Colegio De San Juan De Letran Calamba

BUCAL, CALAMBA CITY LAGUNA

ACUTE GASTROENTERITIS WITH SEVERE DEHYDRATION

Submitted by: GROUP 3 GRANADA, Abigail HUMARANG, Chrisselle JUANILLO, Janine Marie LALUZ, Diane Lauriz LAPITAN, Ma. Fatima LERIT, Michelle MALAPITAN, Rene MARQUEZ, Joanna Marie MEDINA, Sandra MOLINO, Hazel Anne NICANOR, Monica NOBLEJAS, Adrian OCAMPO, Marinel OLEA, John Rogel

Submitted to: Lady Anne De Jesus RN RM MAN Bienvenida Alcantara RN MAN Natalia Badenas RN MAN

INTRODUCTION

Gastroenteritis is a general term referring to inflammation or infection of the gastrointestinal tract, primarily the stomach and intestines. It can be caused by infection with bacteria, viruses, or other parasites, or less commonly reactions to new foods or medications. It often involves stomach pain (sometimes to the point of crippling), diarrhea and/or vomiting, with non-inflammatory infection of the upper small bowel, or inflammatory infections of the colon. It usually is of acute onset, normally lasting fewer than 10 days and self-limiting. Sometimes it is referred to simply as 'gastro'. It is often called the stomach flu or gastric flu even though it is not related to influenza. If inflammation is limited to the stomach, the term gastritis is used, and if the small bowel alone is affected it is enteritis

Infectious gastroenteritis Infectious gastroenteritis is caused by a wide variety of bacteria and viruses. Viral gastroenteritis Viruses causing gastroenteritis includerotavirus,norovirus,adenovirusand astrovirus. Viruses do not respond to antibiotics and infected children usually make a full recovery after a few days. Bacterial gastroenteritis Bacterial gastroenteritis is frequently a result of poor sanitation,thelackof safe drinkingwater, or contaminated foodconditionscommon in developing nations. ( www.emedicines.com) Dehydration can occur when the body loses too much fluid. By the time a person becomes severely dehydrated, there is no longer enough fluid in the body to get blood to the vital organs. Severe dehydration is a medical emergency and requires emergency treatment. Mild to moderate dehydration is treated at home by drinking more fluids. Treatment for moderate to severe dehydration may include IV fluids and a stay in the hospital. Dehydration is very dangerous for babies, small children, and older adults. It is most dangerous for newborns. Watch closely for early symptoms anytime there is an illness that causes a high fever, vomiting, or diarrhea.

Symptoms ofmild dehydrationinclude: Increased thirst. Dry mouth and sticky saliva. Reduced urine output with dark yellow urine. Symptoms ofmoderate dehydrationinclude: Extreme thirst. Dry appearance inside the mouth, and the eyes don't tear. Decreased urination, or half the number of urinations in 24 hours (usually 3 or fewer urinations). Urine is dark amber or brown. Lightheadedness that is relieved by lying down. Irritability or restlessness. Arms or legs that feel cool to the touch. Rapid heartbeat. Muscle cramps. Symptoms ofsevere dehydration(even if only one of them is present) include: Altered behavior, such as severe anxiety, confusion, or not being able to stay awake. Faintness that is not relieved by lying down, or lightheadedness that continues after standing for 2 minutes. Inability to stand or walk. Rapid breathing. Weak, rapid pulse. Cold, clammy skin or hot, dry skin. Little or no urination for 12 hours or longer. Loss of consciousness.

NURSING HISTORY
NAME OF PATIENT: RN AGE: 15 YEARS OLD CHIEF COMPLAINT: LOSS BOWEL MOVEMENT (LBM) ADMITTING DOCTOR: DRA.VALDELLON ATTENDING PHYSICIAN: DR.MORAN

PRESENT MEDICAL HISTORY The patient experienced 2days of continuous vomiting, and more the 8 loose bowel movement prior to admission. He report nausea and abdominal cramps. He was admitted for severe dehydration. The patient has been admitted at Los Banos Doctors Hospital having an acute diarrhea but the father denied that his child does not have known allergies to drugs and foods nor his child received a blood transfusion.

