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Acute Gastroenteritis is 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.

Different species of ba cteria can cause gastroenteritis, including Ô


,

Ô

, Ô

 ,  

   , 
  ,  
,  ,
and others. Each organism causes slightly different symptoms but all result in diarrhea.
Colitis, inflammation of the large intestine, may also be present. Some types of acute
gastroenteritis will not resolve without antibiotic treatment, especially when bacteria or
exposure to parasites are the cause. Physicians may want to diagnose the cause by
analyzing a stool sample, when stomach symptoms remain problematic.

Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per

year and is a leading cause of death among infants and children under 5. The most
common symptoms are diarrhea, vomiting and stomach pain, because whatever causes
the condition inflames the gastrointestinal tract. Another reason to seek medical treatment
is that some forms of acute gastroenteritis mimic appendicitis, which may require
emergency treatment. As well, young children run an especially high risk of becoming
dehydrated during a long course of the stomach flu. One should receive directions
regarding how to help affected kids or adults get more fluids. Sometimes children, those
with compromised immune systems, and the elderly may require hospitalization and
intravenous fluids. Dehydration can actually cause greater nausea, and can begin to cause
organ shut down if not properly addressed.

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. Also, it is a common and costly
clinical problem in children. It is a largely self-limited disease with many etiologies. The
evaluation of the child with acute gastroenteritis requires a careful history and a complete
physical examination to uncover other illness with similar presentations. Minimal
laboratory testing is generally required. Treatment is primary supportive and is directed at
preventing or treating dehydration. When positive, an age-supportive diet and fluids
should be continued. Oral rehydration therapy using a commercial pediatric oral
rehydration solution is preferred approach to mild or moderate dehydration. The
traditional approach using ³clear liquids´ is inadequate. Severe dehydration requires the
prompt restoration of intravascular volume through the intravenous administration of
fluids followed by oral rehydration therapy. When rehydration is achieved, an aged-
appropriate diet should be promptly resumed. Anti-emetic and anti-diarrheal medications
are generally not indicated and may contribute to complications.

Acute gastroenteritis remains a serious health issue, and is responsible for over
50,000 hospitalizations of children. In developing countries, acute gastroenteritis is the
leading cause of death for infants. Acute gastroenteritis should thus be taken seriously,
and people should not hesitate to seek medical treatment for especially seniors and
children who have been ill for more than a day.

In the Philippine Health Statistics, 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.

Last January 6, 2010, we encountered a patient with such kind of infection. This
patient has caught our attention and has given the opportunity to study his case. The
objective of this study is to help us understand the disease process of gastroenteritis and
to orient ourselves for appropriate nursing interventions that we could offer to the patient.
This approach enables us to exercise our duties as student nurses which is to render care.
We were given the chance to improve the quality of care we can offer and to pursue our
chosen profession as future nurses.
 cc Ê 
c  

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c 

This study aims to fully understand the underlying causes of diseases of Acute
Gastroenteritis and to express familiarity and to offer an effective nursing care to a patient
diagnosed with Acute Gastroenteritis through understanding the patient history, disease
process and management.

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c 

1. To know the other complications that affects Acute Gastroenteritis.

2. To determine the present and past clinical history of the patient.
3. To perform a thorough assessment, through Nursing Health History, Physical Assessment,
and the interpretation of the laboratory examination done on the patient.
4. To show the laboratory examinations results with corresponding normal values, actual result
from the patient.
5. To trace and understand the pathophysiology of the Acute Gastroenteritis.
6. To use the nursing process use to identify nursing problems and provide the appropriate
nursing care plan.
7. To provide nursing interventions to the patient with Acute Gastroenteritis.
8. To have knowledge to the client medication and be familiar to that medication.
9. To formulate a workable nursing care plan on the subjective and objective cues gathered
through nurse-patient interaction to be able to help the patient recover‘


 ccc Ê
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The present condition started 3 days prior to admission when patient had 6 episodes of
yellowish, non-blood streaked, mucoid stool, non-foul smelling amounting to 1 tsp per bowel
movement. Watery lined stool was accompanied with fever and productive cough as well as
vomiting, 4 episodes of previously injected milk amounting to ½ cup per bout. No consultations
done, (+) meds given are Paracetamol (Tempra) 10 ml, Carbocentric (Solmux), and
Cotrimoxazole (Kathrex) 2 ml BID x 3 days.Ê

One day prior to admission, still with four (4) episodes of LBM now watery based. Few
hours prior to admission, still with above condition accompanied with high grade fever (40 C),
difficulty of breathing and circumoral cyanosis. No seizures noted. He was brought to East
Avenue Medical Center and was advised admission but due to no vacancy, he was brought to Dr.
Jose Fabella Memorial Hospital hence admission.

