OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING
Km. 311, Maharlika Highway, 3100 Cabanatuan, Nueva Ecija

In Partial Fulfillment of Requirements for RLE 219

ACUTE GASTROENTERITIS
Case Study

Submitted by:

AUBREY ROSE A. VIDON

MR. ALEXANDER ALMIROL, RN

Clinical Instructor

April 15, 2020

Date
 Table of Contents

I. Introduction

II. Patient Profile

III. General Survey

IV. Gordon’s Functional Health Pattern

V. Anatomy and Physiology

VI. Laboratory and Diagnostic Exam

VII. Pathophysiology

VIII. Drug Study

IX. Course in the Ward

X. Nursing Care Plan

XI. Discharge Planning

OBJECTIVES
General Objective
This study aims to convey familiarity and to provide an effective nursing care to a patient
diagnosed with Acute Gastroenteritis through understanding the patient history, disease
process and management.

Specific Objectives

 To present a thorough assessment, through Nursing Health History, Gordon’s Functional

Health Pattern, Physical Assessment, and the interpretation of the laboratory
examination done on the patient.
 To discuss the anatomy and physiology, pathophysiology of the patient’s condition,
usual clinical manifestations and possible complications of this condition.
 To have knowledge to the client medication and be familiar to that medication.
 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.

I. INTRODUCTION
Acute gastroenteritis is inflammation and/or irritation of the digestive tract that can cause
nausea, vomiting, diarrhea, and/or abdominal pain that lasts less than 14 days. When
symptoms last 14 to 30 days, the condition is considered persistent gastroenteritis. When
symptoms last longer than 30 days, it is considered chronic.

Various pathogens and noninfectious agents cause gastroenteritis, and it is one of the most
common infectious disease syndromes. In the United States, viral gastroenteritis accounts for
about 50% to 70% of acute gastroenteritis cases, with norovirus being the leading cause. Since
the introduction of the rotavirus vaccine, the incidences of rotavirus gastroenteritis and related
hospitalizations have been greatly reduced. On the other hand, norovirus is common and highly
contagious.

After viral gastroenteritis, another 10% to 15% of acute cases have a parasitic cause, while
bacterial gastroenteritis accounts for about 15% to 20% of cases. Infectious diarrhea can also be
classified into 2 categories: inflammatory or non-inflammatory. Non-inflammatory diarrhea is
more common, and although the cause is usually viral, it can be bacterial or parasitic in origin,
as well. Non-inflammatory diarrhea, which is typically less severe than inflammatory diarrhea,
causes large, watery stool with cramping but no blood; fecal leukocytes are absent. Common
causes of non-inflammatory diarrhea are enterotoxigenic Escherichia coli, Clostridium
perfringens, Bacillus cereus, Staphylococcus aureus, rotavirus, norovirus, Giardia,
Cryptosporidium, and Vibrio cholerae. Inflammatory diarrhea is more severe and caused by
toxin-producing bacteria. It disrupts the mucosa, causing bloody diarrhea, abdominal pain, and
fever, and fecal leukocytes are present. Common causes of inflammatory diarrhea are
Salmonella, Shigella, Campylobacter, Shiga toxin-producing E. coli, enteroinvasive E. coli, C.
difficile, Entamoeba histolytica, and Yersinia.
II. PATIENT PROFILE

Name: A.D.C

Age: 2 y/o

Gender: Male

Birthday: September 1, 2017

Address: Caalibangbangan, Cabanatuan City

Citizenship: Filipino

Religion: Catholic

Date of Admission: February 4, 2020

Vital Signs upon Admission:

BP:

Respiratory Rate: 30 breathe per minute

Pulse Rate: 85 beat per minute

Temperature: 37.7 C

Chief Complaint: Diarrhea, Fever, Vomiting

Admitting Diagnosis: Acute Gastroenteritis with moderate dehydration

History of Present Illness

Prior to admission, the client was vomiting and defecating. Her stool was watery and its
color is green. At first, they went to the baranggay health center and the staff gave them
medication. According to the staff, the medication is for LBM, but after drinking the medication,
the client was still defecating and vomiting so the family decided to rush the client at Eduardo L.
Joson Memorial Hospital the next day.

Past Medical History

Mrs. D.C Cruz says “ ito first time niya ma-admit buhat nung ipanganak ko siya.” A.D.
gets seasonal cough and colds at times but never serious because it usually last only for a few
days. They always consult their doctor once sick. He is complete in his vaccinations.
Family Medical History

According to the significant others of D.C they have a familial disease of asthma, both on
her father and mother's side. An incident of hypertension on his father's side.