ADMITTING

DIAGNOSIS: ACUTE GASTROENTERITIS WITH SEVERE DEHYDRATION

 Past

Health History The father claimed that his child past illnesses were a typical cough, colds and fever that usually lasted for three days.

FAMILIAL GENOGRAM
GRAND MOTHER (HYPERTENSIVE ) GRAND FATHER ( ALLERGY TO SHRIMP )

MOTHER ( BREAST CANCER )

FATHER

RV PATIENT

GORDON

Health perception and health management

Client states he usually got sick because of eating street foods which he does not know if it is clean or not. He always experience stomach ache that lasts for 3 days. He believed that the cause of his condition is from eating fish balls outside their school.

Nutritional and metabolic pattern

Clients daily food intake typically consist of fried foods and soft drinks. He dont take vitamins. His average consumption of water is 6-9 glass a day. In his hospital days he only drinks 3-4 glass a day.

Elimination Pattern
soft and experience pain upon defacating. Upon hospitalization, he experienced more than 8 bowel movement.

He usually have a bowel movement daily. Sometimes constipated but usually loose and Activity-Exercise Pattern

Client has enough energy for daily activities, he used to play basketball after school. Upon admission he didnt have any exercises.

Sleep-Rest Pattern

Client usually sleeps from 10pm to 6am. He also sleeps after lunch every Saturday and Sunday. During hospital days he had disturbed sleeping pattern. He usually had 3 hours of sleep because of frequent vomiting and bowel movements.

Cognitive-Perceptual Pattern

No problem reported w/ hearing, vision and memory. Client report no changes in his physical health. On hospital days the mother verbalized that his son is confused.

Self-Perception and Self- Concept Pattern

Client described self as healthy teenager despite of illness, and no changes in physical capacity. He also report of loosen appetite easily in doing school stuff.

Role-Relationship

Client lives with his parents, siblings and grandmother. He described their family as supporting and caring with each other and have no major problems in the family. He also has a good relationship with neighbors and friends. He believed that because of his hospitalization, his family had a greater care to each other. Sexuality-Reproductive Pattern Client stated he has no sex life. Coping-stress Tolerance Pattern Client pays basketball in order to forget problems specially when stressed with school works. He talks to his father when he has problems. Values and Belief Pattern Clients religion is roman catholic but seldom goes to miss every Sunday.

NURSING THEORY
Developmental Task Theory of Robert Havighurst A developmental task is a task which arises at or about a certain period in the life of an individual. Havighurst has identified six major age periods:infancy and early childhood (0-5 years), middle childhood (6-12 years), adolescence (13-18 years), early adulthood (1929 years), middle adulthood (30-60 years), and later maturity (61+). Basing on Havighursts Theory, our patient belongs in adolescence stage wherein he is developing concepts necessary for everyday living and achieving personal independence.

Cognitive Theory of Jean Piaget Cognitive development refers to how a person perceives, thinks, and gains understanding of his or her world through the interaction and influence of genetic and learning factors. This is divided into five major phases: Sensorimotor Phase Birth to 2 years Pre-conceptual Phase 2 3 years Intuitive Thought Phase 4 6 years Concrete Operations Phase 7 11 years Formal Operational Phase 12 adulthood Basing on this theory, our patient belongs to the formal operational stage in which he move beyond concrete experiences and begin to think abstractly, reason logically and draw conclusions from the information available, as well as apply all these processes to hypothetical situations.