Ê c  c
 

According to the patient¶s mother, he had completed his vaccinations including BCG,
DPT, OPV, MMR and Hepatitis B vaccine. The client had cough, colds and fever occurring
eight (8) times last year and didn¶t have an otitis media. The patient had never been any of
the childhood diseases such as measles, mumps and chicken pox. The patient has no history
of any accident or injury. He was not hospitalized before and does not take any medications
or supplements to maintain health.

 Ê cc 

Father: Age ± 42 years old

Occupation ± Security Guard
Educational Attainment - High School Graduate
Mother: Age ± 30 years old
Occupation ± Housewife
Educational Attainment ± Elementary Graduate

According to the patient¶s mother, their family have history of hypertension, diabetes
mellitus and asthma.
 c
 c

 Jerome Niel Guillamac Basibasi


 Gastro-27

 1 year old and 5 months


 Male

  173 Old Balara, Tandang Sora, Quezon City

c August 20, 2008

c Bulacan

c
 N/A

c
c Filipino

cc   Child / Single

cc
 Roman Catholic

c c
 January 2, 2010

cc c
 5:00 am


c
 cc
 Dr. Gregorio / Dr. Ballesteros

cc
 LBM & vomiting; days PTC ± (+) productive cough accompanied by
fever & watery nasal discharge, no consult done, meds: Paracetamol

cc
c
 c  Acute Gastroenteritis with some Dehydration

c
c
 c  Acute Gastroenteritis with some Dehydration

 c Ê  c  

January 06, 2010
 neat, conscious and coherent

!""# !Fairly nourished
c""$""%&36.3 C, =34, =120
"%' 34 ½ inches
("%'9.6 kg
')")! *) 19 ½ inches / 50 cm


 )'"+!
# ""% )!""% $!"#

#, !)! Inspection   

Stature Depends Tall Normal

 (Short & Tall)
Symmetry  Symmetrical Symmetrical Normal

-"   
Color Inspection Light brown, tanned Tanned skin Normal
skin (vary according
to race)

Lips, nail beds, Lighter colored Lighter colored

soles and palms palms, soles, lips and palms, soles, lips and
Inspection nail beds nail beds Normal

Moisture Inspection/ Skin normally dry Skin normally dry Normal

Palpation

Temperature Palpation Normally warm o Normal

36.3 C

 Smooth, soft and Smooth, soft and

flexible palms and flexible palms and
Texture Palpation soles (thicker) soles (thicker) Normal

Turgor Palpation Skin snaps back Skin snaps back Normal

immediately, good immediately, good

-"..%

a. Nails
 Inspection Transparent, smooth Transparent, smooth Normal
and convex and convex

Nail beds & folds Inspection Pinkish & intact Pinkish & intact Normal

Nail base & Inspection Firm & soft Firm & soft Normal
texture


Head Inspection Normocephalic Normocephalic Normal

Fontanels Inspection/Palpat Anterior: Closed Anterior: Closed but d/t dehydration

ion (12-18 mos) depressed
Posterior: Closed Posterior: Closed
(2-5 mos)
b. Hair

Distribution Inspection Evenly distributed Evenly distributed Normal

Color Inspection Black Black Normal

Texture Inspection/ Smooth Smooth Normal

Palpation

,

Eyes Inspection Parallel to each other Parallel to each other d/t dehydration
but sunken

Visual Acuity Inspection PERRLA- Pupils PERRLA- Pupils Normal

(penlight) equally round react to equally round react to
light and light and
accommodation accommodation

Eyebrows Inspection Symmetrical in size, Symmetrical in size, Normal

extension, hair extension, hair
texture and texture and
movement movement

Eyelashes Inspection Distributed evenly Distributed evenly Normal

and curved outward and curved outward

Eyelids Inspection Same color as the Same color as the Normal

skin skin
 Blinks involuntarily Blinks involuntarily
and bilaterally up to and bilaterally up to
20 times per minute 16 times per minute Normal

Do not cover the Do not cover the

pupil and the sclera, pupil and the sclera,
lids normally close lids normally close
symmetrically symmetrically Normal

