Professional Documents
Culture Documents
Case (Acute Gastroenteritis) Group 4
Case (Acute Gastroenteritis) Group 4
Case (Acute Gastroenteritis) Group 4
A Case Study on
Acute Gastroenteritis
Submitted by:
Noe Cabantangan
Jackielyn Calaramo
Shanette Ganotisi
I. Readings
Definition
Incidence
Predisposing Factors
III. Pathophysiology
Family Background
Lifestyle
Psychological Data
Acute Gastroenteritis is a catchall term for infection or irritation of the digestive tract,
particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu,
although the influenza virus is not associated with this illness. Major symptoms include nausea
and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also
accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days.
Adults usually recover without problem, but children, the elderly, and anyone with an underlying
The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus,
adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all
over the world. Exposure typically occurs through the fecal-oral route, such as by consuming
foods contaminated by fecal material related to poor sanitation. However, the infective dose can
be very low (approximately 100 virus particles), so other routes of transmission are quite
probable. Typically, children are more vulnerable to rotaviruses, the most significant cause of
Colloquially referred to as the "stomach flu," viral gastroenteritis can be passed from one
infected individual to another with relative ease. Sometimes, extremely spicy or unfamiliar food
can cause a short bout of acute gastroenteritis. This happens regularly in young children. Food
contaminated with bacteria can also cause inflammation. Drinking plenty of fluid and avoiding
childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major
causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause
illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton,
and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major
symptom.
Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking
disasters can make underlying problems in sanitation and food safety worse. In developed
nations, the modern food production system potentially exposes millions of people to disease-
causing bacteria through its intensive production and distribution methods. Common types of
Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed
nations.
INCIDENCE
Every year worldwide rotavirus in children under 5 causes 111 million cases of
gastroenteritis and nearly half a million deaths. 82% of these deaths occur in the world's poorest
nations.
In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of
these occurring in the third world. Lack of adequate safe water and sewage treatment has
contributed to the spread of infectious gastroenteritis. Current death rates have come down
significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the
The incidence in the developed world is as high as 1-2.5 cases per child per year and is a
Age, living conditions, hygiene and cultural habits are important factors. Aetiological
agents vary depending on the climate. Furthermore, most cases of gastroenteritis are seen during
Gastroenteritis occurs all over the world, affecting people of every age, race and
background.
AGE: Children's immune systems aren't mature until about age 6, and adult
Adults whose resistance is low — often because their immune systems are
Mild-to-moderate diarrhea:
Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and
Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort
and convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve
the symptoms. These medications work by altering the ability of the intestine to move or secrete
spontaneously, absorbing toxins and water, or altering intestinal microflora. Some over-the-
may prescribe a more powerful anti-diarrheal drug, such as motofen or lomotil. Should
pathogenic bacteria or parasites be identified in the patient's stool sample, medications such as
dehydration is absent, the drinking of generous amounts of nonalcoholic fluids, such as water or
juice, is adequate. Caffeine, since it increases urine output, should be avoided. The traditional
BRAT diet-bananas, rice, applesauce, and toast-is tolerated by the tender gastrointestinal system,
but it is not particularly nutritious. Many, but not all, medical researchers recommend a diet that
includes complex carbohydrates (e.g., rice, wheat, potatoes, bread, and cereal), lean meats,
yogurt, fruit, and vegetables. Milk and other dairy products shouldn't create problems if they are
part of the normal diet. Fatty foods or foods with a lot of sugar should be avoided. These
recommendations are based on clinical experience and controlled trials, but are not universally
accepted.
Minimal to moderate dehydration is treated with oral rehydrating solutions that contain
glucose and electrolytes. These solutions are commercially available under names such as
Naturalyte, Pedialyte, Infalyte, and Rehydralyte. Oral rehydrating solutions are formulated based
on physiological properties. Fluids that are not based on these properties-such as cola, apple
juice, broth, and sports beverages-are not recommended treating dehydration. If vomiting
interferes with oral rehydration, small frequent fluid intake may be better tolerated. Should oral
rehydration fail or severe dehydration occur, medical treatment in the form of intravenous (IV)
therapy is required? IV therapy can be followed with oral rehydration as the patient's condition
improves. Once normal hydration is achieved, the patient can return to a regular diet.
effective in reducing nausea and stomach acidity. Once the worst symptoms are relieved,
slippery elm (Ulmus fulva) can help calm the digestive tract. Of the homeopathic remedies
available, Arsenicum album, ipecac, or Nux vomica are three said to relieve the symptoms of
gastroenteritis.