Physical assessment
General:

the patient loses weight from 45kg to

43kg. Skin: The patient is slightly pale. There is a rashes in buttocks area Hair: moist and black. There is no dandruff. Nails: The nails are soft and dirty. Capillary refill is poor. Eyes: eary and the conjunctiva is pinkish, Ears: The color of auricle is same as facial skin, firm symmetrical and aligned with the outer canthus of eye,

 Mouth:

With good swallowing reflex and gag reflex. The gums is slightly pale. Throat and neck: Breast and Axilla: breast is symmetrical. There are no rashes. Respiratory: no signs of sneezing, crackles and stridor. Cardiovascular and peripheral vasculature: The heart rate is 92 BPM. There is no edema in upper and lower extremities Gastrointestinal: There is burburing sound opun auscultation, more than 8 bowel movement for this morning. Bowel is watery and brownish.

 Urinary:

The client has decreased urinary output. Musculoskeletal: Can Moving his feet upward and downward. male: reproductive: the appearance of penis is normal. The buttocks are has rashes.

ANATOMY AND PHYSIOLOGY

Digestive system is also called gastrointestinal system or alimentary canal. Digestive tract starts from the mouth and ends at the anus. Food enters into the body through the mouth and then enters into the intestines, after the food material absorbed, and the waste material excreted out from the anus. Food travel starts first from mouth to pharynx to esophagus to stomach to duodenum where gallbladder, liver, and pancreas take part in the travel of the food then to jejunum to ileum to cecum to ascending colon to transverse colon to descending colon to sigmoid colon to rectum to anus. What happens to the food as travels when enters into the GI (gastrointestinal tract)?

The food enters the body as a complex food material, we chewed the food, the saliva mixed with the food. The complex food material broken down into simpler material. The food material chemically and mechanically broken down. These processes happen as the food travels from the mouth to the intestines. The complex food materials broken into simpler amino acids. The complex glucose or sugar material in the food broken into simpler sugars, and also the large triglycerides made up of fat molecules are broken down into glycerol and simpler fatty acids. This process is called catabolism. The food now digested and the digested food must be absorbed in the bloodstream in this stage. This process is happened when the food in the small intestine absorbed by the walls of it. These energy particles in the food such as catabolized nutrients in the blood such as amino acids, glucose, triglycerides, and glycerol and burnt in the presence of oxygen and energy stored in the food is released.

Functions of the Digestive System Take in food Break down the food Absorb digested molecules Provide nutrients Eliminate wastes

Anatomy of the stomach

Role of Digestion Bolus (masticated food) enters the stomach through the esophagus via the esophageal sphincter. The stomach releases proteases (protein-digesting enzymes such as pepsin) and hydrochloric acid, which kills or inhibits bacteria and provides the acidic pH of 2 for the proteases to work. Food is churned by the stomach through muscular contractions of the wall - reducing the volume of the fundus, before looping around the fundus[3] and the body of stomach as the boluses are converted into chyme (juice ; partially digested food). Chyme slowly passes through the pyloric sphincter and into the duodenum, where the extraction of nutrients begins. Depending on the quantity and contents of the meal, the stomach will digest the food into chyme anywhere between 40 minutes and a few hours.

PATHOPHYSIOLOGY

GASTROENTERITI S PREDISPOSING FACTOR environme nt Hygiene Stress

CONTRIBUTING FACTOR consumption of improperly prepared foods drinking contaminated water improper hand washing residence in areas of poor sanitation
SIGNS AND SYMPTOMS Dehydration Diarrhea Loss of appetite Fever Headaches Abnormal flatulence Abdominal pain Abdominal cramps Bloody Fainting and Weakness Heartburn Nausea and vomiting

PRECIPITATING FACTOR
contaminated food and liquids ingestion of chemical toxins, most often found in seafood, food allergies heavy metals allergy to medications and antibiotics

DEFENITION OF TERMS
Gastroenteritis

- is a catchall term for infection or irritation of the digestive tract, particularly the stomach and intestine. Dehydration A condition in which the body lacks the normal level of fluids, potentially impairing normal body functions. Electrolyte An ion, or weakly charged element, that conducts reactions and signals in the body. Examples of electrolytes are sodium and potassium ions. HEMATOCHEZIA- the passage of red blood through the rectum.