Conjunctiva Inspection Transparent with Pale d/t AGE with

light pink color DHN

Sclera Inspection Color is white Color is white Normal

Cornea Inspection Transparent, shiny Transparent, shiny Normal

Pupils Inspection Black, constrict Black, constrict Normal

briskly briskly

Iris Inspection Clearly visible Clearly visible Normal

Color Inspection Even coloration Even coloration Normal



Ear canal opening Inspection Free of lesions, Free of lesions, Normal

discharge of discharge of
inflammation inflammation

Canal walls pink Canal walls pink

Normal

Symmetry Inspection Symmetrical aligned Symmetrical aligned Normal

with outer cantus with outer cantus

Hearing Acuity Inspection Client normally hears Client normally hears

words when words when
whispered whispered Normal

Discharges Inspection Absent Absent Normal

#

Shape, size and Inspection Smooth, symmetric Smooth, symmetric

skin color with same color as with same color as
 the face the face Normal

Nasal septum Inspection Close to midline, Close to midline,

thicker anteriorly thicker anteriorly
than posteriorly; than posteriorly; Normal
deviated deviated

Nares Inspection Oval, symmetric Oval, symmetric

Normal

Discharges Inspection Absent Watery & clear d/t colds

#!'
',/

Lips
Inspection Pink, moist Pale, dry with lesions d/t AGE with
symmetric without DHN
lesions

Cleft inspection Absent Absent Normal

Buccal mucosa Inspection Glistening pink soft Glistening pink soft Normal
moist moist

Gums Inspection Slightly pink color, Slightly pink color,

moist and tightly fit moist and tightly fit
against each tooth against each tooth Normal

Tongue Inspection Moist, slightly rough Moist, slightly rough

on dorsal surface on dorsal surface
medium or dull red / medium or dull red / Normal
pink pink

Teeth Inspection Firmly set, shiny, Firmly set, shiny, Normal

white white

No tooth decay

Hard and soft Inspection Hard palate- dome- Hard palate- dome-
palate shaped shaped
Normal
Soft Palate- light Soft Palate- light pink
 pink

Uvula Inspection Present Present Normal

)-

Symmetry of neck Neck is slightly Neck is slightly hyper

muscles, hyper extended, extended, without
alignment of Inspection without masses or masses or asymmetry Normal
trachea asymmetry

Neck Range of Inspection Neck moves freely, Neck moves freely, Normal
Motion full without full without
discomfort discomfort

Thyroid gland Palpation Rises freely with Rises freely with Normal
swallowing swallowing

Trachea Inspection Midline Midline Normal

'#/ Auscultation Clear breath sounds Clear breath sounds Normal

!%



Pulsation Auscultation Present Normal

Rhythm Regular Normal

0#  Inspection Skin same color with Skin same color with Normal
the rest of the body the rest of the body

Clicks or gurling Clicks or gurling

sounds occur sounds occur
Bowel sounds Auscultation irregularly and range Hyperactive d/t AGE
from 5-35 per minute

Symmetry Inspection Symmetrical Symmetrical Normal

Contour Inspection Flat Normal

Umbilicus Inspection Midline Midline Normal

.#!)"$

Male
Testicles Palpation Descended Descended Normal

Hernia Palpation Absent Absent Normal

Anus Inspection Perforated Perforated Normal

!##%,
, 

Level of
consciousness Inspection Fully conscious Fully conscious Normal

Behavior and Inspection Makes eye contact Makes eye contact

appearance with examiner, with examiner,
hyperactive expresses hyperactive expresses
feelings with feelings with Normal
response to the response to the
situation situation

(



##

î Hands often open

î Begins reaching and grasping with palm
î Transfer objects from one hand to another
î Picks up objects well with whole hand
î Reaches for toys
î Rakes for objects and releases objects
î Releases hold on cup

,)'##)"

î Knows parents
î Shows emotions of fear and anger
î Has mood changes
î Quiets self

#,1#%""$

î Notes bright objects if in line of vision

î Follows an object with eyes
 î Begins to play with objects
î Recognizes familiar faces
î Turns head to locate sounds
î Recognizes parent in other clothes, places
î Uses hands to learn concepts of in and out
î Searches for hidden toys
î Explores boxes, inserts objects in container

%!%1# !")"#

î Strong cry
î Respond to human faces
î Responds to voices, watches speaker
î Can say mama, dada
î Understand and obey simple commands, such as ³wave, bye-bye´
î Responds to ³no´

#0"",

î Raises head, holds position

î Moves all extremities, kicking arms and legs when prone
î Sits alone, using hands for support
î Begins to pull up
î Takes first step
î Walks alone
î Sits from a standing position
 Ê 
 c

c c  

Every morsel of food we eat has to be broken down into nutrients that can be absorbed by
the body, which is why it takes hours to fully digest food. In humans, protein must be broken
down into amino acids, starches into simple sugars, and fats into fatty acids and glycerol. The
water in our food and drink is also absorbed into the bloodstream to provide the body with the
fluid it needs.