Personal and Social History

The patient belongs to a nuclear family. He is currently living with his parents together
with his brother.

Immunization History
The patient had a complete vaccination as follows:
September 1, 2017 (at birth) Vitamin K, Hepatitis B, BCG January 8,
2018 Pentahib1, OPV1, PCV1, Rotavirus1 February 5, 2018 Pentahib2,
OPV2, PCV2, Rotavirus2 March 4, 2018 Pentahib3, OPV3, PCV3, IPV
August 30, 2018 Measles

III. GENERAL SURVEY

Body Parts Actual Findings
SKIN
Color Brown in color

Lips, nail beds, soles and palms Lighter colored palms, soles, lips and nail beds

Moisture Skin normally dry

Temperature 37.7

Texture Smooth, soft and flexible palms and soles (thicker)

Turgor Skin snaps back slowly

HAIR DISTRIBUTION Evenly distributed

EYES Parallel to each other but with sunken eye

EARS
Ear canal opening Free of lesions, discharge of inflammation

NOSE
Shape, size and skin color Smooth, symmetric with same color as the face

MOUTH
Lips Pink, moist symmetric

NECK Neck moves freely, without discomfort

ABDOMEN Skin same color with the rest of the body

IV. GORDON’S FUNCTIONAL HEALTH PATTERNS

 PATTERN BEFORE
HOSPITALIZATION
Health Perception A.D.C. has a mannerism of
sticking anything on his mouth.
Whatever he touches he directs
it toward his mouth. Although,
he doesn’t practice hand
washing every now and then.
There are some medications he
takes easily but there are also
those medications which are
hard for him because of the
taste.
Nutritional Metabolic A.D.C. weighs 9.7 kg. He eats
any kind of foods. She drinks 4-
5 glass of water in a day.
Elimination He defecates once or twice a
day in her usual days. She
changes diaper 3-5 times in a
day when full or had defecated.
Activity/Exercises A.D.C. is a very playful and
active girl. He has lots of energy
but cries when he doesn’t like
something. He smiles and
laughs a lot. His daily living
activities were provided by her
parents. There is no
musculoskeletal impairment.
He usually plays after she
wakes up in the morning.
Cognitive Perceptual A.D.C. has no sensory deficits.
His response well to verbal
stimulus by looking at you or
having facial expressions
Sleep/Rest He sleeps at 8 P.M. in the
evening and usually gets up 7
A.M. – 8 A.M. in the morning.
After playing or eating he takes
a nap. He has straight
undisturbed sleep at night.
DURING
HOSPITALIZATION
The patient experienced a
diarrhea once he was
admitted. He regularly
follows the order of
medication given by the
doctor with the help of his
mother.
Due to his condition, he
barely eats food and drink
water.
He only defecates 4x a
week and urinate 3x a day.
he was on bed most of the
time to promote adequate
rest and needed minimal
assistance.
There are no other health
issues in the patient, she
was in pain scaled 2/10
during the interview and
seemed like she was not
interested in talking and
giving information.
The patient sleeps well but
sometimes distracted due
to vital signs monitoring.
He also watches cartoon
on his mother’s phone
when he was resting.
Sexuality/Reproductive
Interpersonal
Relationship/Resources
Coping and Stress
Management/Tolerance
Pattern
Self-Perception/Self Pattern
Role’s/Relationship Pattern
Values/Belief Pattern
V. ANATOMY AND PHYSIOLOGY
Prior to age, A.D.C. is not yet
oriented with any sexual
matters.
The patient lives with his both The patient is well
of his parent together with his supported by his family.
brother.
In his age, he usually cries
when something is wrong
about him. Simple smile or cry
is a sign of his comfort, distress
or feelings. He is familiarized to
his family members and long
for them when he doesn’t want
the situation like giving of
medications or other
procedures.
A.D.C. is not afraid of new
people around him. He is
friendly and is easy to
accommodate. Sometimes he
got shy when the focus in on
him.
He doesn’t know the concept The patient was well-
of death yet due to age. Forms supported by her family
words like “dede” and “dada”. emotionally and financially.
He knows her family members
and can easily familiarize the
people around her.
The family is Catholic. They are There were no changes in
not regularly attending church her beliefs.
together with all the members
of the family. Once one is sick
in the family, they go
immediately to the hospital or
for check-up.
The human digestive system is a complex series of organs and glands that processes food. In
order to use the food we eat, our body has to break the food down into smaller molecules that
it can process; it also has to excrete waste.

Most of the digestive organs (like the stomach and intestines) are tube-like and contain the
food as it makes its way through the body.

The digestive system is essentially a long, twisting tube that runs from the mouth to the anus,
plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.