MELENA- refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage.[1 HEMATEMESIS- is the vomiting of blood. The source is generally the upper gastrointestinal tract FLATUS- Gas generated in or expelled from the digestive tract, especially the stomach or intestines. Microflora The bacterial population in the intestine. Pathogenic bacteria Bacteria that produce illness. Probiotics Bacteria that are beneficial to a person's health, either through protecting the body against pathogenic bacteria or assisting in recovery from an illness

 Loose

Bowel Movement (LBM) - is a natural occurrence where much of the body mineralswould be affected as well. Changes in the bowel movement are sure to occur in bad digestive instances. Experiencing stomach cramps, slight chills and the usual uncomfortable feelings are among the things to watch out for in such cases. Intestinalcolic -is severe abdominal pain associated with malfunction in the intestines, such as a blockage or air bubble the patient cannot pass. Abdominal distention - A swollen abdomen is when your belly area is bigger than usual.

q qd qh q2h q3h q4h qid or Q.I.D. bid or B.I.D. or b.i.d. tid or T.I.D.

Every Every day Every hour Every 2 hours Every 3 hours Every 4 hours Four times a day Twice a day Three times a day

LABORATORY TEST WITH NORMS

Misc. Amoeba Fat Yeast RBCcells PusGlobules Parasite Bacteria Occult or Color EXAMINATION seen Odor cell Character ova RESULTS FECAL Blood negative 0-1/ None Moderate Brown -- hpf Watery
NORMAL VALUES Negative None seen brown soft and bulky,

small and dry, depending on the diet

INTERPRETA TION

HEMATOLOGY
RESULTS NORMAL VALUES

Hemoglobin

17.6

M= 13 18 gms % F= 12 16 gms % C= 14 26 gms % P= 8.5 14 gms %

INTERPRETA TION

hematocrit WBC RBC Differential count Segmenters Lymphocytes Eosinophils Monophils Basophils Stab cells

55 13, 300 6.1 -80 17 -3 ---

M= 40 54 F= 36 -57 5,000 10, 000/ cumm 4.6 million/ cumm 55 65% 23 35 13 37% 0.1 0.1 % 5 10 %

URINALYSIS
RESULTS NORMAL VALUES

Volume Color Transparency Reaction SP. Gravity Sugar Albumin Pregnancy test Pus RBC Epith. Cells Amurates Phosphates Mucus threads Bacteria

INTERPRETA TION

Yellow Hazy 6.0 1.010 Negative Negative -1 2 hpf 1 2 hpf Few --Few --

Yellow to amber Clear to Hazy 1.015 1.025 Negative Negative

Negative

MEDICATION AND TREATMENT

Generic Drugs Name: Dosage 2gms 200mg/cap 100mg/cap 10mg/tab Ceftazidime Omeprazole racecadotril hyoscine Brand Name: Brand Name: butylbromide Omepron : Hidrasec/Acetorpha Zeptrigen Brand Name n Buscopan o.d T.i.d q8 Time injection Oral Route

INTRAVENOUS THERAPY
IV Name Classification Purpose Indications ContraindicationSide Effects/ s Adverse Effects -allergic reactions or anaphylactoid symptoms such as: generalized urticaria & pruritus periorbital facial and/or laryngeal edema coughing sneezing DOB, SOB Nursing Considerations D5LR -5% glucose in Lactated Ringers Solution Hypertonic -indicated as a contraindicated Solution source of with patients -draws fluids from water, allergic to corn the Intracellular electrolyte and and corn fluid (ICF) causing calories or as products cells to shrink and an alkalizing extracellular fluid agent to expand -use to treat -given to patients hypovolemic with shock, hyponatremias (Na hemorrhagic deficits) with shock, and edema certain causes of acidosis -skin test or check for allergies -do not administer in patients with cardiac or renal dysfunction -monitor patient closely for signs of circulatory overload