The digestive system is made up of the " ,) and the other abdominal organs
that play a part in digestion, such as the liver and pancreas. The alimentary canal (also called the
"%"$ )) is the long tube of organs ² including the esophagus, the stomach, and the
intestines ² that runs from the mouth to the anus. An adult's digestive tract is about 30 feet long.

Digestion begins in the mouth, well before food reaches the stomach. When we see,
smell, taste, or even imagine a tasty snack, our "$, %, which are located under the
tongue and near the lower jaw, be gin producing saliva. This flow of saliva is set in motion by a
brain reflex that's triggered when we sense food or even think about eating. In response to this
sensory stimulation, the brain sends impulses through the nerves that control the salivary glands,
telling them to prepare for a meal.

As the teeth tear and chop the food, "$ moistens it for easy swallowing. A digestive
enzyme called  ,, which is found in saliva, starts to break down some of the carbohydrates
(starches and sugars) in the food even before it leaves the mouth.

Swallowing, which is accomplished by muscle movements in the tongue and mouth,

moves the food into the throat, or pharynx. The .',/ (pronounced: *"-inks), a passageway
for food and air, is about 5 inches long. A flexible flap of tissue called the ."%#" reflexively
closes over the windpipe when we swallow to prevent choking.

From the throat, food travels down a muscular tube in the chest called the #.'%!.
Waves of muscle contractions called ."" force food down through the esophagus to the
stomach. A person normally isn't aware of the movements of the esophagus, stomach, and
intestine that take place as food passes through the digestive tract.

At the end of the esophagus, a muscular ring called a .'") allows food to enter the
stomach and then squeezes shut to keep food or fluid from flowing back up into the esophagus.
The stomach muscles churn and mix the food with acids and enzymes, breaking it into much
smaller, more digestible pieces. An acidic environment is needed for the digestion that takes
place in the stomach. Glands in the stomach lining produce about 3 quarts of these digestive
juices each day.

Most substances in the food we eat need further digestion and must travel into the
intestine before being absorbed. When it's empty, an adult's stomach has a volume of one fifth of
a cup, but it can expand to hold more than 8 cups of food after a large meal.
 By the time food is ready to leave the stomach, it has been processed into a thick liquid
called )', . A walnut-sized muscular tube at the outlet of the stomach called the .,#!
keeps chyme in the stomach until it reaches the right consistency to pass into the small intestine.
Chyme is then squirted down into the small intestine, where digestion of food continues so the
body can absorb the nutrients into the bloodstream.

The small intestine is made up of three parts:

1. the !#! , the C-shaped first part

2. the ¦¦!! 2the coiled midsection
3. the "! , the final section that leads into the large intestine

The inner wall of the small intestine is covered with millions of microscopic, finger-like
projections called $"". The villi are the vehicles through which nutrients can be absorbed into
the body.

The "$ (located under the ribcage in the right upper part of the abdomen), the %0
(hidden just below the liver), and the .) (beneath the stomach) are not part of the
alimentary canal, but these organs are still important for healthy digestion.

The pancreas produces enzymes that help digest proteins, fats, and carbohydrates. It also
makes a substance that neutralizes stomach acid. The liver produces 0", which helps the body
absorb fat. Bile is stored in the gallbladder until it is needed. These enzymes and bile travel
through special channels (called ducts) directly into the small intestine, where they help to break
down food.

The liver also plays a major role in the handling and processing of nutrients. These nutrients
are carried to the liver in the blood from the small intestine.

From the small intestine, food that has not been digested (and some water) travels to the large
intestine through a valve that prevents food from returning to the small intestine. By the time
food reaches the large intestine, the work of absorbing nutrients is nearly finished. The large
intestine's main function is to remove water from the undigested matter and form solid waste that
can be excreted. The large intestine is made up of three parts:

1. The ))! is a pouch at the beginning of the large intestine that joins the small intestine
to the large intestine. This transition area allows food to travel from the small intestine to
the large intestine. The .."/, a small, hollow, finger-like pouch, hangs off the
cecum. Doctors believe the appendix is left over from a previous time in human
evolution. It no longer appears to be useful to the digestive process.
2. The )## extends from the cecum up the right side of the abdomen, across the upper
abdomen, and then down the left side of the abdomen, finally connecting to the rectum.
The colon has three parts: the ascending colon and transverse colon, which absorb water
and salts, and the descending colon, which holds the resulting waste. Bacteria in the
colon help to digest the remaining food products.
3. The )! is where feces are stored until they leave the digestive system through the
anus as a bowel movement.