THE DIGESTIVE PROCESS:

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

On the way to the stomach: the esophagus - After being chewed and swallowed, the food
enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach.
It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat
into the stomach. This muscle movement gives us the ability to eat or drink even when we're
upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a
very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with
stomach acids is called chyme.
In the small intestine - After being in the stomach, food enters the duodenum, the first part of
the small intestine. It then enters the jejunum and then the ileum (the final part of the small
intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),
pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small
intestine help in the breakdown of food.

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

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

Digestive System Glossary:

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

VI. PATHOPHYSIOLOGY

Predisposing Factor Precipitating Factor

 Age  Food and Water

 Malnutrition Contamination

Ingestion of fecally contaminated

food and water

Direct invasion of the

Enterotoxins are released
bowel wall

Stimulation and destruction of

mucosal lining of the bowel wall

Digestive and absorptive

malfunction

Excessive gas formation Increase peristaltic movement Secretion of F&E in the

 LI is overwhelmed & unable to
reabsorb the lost fluid

Intense Diarrhea (>10x) (Watery

Stool)

Serious Fluid Volume Deficit

If untreated

Hypovolemic Shock

Death
VII. LABORATORY AND DIAGNOSTIC EXAM
NAME: A.D.C AGE: 2 y/o ROOM: Pedia Ward

URINALYSIS

03/04/20 Interpretation 03/05/20 Interpretation 03/06/20 Interpretation 03/07/20 Interpretation

Color Yellow Normal Yellow Normal Light Normal Light Normal
Yellow Yellow

Transparenc SI turbid Increase urine SI turbid Increase urine Clear Normal Clear Normal
y concentration concentration

Reaction 5.5 Decrease 6.0 Normal 8.0 Normal 8.0 Normal

Specific 1.025 Normal 1.010 Normal 1.025 Normal 1.010 Normal

Gravity

Albumin Traces Normal Traces Normal (-) Normal (-) Normal

Sugar (#) Increase sugar (-) Normal (-) Normal (-) Normal

WBC 7-10 Infection 15-20 Infection 28-30 Infection 1-3 Normal

Fecalysis

03/05/20 Interpretation
Color Green Sign of diarrhea
Consistency Soft Sign of diarrhea

Parasites No OVA or parasites seen Normal

VIII. DRUG STUDY
DRUG NAME MECHANISM OF ACTION RATIONALE ADVERSE EFFECT NURSING
CONSIDERATIONS
GENERIC NAME: Overcome the gastric acid Given to patient NONE Monitor the patient for
BACILLUS CLAUSII barrier due to their high for the the sign and symptoms of
resistance to both chemical treatment of Possible Side Effects: diarrhea.
CLASSIFICATION: and physical agents, and reach acute diarrhea.  Diarrhea
ANTI-BIOTIC the intestinal tract intact  Nausea Instruct the patient to take
where they are transformed  Taste Distortion drug after meal.
ADMINISTRATION: into metabolically active  Stomatitis and Bloating
ORAL vegetative cells.
GENERIC NAME: It inhibits the third and final Given to the NONE Observe for signs of
AMPICILLIN stage of bacterial cell wall patient to treat adverse reactions -
synthesis in binary fission, the wide variety Possible Side Effects: "ampicillin rash" usually
CLASSIFICATION: which ultimately leads to cell of bacterial  Diarrhea seen after 5 - 14 days of
ANTI-BIOTIC lysis. infection  Nausea and vomiting. treatment.
 Hives or rash.
ADMINISTRATION:  Swelling of the tongue. Monitor renal, hepatic,
IV 50mg q 6  Thrush or yeast infection. hematopoietic functions.
 Black, hairy tongue.
GENERIC NAME: Participate in synthesis & To prevent NONE Explain need for zinc
ZINC-SULFATE stabilization of protein & individual trace administration to patient &
nucleic acids in subcellular & element Possible Side Effects: family
CLASSIFICATION: membrane transport system. deficiencies in  Stomach upset
VITAMINS & patient  Heartburn Report signs of
MINERALS receiving long hypersensitivity promptly.
term total
ADMINISTRATION: parenteral
ORAL OD nutrition

GENERIC NAME:
ONDANSETRON
CLASSIFICATION:
5-HT3 antagonist
IX. COURSE IN THE WARD
On the first day, March 9, 2020, IVF was changed to #2 D5 IMB 500 ml x
10cc/hr at 9:50 am. He was seen by his Physician at 11:15 am and given an order
of urinalysis and fecalysis. He was prescribed with Ampicillin 50 mg IV every 6
hours. Also, Zinc Sulfate (E-Zinc) drops (0.6 ml) once daily was ordered. His fever
decreases gradually until there administration of paracetamol every 4 hours for
fever was discontinued. His vital signs were monitored and recorded.