DRUG STUDY

Name of the drug

Dosage

Indicatio Side n effect

contrain dication

Nursing consideration

Typical dose Generic is 10mg 3 Acute GI, -dry mouth Name: times daily. biliary and - skin Hyoscine Adult dose genitourina rash. ButylBromid may be ry spasm -urinary e increased if >paroxysmal urgency required up pian of and Brand Name: to to 20mg 4 diseases in urinary Buscopan times daily stomach or retention. (max 80mg/day). intestine -confusion >dysmenorrh - nausea ea - vomiting -dizziness constipati on

- glaucoma Advise patient to apply patch the myasthenia night before a planned trip. Transdermal method releases a gravis controlled therapeutic amount of drug. paralytic Transderm-Scop is effective if applied 2 or 3 hours before experiencing motion ileus but is more effective if applied 12 hours - pyloric before. stenosis Instruct patient to remove one patch before applying another prostatic Instruct patient to wash and dry enlargemen hands thoroughly before and after t applying the transdermal patch (on dry skin behind the ear) and before porphyria touching the eye because pupil may -mega dilate. Tell patient to discard patch after colon removing it and to wash application site
thoroughly. Tell patient that if patch becomes displaced, he should remove it and apply another patch on a fresh skin site behind the ear. Alert patient to possible withdrawal signs or symptoms (nausea, vomiting, headache, dizziness) when transdermal system is used for longer than 72 hours.

Name of the drug Dosage Generic Name: Omeprazole Brand Name: Omepron

Indication

Side effect

contraindication

Nursing consideration
>Give before meals >Do not crush or chew tablets, swallow whole >Evaluate for therapeutic response like relief of Gastrointestinal symptoms >Question if Gastrointestinal discomfort, nausea, and diarrhea occurs.

ADULTS, ELDERLY: >Omeprazole is in >diarrhea, >nausea, hypersensitivity to 20-40 mg per day. a class of drugs >vomiting any component of called proton pump >headaches the formulation inhibitors (PPI) that >rash and block the production >dizziness of acid by the >Nervousness stomach. >abnormal >heartbeat >muscle pain >weakness > leg cramps, >water retention

Name of the drug Dosage Generic Name: racecadotril Brand Nam Hidrasece:

Indication

Side effect contraindication Nursing consideration >Pregnancy and Drowsiness lactation >Before starting the medication Nausea >Renal or hepatic determine if the patient has Vomiting impairment hypersensitivity to racecadotril Constipation >Asses baseline CBC and Kidney dizzines and Liver function test >if patient will have to receive high dose monitor closely for seizures; be prepared to intervene appropriately >Advice pt to maintain fluid intake during medication

Cap adult 100 Adjunct to oral mg. further or parenteral treatment: 8 hrly rehydration for until cessation the of diarrhea. symptomatic treatment of acute diarrhea

Name of the drug Generic Name: Ceftazidime Brand Name: Zeptrigen

Dosage The usual adult dosage is 1 gram administered intravenously or intramuscularly every 8 to 12 hours.

Indication

Side effect

contraindication Nursing consideration

>Treatment for Lower >phlebitis and >hypersensitivity >Assess for liver and renal Respiratory Tract inflammationat to ceftazidime or dysfunction Infections the site of the cephalosporin >Culture infection, and >Urinary Tract injection group of arrange sensitivity tests Infections > pruritus, antibiotics. before and during therapy if >Bacterial septicemia rash, and fever expected response is not >GI seen. disturbance Warning: >Do not mix with aminoglycoside solutions, administer these drugs separately. >Powder and reconstituted solution darken with storage. > Have Vit. K available in case hypoprothrombinemia occurs >Discontinue if hypersensitivity occurs > Teach SO that patients may experience upset stomach or diarrhea but must report severe diarrhea, difficulty breathing, fatigue, pain at injection site.

