headache, nausea, impaired hearing, pruritus, ECG changes,
musculoskeletal pain, rash, chest discomfort, renal failure,
premature ejaculation, thrombocytopenia, hypokalemia,
hypomagnesaemia, hyponatremia, hyperuricemia, hyperglycemia,
hypocalcaemia.
Nursing Measures:
Give with food or milk to prevent GI upset.
Avoid IV use if oral use is possible.
Arrange to monitor serum electrolytes, hydration, liver function
during long-term therapy.
Provide diet rich in potassium or supplemental potassium.
Take the drug early in day so increased urination will not disturb
Brand Names: Ace-Bloc tab Capomed tab Capotec tab Capoten tab
Captor tab Captril tab Cardiovaz tab Conamid tab Hartylox tab
Normil tab Phil Pharmawealth/Panion & BF Captopril tab Prelat tab
Primace tab Retensin tab Spec-Ace tab Tensoril tab Unihype tab
Vasostad tab
Classification: ACE Inhibitors
Indication/Dosage: PO HTN Initial: 12.5 mg twice daily.
Maintenance: 25-50 mg twice daily. Max: 50 mg 3 times/day. Heart
failure Initial: 6.25-12.5 mg 2-3 times/day. Max: 50 mg 3
times/day. Post MI Start 3 days after MI. Initial: 6.25 mg/day, may
increase after several wk to 150 mg/day in divided doses if needed
and tolerated. HTN in diabetic nephropathy 75-100 mg/day in
divided doses.
Action: inhibits ACE, reduces Sodium and water retention, lowers
blood pressure
Adverse Reactions: Hypotension, tachycardia, chest pain,
palpitations, pruritus, hyperkalaemia. Proteinuria; angioedema, skin
rashes; taste disturbance, nonproductive cough, headache.
Potentially Fatal: Neutropenia, usually occurs within 3 mth of
starting therapy especially in patients with renal dysfunction or
collagen diseases. Hyperkalaemia. Anaphylactic reactions.
Nursing Measures:
Monitor patient closely for fall in BP secondary to reduction in fluid
volume (excessive perspiration and dehydration, vomiting,
diarrhea); excessive hypotension may occur.
Take drug 1 hr before or 2 hr after meals; do not take with food.
Do not stop without consulting your health care provider.
Report mouth sores; sore throat, fever, chills; swelling of the
hands, feet; irregular heartbeat, chest pains; swelling of the face,
Diazepam
Brand name: Valium
Classification: Anxiolytics
Dosage: 10mg/2ml
Indication: relief of anxiety, agitation & tension due to
psychoneurotic states & transient situational disturbances
Action: a benzodiazepine that probably potentiates the effects of
GABA, depresses the CNS & suppresses the spread of seizure
activity
Adverse Reaction: drowsiness,dysarthria, slurred speech, tremor,
transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical
anxiety, hallucination
Nursing Measures:
Do not administer intra-arterially; may produce arteriospasm,
gangrene.
Change from IV therapy to oral therapy as soon as possible.
Do not use small veins (dorsum of hand or wrist) for IV injection.
Reduce dose of narcotic analgesics with IV diazepam; dose should
be reduced by at least one-third or eliminated.
Carefully monitor P, BP, respiration during IV administration.
Maintain patients receiving parenteral benzodiazepines in bed for
3 hr; do not permit ambulatory patients to operate a vehicle
following an injection.
Monitor EEG in patients treated for status epilepticus; seizures
may recur after initial control, presumably because of short
duration of drug effect.
EPINEPHRINE
Brand name:
Epinephrine Bitartrate
Aerosols: Primatene Mist
Epinephrine Borate
Ophthalmic solution: Epinal
Epinephrine Hydrochloride
Injection, OTC nasal solution: Adrenalin Chloride
Ophthalmic solution: Epifrin, Glaucon
Insect sting emergencies: EpiPen Auto-Injector (delivers 0.3 mg IM
adult dose), EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for
children)
OTC solutions for nebulization: AsthmaNefrin, microNefrin,
Nephron, S2
Classification: Sympathomimetic, Alpha-adrenergic agonist,
Beta1and beta2-adrenergic agonist, Cardiac stimulant, Vasopressor,
Bronchodilator, Antasthmatic drug, Nasal decongestant, Mydriatic,
Antiglaucoma drug
Dosage: 1mg/ml
Indication: Acute asthmatic attacks, Advanced cardiac life support
Action: Naturally occurring neurotransmitter, the effects of which
are mediated by alpha or beta receptors in target organs. Effects on
alpha receptors include vasoconstriction, contraction of dilator
muscles of iris. Effects on beta receptors include positive
chronotropic and inotropic effects on the heart (beta1 receptors);
MEPERIDINE HYDROCHLORIDE
Brand name: Demerol
Classification: antivertigo drug
Dosage: 100 mg/ 2mL
Indication: relief of moderate to severe pain, pre-op medication,
support of anesth & obstet analgesia
Action: binds with opiate receptors in the CNS, altering perception
of and emotional response to pain
Adverse Reactions: resp. depression, circulatory depression, resp
arrest, shock, cardiac arrest, GI disturbance, light headedness,
dizziness, sedation, nausea, vomiting, sweating, euphoria,
dysphoria, weakness, headache, tremor, agitation, uncoordinated
muscle movements, severe convulsions, transient hallucinations &
disorientation, visual disturbance, flushing, tachycardia,
bradycardia, palpitation, hypotension, syncope, phlebitis, urinary
retention, allergic reactions, pain at injection site and local tissue
irritation.