The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral
cavity, where food enters the mouth, continuing through the pharynx, oesophagus, stomach
and intestines to the rectum and anus, where food is expelled. There are various accessory
organs that assist the tract by secreting enzymes to help break down food into its component
nutrients. Thus the salivary glands, liver, pancreas and gall bladder have important functions
in the digestive system. Food is propelled along the length of the GIT by peristaltic
movements of the muscular walls.

The primary purpose of the gastrointestinal tract is to break down food into nutrients,
which can be absorbed into the body to provide energy. First food must be ingested into the
mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the
stomach and small intestine where proteins, fats and carbohydrates are chemically broken
down into their basic building blocks. Smaller molecules are then absorbed across the
epithelium of the small intestine and subsequently enter the circulation. The large intestine
plays a key role in reabsorbing excess water. Finally, undigested material and secreted waste
products are excreted from the body via defecation (passing of faeces). In the case of
gastrointestinal disease or disorders, these functions of the gastrointestinal tract are not
achieved successfully. Patients may develop symptoms of nausea, vomiting, diarrhoea,
malabsorption, constipation or obstruction. Gastrointestinal problems are very common and
most people will have experienced some of the above symptoms several times throughout
their lives.
 cc Ê c
 c    


 : Basibasi, Jerome Neil G. 0
! 0: 118318
%: 1Y 4M 12D (: Pedia 
! 0: 27
/: Male !: 01/02/10 09:21AM
',")"Dr. Gregorio / Dr. Ballesteros ": 01/02/10 09:26AM

 


    
 
c

3c
c
 
CBC 105 110-160 g/l
Hemoglobin 0.31 0.30-0.43 %
Hematocrit 4.83 3.9-5.3 X10^12/L
RBC count 65 75-81 Fl
MCV 22 24-30 P6
MCH 33 31-34 g/dl
MCHC 4.3 5.5-15.5 X10^g/L
WBC count

 3c
c
   
 
c

Differential Count 0.43 0.00-0.33 %
Neutrophils 0.44 0.00-0.59 %
Lymphocytes 0.01 0.00-0.01 %
Basophils 0.11 0.00-0.03 %
Monocytes 0.01 0.00-0.03 %
Eosinophils 272 150-400 X10^ 9/L
Platelet Count
 3 c

c 


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

")"# - 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.

/)" - Exercise should be promoted in a way by stretching hand and feet every morning
and exercise burping every after bottle feeding.

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

,%" - 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.

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

" - Diet should be promoted, since, during admission, the patient was on NPO. Proper
selection of milk that is suitable for babies will help enhance immunity.

Also:

î Bed rest
î Fluids - to avoid dehydration
î Salt solutions
î Symptomatic treatment
î Diet changes
Ú Clear fluids
Ú Bland foods - e.g. cereals, rice, soup, crackers, applesauce etc.
Ú Avoid fried foods
Ú Avoid spicy foods
Ú Avoid fruits and vegetables
Ú Gradual addition of solid foods
Ú Gradual return to usual diet


 3c c


Within the span of 3 days of rendering care to Jerome Basibasi, we were able to identify
potential problems and specific nursing interventions were provided. With the help of health
teachings and other interventions, mother of Jerome Niel Basibasi was able to learn how to
recognize signs and symptoms and other risk factors of the condition of her son. The parent of
Jerome Niel Basibasi was able to verbalize the importance of giving medications and how to take
care of her son. They had also recognized the importance of compliance to treatment regimen in
order to manage the condition of their son, Jerome Niel Basibasi. The patient¶s mother was
advised by the physician that his son can go home for full health restoration.


 Ê

ÊÊ Ê
Ê
   Ê
   Ê Ê
 Ê
Ê
Ê
Ê
Ê

 Ê
Ê

 Ê    ÊÊ
 Ê
Ê
  Ê
Ê
!0 "0,
Perez, Yulladee Q.
Reyes, Joe Marie M.
Rosales, Charmaine Angel S.
Solas, Maria Rose L.
Tolentino, Pamela Marie M.
BSN 2Y2-4E

!0 "#
Mrs. Myrna B. Makiling

 !0 "
January 13, 2010