NURSING PROBLEM
Acute gastroenteritis Severe dehydration Vomiting Nausea Loose bowel movement Abdominal cramping confused

NURSING DIAGNOSIS
Fluid

volume deficit Knowledge deficient Alteration in Nutrition: Less Than Body Requirements Acute Pain

NURSING CARE PLAN

ASSESMENT

DIAGNOSIS

PLANNING Short Term: Within 2 hours of shift patient will be able to Verbalize understanding of causative factors and therapeutic Regimen Long Term Within 2 days of duty the patient will be able to: >Demonstrate improved fluid balanced as evidence by adequate urine output, stable vital signs, moist mucous membrane, an d good skin turgor.

INTERVENTION

RATIONALE

EVELUATION

Subjective: Fluid volume miyat miya sya deficit R/T nadumi at inadequate nasuka halos intake of fluid nakaka 4 na sya and increase GI ngayong fluid loss as umaga as evidenced by verbalized by the decrease urine mother. output. Objective: >V/S RR: 19 P: 92 BP: 120/80 T: 37.3 >Dry skin and Mucous membrane. > decreased skin turgor. >decreased urine output. >body malaise >continued vomiting >confused

Independent Short Term: 1. Monitor V/S of the 1. Fluid and electrolyte >Goal is met. patient. imbalances The patient 2. Assess hydration can alter vital body verbalized status (capillary functions. understanding refill, and skin turgor).2. To determine the condition of of causative 3. Note change in the circulation of the factors and neurologic status. patient. And also to determine if therapeutic 4. Monitor amount of there is any alteration so that regimen fluid intakes and may given appropriate measure intervention. Long Term the output 3. Neurologic status Goal is met. accurately. may become evident in The patient has 5. Obtain daily severe dehydration. adequate urine weight 4. Pt. may abstain from all intakes output, stable Dependent: resulting to vital signs, and 6. Provide oral dehydration good skin fluid and 5. To determine the hydration turgur. electrolyte status and weight gain or loss. replacement 6. To replace the fluid solution if able to loss tolerate as 7. Use of IV replacement is indicated. based on the degree of 7. Provide and dehydration, ongoing losses, maintain IV insensible water losses and replacement electrolyte results. therapy, as 8. Frequent defecation and ordered. some Collaborative infectious organisms can 8. Test stools for cause occult blood. bleeding.

ASSESMENT SUBJECTIVE hindi sya makakain, lagi kase sya nasuka as verbalized by the mother OBJECTIVE Fatigue weakness Weight loss 2kgs Nausea Vomiting after meals Eating less than 50% of meals Height: 52 (170cm) Weight: 43 kg BMI: 14.9

DIAGNOSIS Nutritional imbalance: Less Than Body Requirements related to vomiting as evidenced by Weight 10% to 20% or more below ideal for height and frame.

PLANNING

INTERVENTION

RATIONALE

EVELUATION

Short Term: Independent After 4 hours of >Assess change in weight shift the Client >Obtain nutritional history: is able to intake, difficulty in consume swallowing adequate >Evaluate for possible nutrition of at adverse reactions to least 75% of medications food at >administer/instruct pt. on mealtimes good oral hygiene before and after feedings Long Term: >provide distraction from After 3 days of the sensation of nausea, NX intervention using soft music, the patient will television, and videos per gain weight of the client preference. at least 1kg. Dependent >Administer dietary supplements/total parenteral nutrition (TPN) as ordered. >Provide antiemetics before meals Collaborative: >Consult with dietitian >monitor serum glucose and electrolyte level

Short Term: > to monitor the Goal is met weight loss or gain. Client is able to >to determine the consume nutritional status of adequate the pt. nutrition of at >to know the least 75% of food contributing factor for at mealtimes vomiting. >to provide comfort Long Term to the pt. before Goal is partially eating. met. The patient > distraction can gain 1.9 pounds help direct attention after 5 days. away from the sensation of nausea >to replace nutrition lost from vomiting >antiemetics is effective against vomiting and nausea. >to know the proper diet for the pt. >to know the electrolyte lost and monitor if the diet is effective.