Probiotics, bacteria that are beneficial to a person's health, are recommended during the
recovery phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said
to be effective in soothing the digestive tract and returning the intestinal flora to normal. L.
acidophilus is found in live-culture yogurt, as well as in capsule or powder form at health food
stores. The use of probiotics is found in folk remedies and has some support in the medical
literature. Castor oil packs to the abdomen can reduce inflammation and also reduce spasms or
discomfort.
Gastroenteritis is usually resolved within two to three days and there are no long-term
long. In humans, digestion begins in the mouth, where both mechanical and chemical digestion
occurs. The mouth quickly converts food into a soft, moist mass. The muscular tongue pushes
the food against the teeth, which cut, chop, and grind the food. Glands in the cheek linings
secrete mucus, which lubricates the food, making it easier to chew and swallow. Three pairs of
glands empty saliva into the mouth through ducts to moisten the food. Saliva contains the
enzyme ptyalin, which begins to hydrolyze (break down) starch—a carbohydrate manufactured
by green plants.
pushes this mass—called a bolus—to the back of the mouth and into the pharynx. This cavity
between the mouth and windpipe serves as a passageway both for food on its way down the
alimentary canal and for air passing into the windpipe. The epiglottis, a flap of cartilage, covers
the trachea (windpipe) when a person swallows. This action of the epiglottis prevents choking by
I. Stomach
A. Anatomy
The stomach is an enlarged segment of the digestive tract in the left superior portion of
the abdomen. It lies obliquely from left to right across the upper abdomen directly beneath the
diaphragm. When empty, the stomach resembles a J-shaped tube, a when full, a giant pear. The
normal capacity of the stomach is 1-2 liters. Anatomically, the stomach is divided into the
fundus, the body, and the pyloric antrum or pylorus. The concave lesser curvature forms the
upper right border of the stomach and the convex greater curvature forms the left and lower
borders. Sphincters at each end of the stomach regulate inflow and outflow. The cardiac
sphincter or lower esophageal sphincter (LES) allows foods to flow into the stomach and
prevents reflux of the gastric contents into the esophagus. The area of the stomach into which the
cardiac sphincter opens is known as the cardiac region. The terminal pyloric sphincter relaxes to
permit food to enter the duodenum, and when contracted prevents backflow of the intestinal
(stenosis) may occur as a complication of peptic ulcer disease. Pyloric stenosis or pylorospasm
results when hypertrophied or spastic muscle fibers surrounding the opening fail to relax
sufficiently to permit food to pass easily from the stomach to the duodenum.
The stomach is composed of four layers. The serosa, or outer layer, is a part of the
visceral peritoneum. The two layers of the visceral peritoneum come together at the lesser
curvature of the stomach and the duodenum and extend upward to the liver, forming the lesser
omentum. Peritoneal folds reflected from one organ to another are distinguished as ligaments.
Thus, the lesser omentum (also known as the hepatogastric and hepatoduodenal ligaments)
suspense the stomach along its lesser curvature to the liver. At the greater curvature, the
peritoneum continuous downward as the greater omentum, dropping over the intestines like a
large apron.
middle circular layer, and an inner oblique layer. This unique arrangement of fibers provides the
variety of contractions necessary to break food into the parietal cells, chum and mix it with
mucosal layer. It permits the mucosa to move with peristaltic motion. This layer also contains the
nerve plexuses, blood vessels and lymph channels. Nerve plexuses; compose of parasympathetic
nerve fibers and cell bodies are found in the submucosa and muscularis layers. Together, the
nerve plexuses of both layers compose the intramural plexuses, which extremely important for
The mucosa, the inner layer of the stomach, is arranged in longitudinal folds called rugae,
which allow for distention as the stomach becomes filled with food. Several types of glands are
located in this layer and are categorized according to anatomic portion of the stomach in which
they are located. Cardiac glands lie near the cardiac orifice and secrete mucus. The fundic or
gastric glands are located in the fundus and over the greater part of the stomach. Gastric glands
have three main types of cells. The Zymogenic or chief cells secrete pepsinogen. Pepsinogen is
converted into pepsin in acid environment. Parietal cells secrete hydrochloric acid and intrinsic
factor. Intrinsic factor is necessary for the absorption of vitamin B12 in the small intestine.