Nursing Measures:
Make position changes slowly and in stages particularly from
recumbent to upright posture. Lie down immediately if light-
headedness or dizziness occurs.
Lie down when feeling nauseated and to notify physician if this
symptom persists. Nausea appears to worsen with ambulation.
Avoid driving and other potentially hazardous activities until
reaction to drug is known. Codeine may impair ability to perform
DIGOXIN
Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)
Classification: Inotropics
Dosage: 5mg/2ml
Indication: Cardiac failure accompanied by atrial fibrillation;
management of chronic cardiac failure where systolic dysfunction or
ventricular dilatation is dominant; management of certain
supraventricular arrhythmias, particularly chronic atrial flutter &
fibrillation.
Action: inhibits sodium-potassium activated adenosine
triphosphate, promoting movement of calcium from extracellular to
intra-cytoplasm and strengthening myocardial contraction, also acts
on CNS to enhance vagal tone
Adverse Reaction: nausea, vomiting, anorexia, headache, facial
pain, fatigue, weakness, dizziness, drowsiness, disorientation,
mental confusion, bad dreams, convulsions
Nursing Measures:
Monitor apical pulse for 1 min before administering; hold dose if
pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult
pulse remains < 60 or infant < 90, hold drug and notify prescriber.
Note any change from baseline rhythm or rate.
Check dosage and preparation carefully.
Avoid IM injections, which may be very painful.
Follow diluting instructions carefully, and use diluted solution
promptly.
FUROSEMIDE
Brand name: Apo-Furosemide (CAN), Furoside (CAN), Lasix,
Myrosemide (CAN)
Classification: loop diuretics
Dosage: 20mg/2ml
Indication: edema, hypertension
Action: inhibits Sodium and Chloride reabsorption at the proximal
and distal tubules and the ascending loop of Henle
Adverse Reaction: vertigo, headache, dizziness, paresthesia,
weakness, restlessness, fever, nocturia, oliguria, polyguria
Nursing Measures:
Monitor BP after administration
Administer with food or milk to prevent GI upset.
Reduce dosage if given with other antihypertensives; readjust
dosage gradually as BP responds.
Give early in the day so that increased urination will not disturb
sleep.
Avoid IV use if oral use is at all possible.
Do not mix parenteral solution with highly acidic solutions with pH
below 3.5.
Do not expose to light, may discolor tablets or solution; do not
use discolored drug or solutions.
Discard diluted solution after 24 hr.
Refrigerate oral solution.
Measure and record weight to monitor fluid changes.
METOCLOPRAMIDE
Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-
Metoclopramide (CAN), Octamide PFS, Reglan
Classification: antiemetic & anti-spasmodic
Dosage: 10 mg/ 2mL
Indication: disturbances of GI motility, nausea & vomiting of central
& peripheral origin associated w/ surgery, metabolic diseases,
infectious & drug induced diseases, facilitate small bowel intubation
& radiological procedures of GIT
Action: stimulates motility of upper GI tract, increases lower
esophageal sphincter tone, and blocks dopamine receptors at the
chemoreceptor trigger zone
Adverse Reactions: extrapyramidal reactions, drowsiness, fatigue &
lassitude, anxiety, less frequently, insomnia, headache, dizziness,
nausea, galactorrhea, gynecomastia, bowel disturbances.
Nursing Measures:
Monitor BP carefully during IV administration.
Monitor for extrapyramidal reactions, and consult physician if they
occur.
Monitor diabetic patients, arrange for alteration in insulin dose or
timing if diabetic control is compromised by alterations in timing of
food absorption.
Keep diphenhydramine injection readily available in case
extrapyramidal reactions occur (50 mg IM).
Have phentolamine readily available in case of hypertensive crisis