ASSESMENT Subjective > Reports of colicky, cramping abdominal pain >ang sakit sakit ng tyan ko as verbalized by the patient >Pain Rate: 8/10 Objective: >V/S RR: 19 P: 92 BP: 120/80 T: 37.3 >Facial mask of pain >self focusing >restlessness

DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION acute Pain Short Term: Independent: Short term: related to After 2 hrs of >Encourage client to report > May try to tolerate >Goal is met. prolonged loose nx pain. pain rather than >patient bowel intervention > Assess reports of abdominal request analgesics. reported pain movement the patient will cramping or pain, noting > Changes in pain rate of 4/10. Possibly rate the pain location, duration, and intensity characteristics may Long Term: evidenced by 4/10. (such as 010 scale). indicate effective >goal is met. Reports of Long Term > Encourage client to assume intervention >patient report cramping After 10 hours position of comfort, such as > Reduces abdominal relieved and abdominal pain, of nx knees flexed. tension and promotes controlled of and pain rate of intervention > Provide comfort measures sense of control. pain. 8/10. patient will (e.g., back rub, reposition) and >Promotes relaxation, rate the pain diversional activities. refocuses attention, 1/10 or report Dependent: and may enhance pain is relieve. >administer Buscopan as coping abilities. indicated >medication to relieve >Cleanse rectal area with mild pain.Analgesic as soap and water (or wipes) after anticholinergic agents each stool and provide skin for anti-pain and care with a moisture barrier spasm of the lower GI ointment (e.g., A&D ointment, tract can be given Sween ointment, karaya gel, according to clinical Desitin, petroleum jelly, zinc indication. oxide, dimethicone). > Protects skin from Collaborative: bowel acids, > Implement prescribed dietary preventing modifications, for example, excoriation. commence with liquids and > Complete bowel increase to solid foods as rest can reduce pain tolerated. and cramping.

ASSESMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVELUATION SUBJECTIVE Knowledge deficient Short Term: Independent Short Term: ano ba yung regarding to After 8 hrs of >Determine the > promotes >Goal is met. gastroenteritis? condition, self-care shift the patient patients perception understanding >patient verbalized Ngayon lng kase and treatment related will verbalize of disease process. and may understanding may nagkasakit to unfamiliarity with understanding >Assess patient's enhance disease process, samin nyan eh. As resources and disease readiness to learn cooperation with causes, factors verbalized by the pt information process, by assessing regimen contributing to OBJECTIVE misinterpretation as causes, factors emotional response > Allow person to symptoms. >questions evidenced by contributing to to illness: work through and >evidenced by >request for Questions and symptoms. Acceptance, Anger, express intense verbalization of information request for . Anxiety, Denial, emotions prior to understanding the >confusion information Long Term: Depression teaching. disease process, >Verbalizes a After 2 days of > Assess literacy >to provide causes, and deficiency in shift the patient level. appropriate contributing factor. knowledge or skill will be able to > Examine patient's teaching skills. Long Term > Does not Identify needed health beliefs >to correct wrong >Goal was met correctly perform a alterations in >motivate the client notions about >Patient was able desired or lifestyle. to provide health. to Identify needed prescribed health information relevant >to help client alterations in behavior. to situation acquire relevant lifestyle. information >evidenced by verbalization of changing his lifestyle.

DISCHARGE PLAN

Clients with Acute Gastroenteritis 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. Encourage the patient to keep active to adhere to exercise program and to remain as self sufficient as possible. T- Treatment after discharge is expected for patients with Acute Gastroenteritis to fully participate in continuous treatment. H- Health teachings regarding the importance of proper hygiene and handwashing, food and water preparation, intake of adequate vitamins, increasing of oral fluid intake should be conveyed.

O- OPD such as regular follow-up check-ups should be greatly encouraged to clients with Acute Gastroenteritis as ordered by physician to ensure the continuing management and treatment. D- Diet which is prescribed should be followed. Laxative- containing food should be avoided. To include fruits especially banana in the diet is significant -Drink liquids to prevent dehydration

END