On the second day, March 9, 2020, Tuesday, he has no fever, negative

vomiting and playful. He ordered continue all medications and treatment. IVF #3
D5 INM 500 ml x 10 cc/hr was hooked at 11:30 am. He already has no signs of
dehydration. His vital signs are stable, monitored and recorded, plus the intake
and output.
X. NURSING CARE PLAN
Deficient Fluid Volume

ASSESMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

KNOWLEDGE
Subjective: Deficient Fluid The nursing After 8 hours of  Assess  To monitor After 8 hours of
“Nakailang suka Volume related diagnosis is fluid nursing patient’s for other nursing
siya sa bahay, to nausea, volume deficit intervention, no condition signs and intervention, the
naka 3 dumi din vomiting and related to loose signs of symptoms mucosa of the
siya, medyo basa diarrhea as stools and dehydration will  Assess likes  To promote patient was
at mabaho” evidenced by vomiting is a be noted. and dislikes, hydration moist, indicating
stated by the urine output, priority problem provide no signs of
mother skin/tongue because the favorite fluids. dehydration.
turgor, dry patient is  Weight  Changes in
Objective: mucous dehydrated. patient daily weight can
On admission membrane provide
3x Loose stools information
1x vomiting in fluid
(+) decrease balance and
fluid intake the
(+) dry lips adequacy of
fluid volume
replacement
 Encourage  For
increase fluid hydration
intake
providing
appealing
liquids
 Encourage to  For
eat food with hydration
high fluid
 content, such
as
watermelon,
grapes.
 Encourage to  To prevent
avoid food further
that causes dehydration
dehydration
such as
coffee, tea
 Ensure  Accurate
accurate records are
intake and critical in
output assessing
monitoring. the patients
fluid

Diarrhea

ASSESMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION

KNOWLEDGE
Subjective: Diarrhea related Acute Short Term: Short Term:
“Tatlong beses na to infectious Gastroenteritis is After 2-3 hours Independent: Independent: After 8 hours of
siya dumudumi process. an inflammation of nursing 1. Auscultate the 1. For nursing
ngayong araw. of the stomach interventions, abdomen presence, intervention, the
Samantalang and intestinal the patient’s 2. Discuss to the location patients mother
kahapon apat na tract that mother will gain mother the and shall gain
beses. Madalas primarily affects knowledge different characteri knowledge
din siyang the small bowel. about diarrhea. causative factors stic of about diarrhea
sumuka.” stated and rationale for bowel and verbalized
by the mother Long Term: treatment sounds. understanding of
After 1-2 days of regimen 2. For causative factor
Objective: nursing 3. Restrict solid education of diarrhea and
- loosed bowel interventions, food intake of the rationale for
movement with the patient will 4. Provide for patient’s treatment
yellowish watery be free of changes in mother. regimen.
stool minimum of diarrhea. dietary intake. 3. To allow
thrice a day. 5. Limit caffeine, for bowel Long Term:
- Increase bowel high fiber foods rest and After 1-2 days of
sounds/peristalsis and fatty foods reduce nursing
- nausea and intestinal interventions,
vomiting Dependent: workload. the patient shall
- abdominal 1. Administer anti- 4. To allow be free of
cramping diarrheal foods diarrhea as
medications, as that evidenced by re-
indicated precipitat established and
2. Administered es maintained
medications, as diarrhea normal bowel
ordered 5. To movement,
prevent reduced to its
gastric normal
irritation consistency

Dependent:
1. To
decrease
GI
motility
and
 minimize
fluid
losses
2. To treat
infectiou
s
process,
decrease
motility
and
absorb
water
XI. DISCHARGE PLAN
M-edication

 Upon discharge a client was advised to continue intake of Zinc-Sulfate (E-zinc) drops 0.6
ml once a day.

E-nvironment

 Advised client to buy foods within the budget.

T-reatment

 A.D.C. was still advised for increase fluid intake, periodic complete emptying of urinary
bladder and keep hands clean.
 Follow up checkup after 1 week of discharge.

H-ealth Teaching

 Proper hygiene of both child and parent.

 Proper and strict supervision of child until balance, gait, and coordination is gained.
 Advised to restrict child from handling items or objects especially if unfamiliar and not
edible.
 Emphasize importance of hand washing and nail care.

O-ut Patient Department

 Last advises and follow up checkup were reminded

 Other treatments were elaborated.

Diet – Client was ordered with diet for age, with increase fluid intake.