Mucous cells found in the neck of the fundic or gastric glands secrete mucous. The hormone
gastrin is produce by G cells located in the pyloric region of the stomach. Gastrin stimulates the
Digestion of protein by pepsin and HCl is begun; digestion of starches and fats by gastric
Intrinsic factor secretion enables the absorption of Vitamin B12 from the distal small
Mucus secretion forms a protective shell for the stomach as well contributing to
Motor Functions
Reservoir function: stores until it can be partially digested and moved on in GI tract;
adapts to increased volume without an increase in pressure by receptive relaxation of the smooth
Mixing function: breaks food into small particles and mixes it with gastric juice through
rhythm.
influenced by viscosity, volume, acidity, osmotic activity and physical state, as well as by
emotions, drugs and exercise; gastric emptying is controlled by nervous and hormonal factors.
A. Anatomy
The small intestine is the longest segment of the GI tract, accounting for about to thirds
of the total length. IT folds back and forth on itself, providing approximately 7000 cm of surface
area for secretion and absorption. The small intestine is divided into three anatomic parts; the
upper part called the duodenum; the middle part called the jejunum; the lower part called the
ileum. The common bile duct, which allows for the passage of both bile and pancreatic juices
empties into the duodenum and the ampulla of Vater. The junction between the small and the
large intestine, the cecum is located in the right lower portion of the abdomen. HT eileocecal
valve controls the passage of contents into the large intestine and prevents reflux of bacteria.
The large intestine consists of an ascending segment on the right side of the abdomen, a
transverse segment and a descending segment on the left side of the abdomen. The terminal
portion of the large intestine composed of two parts; the sigmoid colon and the rectum. The
rectum is continuous with the anus. A network of striated muscle that forms both the internal and
The digestive process continues in the duodenum. Secretions in the duodenum come from
the accessory digestive organs- pancreas, liver and gallbladder- and the glands in the wall of the
intestine itself. These secretions contain digestive enzymes and bile. Pancreatic secretions have
an alkaline pH because of high concentrations of bicarbonate. This neutralizes the acid coming
from the stomach to the small intestines. The pancreas also secretes digestive enzymes, including
trypsin, which aids in protein digestion; amylase for starch digestion; and lipase for fats. The
intestinal glands secrete mucus, hormones, electrolytes and enzymes. The mucus coats and
protects the mucosa from injury. Hormones, neuroregulators control the rate of intestinal
secretions and also influence GI motility. Small fingerlike projections called villi functions to
produce digestive enzymes as well as absorb nutrients. Absorption is the primary function of the
intestine. This begins in the jejunum and is accomplished by both active transport and diffusion
Within 4 hours after eating, residual waste materials pass into the terminal ileum and into
the proximal portion of the colon. Bacteria make up a major component of the contents of the
large intestine. They assist in completing the breakdown of waste material. Two types of colonic
secretions are added to the residual material. The electrolyte solution neutralizes the end products
formed by the colonic bacterial action. The mucus, on the other hand, protects the colonic
mucosa from the interluminal contents and provides adherence of fecal mass. Low, weak
peristaltic activity moves the colonic contents slowly along the tract. This allows sufficient
reabsorption of water and electrolytes, which is the primary function of the colon. The waste
Ingestion of Food/H2O
Contaminated with
Entameoba Hystolitica
Entry of pathogens in
the G.I. Tract
Activate
Pathogens/Parasites inflammatory
produce or secrete toxins response
Irritation of
G.I. lining Vascular response Cellular response
S/S: Pain
S/S: decrease skin
turgor, dry skin
IV. PERTINENT DATA
PERSONAL DATA
Name : Baby LZ
Sex : Male
Nationality : Filipino
Occupation : ----
Diagnosis:
a. Family Background
Relation-
ship with
Civil Educational
Members the Age Sex Residence Occupation Religion
Status Attainment
Patient
Iglesia
Cuinda Grand- Dumalneg,
54 M M Farmer Filipina Elementary
Andres father I.N.
Independiente
Iglesia
Grand- Dumalneg,
Lydia Andres 50 F M Housewife Filipina Elementary
mother I.N.
Independiente
Iglesia
Dumalneg,
Cleto Andres Uncle 25 M S Student Filipina Graduating
I.N.
Independiente
Iglesia
Ideline Dumalneg, Highschool
Mother 19 F S ---- Filipina
Andres I.N. Graduate
Independiente
Iglesia
Lord Zedrick Dumalneg,
(patient) 1 M S ---- Filipina -----
Andres I.N.
Independiente
Baby LZ belongs to a extended type of family with five members. Their house is
According to the mother with regards to their familial history of disease, her
father side has a history of hypertension and his Aunt died because of cancer. LZ’s
mother was unable to recall the date of the death of her Aunt. On her mother side, the
The patient’s family had already experienced headache, dizziness, fever, cough
and colds, toothache, diarrhea, body ache and flu. They usually manages these illnesses
by taking OTC drugs such as Paracetamol for fever and headache, Alaxan for body ache,
Mefenamic acid for toothache, Neozep for colds, Carbocisteine and Amoxicillin for
cough, Kremil S for stomachache and Imodium for diarrhea. They had already
experienced infectious and communicable diseases such as chicken pox, mumps and
measles.
b. Lifestyle
Baby LZ has a normal sleeping pattern according to his mother. He often sleep
early at night because he is tired playing all day long without any waking disturbances.
He wakes up early and will spend the most of the day playing. He sometimes plays
outside their house without any slippers or shoes said his mother. He sometimes sleeps
early in the afternoon if he is tired. Her mother is giving him formula milk, breast milk
and solid foods like rice and banana. However, if not attended, he would tend pick
c. Psychological Data
Socially, toddlers are little people attempting to become independent at this stage,
which they are commonly called the “terrible twos". They walk, talk, use the toilet, and
get food for themselves. Self-control begins to develop. If taking the initiative to explore,
experiment, risk mistakes in trying new things, and test their limits is encouraged by the
caretaker of the child will become autonomous, self-reliant, and confident. If the
to doubt their abilities and feel ashamed for the desire for independence. The child's
autonomic development will be inhibited, and be less prepared to successfully deal with
Baby LZ is the only son of Ideline. He was born in their house September 8, 2008
The mother claimed that her child’s past illnesses were a typical cough, colds, and
mild fever that usually last for three days. The remedy of her mother is through over-the-
counter drugs such as paracetamol which is used to treat fever and neozep drops for
colds. For his immunizations, his mother claimed that he already completed it and were
all done at their Rural Health Center. There were no particular allergies of Baby LZ being
identified. Baby LZ doesn’t have hereditary diseases or not manifesting any of the
Three days prior to admission, Baby LZ did not manifest any symptoms until one
time he suffered from vomiting and diarrhea for more than three times. His mother was
not alarmed about it because Baby LZ used to adapt normally to his environment and he
would keep on playing and running inside the house. However, they would go to the
Health Center in their barangay for check-up whenever Baby LZ experiences the same
Every check-up, the mother was convinced that the cause of her child’s disease is
because of ingestion of non-potable water because their neighbors also suffered from it.
The mother claimed that she never boils the water for her baby’s drinking purpose.
This prompted the mother to bring Baby LZ to Bangui District Hospital last
February 20, 2010 @ 11:15 in the evening with a chief complaint of LBM and vomiting
and was diagnosed by Dr. Diosdado Garvida to have Acute Gastroenteritis with some
A. General Appearance:
Baby LZ is seen sleeping on bed in lateral position. He wears a red shorts and a white
sando, all neat in appearance. He is still on IV therapy with D5W inserted at his left hand. He
looks happy and is fair in appearance but began to cry when he saw us approaching him. He has
Height: 2’9”
Weight: 9.5 kg
B. Head-to-Toe Assessment
Skin (overall):
Complexion: Fair
darker
Texture Smooth
axillae
Temperature: temperature in normal range (36.6 OC/axilla)
Head:
Size: Normocephalic
Configuration: Proportional to body size
Hair:
Color: Black
Texture: Smooth
Distribution: Equal
Scalp: Clean
Eyes:
Shape: Symmetrical
Movement: Coordinated
Accommodation (PERRLA)
Visual Acuity: Symmetrical visual acuity
Eyelashes and
Ears:
Appearance: With free earlobes and small auricles which are
symmetrical
Alignment: Upper corner of auricles aligned to the outer canthus
of the eyes
Condition: Oily and waxy with small amount of cerumen at the
inner ears
4.5 ft.
Nose:
Appearance: Semi-flat, semi-pointed
Condition: Clean
Nares: Symmetrical
Lips:
Appearance: Thin
lower lips
Color: Varies from pinkish to light brown
Tongue:
Motion: Can move freely to any desired direction
Color: Pink
Abdomen:
Appearance: Round abdomen but not flabby
Upper Extremities:
Appearance: Symmetrical and proportional to body built
Nail: Clean and well-cut, with pink nail beds and with
Lower Extremities:
Appearance: Symmetrical and proportional to body built
deprivation.
Nursing Goal: After 8 hours of nursing interventions, the patient will maintain fluid and
electrolyte balance as evidenced by good skin turgor, smooth skin texture and
1.) Observe for excessively dry skin and mucous membranes, decreased skin
Rationale: Colon is placed at rest for healing and to decreased intestinal fluid
losses.
Nursing Evaluation: After 8 hours of nursing interventions, the patient was able to
maintain fluid and electrolyte balance as evidenced by good skin turgor, smooth skin
causes increase in GIT peristalsis. This then caused increase in the passage of
Nursing Goal: After 1 to 2 days of rendering nursing interventions, the client will
Nursing Interventions:
bowel pattern.
Nursing Evaluation: After 2 days of rendering nursing interventions, the client achieved
LABORATORY PROCEDURES
Date ordered: 02-20-10
Hematology
Definition: The complete blood count (CBC), a screening test, is one of the most frequently
hemoglobin, hematocrit, red blood cell count, white blood cell count, differential
white cell count, red cell indeces and stained red cell examination.
Purpose: The procedure was done to the client to check for infection and other health problem.
HEMOGLOBIN: It is the main component of RBC’s. Its main function is to carry oxygen from
the lungs to the body tissues and to transport carbon dioxide the product of cellular
HEMATOCRIT: The hematocrit is a measurement of the percentage of the red cells in the total
volume of blood.
RED BLOOD CELL: The erthrocytes are a determination of the number of red blood cells
WHITE BLOOD CELLS: The total WBC is the absolute number of WBC circulating in a
cubic millimeter of blood; white cells are produced in the red bone marrow and
lymphatic tissues. After they are formed they enter the blood which transports them
to parts of the body where they are needed to defend against invading
in the body inflammatory reaction because they are both the first and most numerous
Analysis: Since they are the first to migrate towards the site of infection in large number, this
stream.
MONOCYTES: Since monocytes act as a scavenger cells to dispose off non-infectious foreign
BASOPHILS: Their protective function is not fully understood. They contain histamine and
PLATELET COUNT: The adhesive/ sticky quality of platelet allows them to clump together/
aggregate and adhere to injured surfaces. They release a substance that begins the
coagulation process. Along with fibrin they form the network for a clot to form.
Clinical Microscopy
WBC 4-6/hpf Increased
RBC 1-2/hpf Normal
Mucus threads some Normal
URINALYSIS
COLOR: The color of the urine normally ranges from pale yellow to deep amber. It is an
indication on how concentrated the urine is, though certain drugs and certain foods
CLARITY: Fresh voided urine is normally transparent. It becomes cloudy on standing but
adding a few drops of acid can reverse this. Increase’s in opacity, indicates
Specific gravity: It is a measurement of the kidneys ability to concentrate urine. This test can be
used to estimate the person’s general fluid status. Since one of the major function of
the kidney is to maintain fluid balance typically, the more concentrated the urine, the
more fluid depleted the person is. In terms of renal function, this measurement
primarily indicates the person’s concentrating and diluting ability, when the kidneys
lose these abilities, the urine no, longer reflects physiologic stimuli and the specific
Analysis: The patient’s level is still within normal range however it is already on its
lower limit due to the presence of bacteria, epithelial cells, mucus threads, leukocyte
WHITE BLOOD CELLS: It constitutes only one of the total blood volumes. They originate in
the bone marrow and circulate through the lymphoid tissues of the body. There they
Analysis: Since there is the presence of bacteria and inflammation there would be
increased on the number of white blood cells as an immune response to fight off the
bacteria invasion. However in process, some WBC’s are flushed out in the urine.
RED BLOOD CELL: There is a normal microscopic finding in routine urinalysis.
Analysis: The presence of ova in the stool confirms that specific etiologic factor of the patient’s
Classification: Antiemetic
Mechanism of action:
transit; little effects and gallbladder or colon motility; increase lower esophageal sphincter
Desired effect:
This drug was given to our patient to prevent nausea and vomiting.
3.) Administer and monitor response to Provides sedative effect and prevents or
medications that prevent or relieve relieve nausea
nausea
Classification: Antibiotic
Mechanism of action:
penetrate Gram-positive and some Gram-negative bacteria. It differs from penicillin only by
the presence of an amino group. That amino group helps the drug penetrate the outer
needed by bacteria to make their cell walls. It inhibits the third and final stage of bacterial cell
Desired effect: This drug was given to treat the infection caused by the bacteria as well as
administration.
4.) Check for the patency of the IV line To be sure the drug really gets into the
during IV administration.