I.

Introduction
Acute gastroenteritis is an extremely common illness among infants and children worldwide.

According to the Centers for Disease Control and Prevention (CDC), acute diarrhea among children in the United States accounts
for more than 1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths per year. In developing
countries, diarrhea is a common cause of mortality among children younger than age 5 years, with an estimated 2 million deaths
each year. Acute gastroenteritis is a disease state that occurs when food or water that is contaminated with pathogenic
microorganisms (such as

Clostridium perfringens, Vibrio cholera, E. coli,) or their toxins is consumed. Some of its symptoms are nausea, vomiting,
diarrhea, and abdominal pain. Treatment mainly involves symptom relief and fluid replacement. Gastroenteritis is also known as
a tummy bug, stomach flu, intestinal flu, food poisoning, and traveler’s diarrhea.

The most common cause of gastroenteritis is a viral or bacterial infection, and less commonly parasitic infection. The most
common causes of viral gastroenteritis are norovirus and rotavirus. Escherichia coli (E. coli), Salmonella and Campylobacter are
the most common causes of bacterial gastroenteritis. Parasitic gastroenteritis is usually caused by Giardia.

The people most at risk of gastroenteritis are:

• Infants and young children, who have an immature • Children in day care, school children and students living in
immune system dormitories

• The elderly, who have less efficient immune systems, and • Anyone with a weakened immune system, such as people
especially those living in nursing homes with HIV/AIDS or receiving chemotherapy

• Travelers.

The main symptom of gastroenteritis is diarrhea but there are also many other causes of diarrhea. Additional symptoms and
signs of gastroenteritis may include:

• Nausea and vomiting • Headache and muscle aches

• Abdominal pain and cramping • Tiredness and general body weakness

• Mild fever and chills • Incontinence (loss of control over bowel motions)

• Loss of appetite • Poor feeding in infants.

Depending on the cause, symptoms may appear within one to three days after infection and can range from mild to severe.
Symptoms usually last one or two days, but occasionally may persist for up to ten days.

The main complication of viral gastroenteritis is dehydration — a severe loss of water and essential salts and minerals. If you're
healthy and drink enough to replace fluids you lose from vomiting and diarrhea, dehydration shouldn't be a problem.

Infants, older adults and people with suppressed immune systems may become severely dehydrated when they lose more fluids
than they can replace. Hospitalization might be needed so that lost fluids can be replaced intravenously. Dehydration can be
fatal, but rarely.

Gastroenteritis is usually diagnosed by the symptoms that it produces, primarily diarrhoea. However, if the symptoms are severe
or persistent, your doctor may take a stool (faeces) sample to identify the cause of the gastroenteritis.

Stool samples may be taken during outbreaks of gastroenteritis, such as those occurring on cruise ships and in hospitals and
nursing homes, to identify the virus or bacteria that has caused the outbreak. Also, identifying patients with similar histories of
food or drink they have recently consumed often helps to determine the source of the outbreak. Handwashing, breastfeeding,
and rotavirus vaccination reduce the incidence of acute gastroenteritis in young children.

Most people with gastroenteritis recover within several days without the need for medical treatment, as long as they stay
properly hydrated.

For infants with gastroenteritis, let the baby's stomach rest for 15 to 20 minutes after vomiting or a bout of diarrhea, then offer
small amounts of liquid. Let the baby nurse if being breast-fed. If you are bottlefeeding, offer a small amount of an oral
rehydration solution or regular formula.

Anti-diarrheal medications, such as Imodium, can be taken to slow the diarrhea. In most cases, however, it is better for the body
to clear itself of the virus or bacteria causing the gastroenteritis.
Use of antibiotics is also usually avoided because they are not effective against viruses, and their overuse contributes to the
development of antibiotic-resistant strains of bacteria.

Although often considered a benign disease, acute gastroenteritis remains a major cause of morbidity and mortality in children
around the world, accounting for 1.34 million deaths annually in children younger than 5 years, or roughly 15% of all child
deaths. As the disease severity depends on the degree of fluid loss, accurately assessing dehydration status remains a crucial
step in preventing mortality.

II. Objectives
 General:
Learners will be able to understand and be educated about acute gastroenteritis and its
causes. Together with its nursing management and intervention to properly manage the
disease. To acquire proper knowledge and skill and also the attitude in providing patient care
 Knowledge:
To properly define what is acute gastroenteritis
Further understand the pathophysiology behind the disease
Identify it predisposing and precipitating factors
Recognizing its signs and symptoms
Distinguish what proper nursing interventions to implement
 Skills:
Identify appropriate nursing diagnosis in accordance to the needs of the patient
Create and impellent a nursing care plan for the patient management using nursing process
Document patient’s condition, nursing intervention and evaluation of patient care
 Attitude:
Establish rapport with the patient
Provide patient privacy
Recognize patient’s needs using holistic approach
Show outermost confidence in managing patient’s bedside care
III. Nursing Health History
 Biographic data:
Name: Elsa
Age: 1-year-old
Sex: Female
Marital status: Single
Religion: Roman Catholic
Source of information: Mother
Relationship: Daughter
Attending physician: Pedia resident on duty
Admitting impression: Acute Gastroenteritis
 Chief complaint:
Passing out watery stools and fever
 History of present illness:
Patient passed out watery stools 10 times approximately 1 full glass, 2 days prior to
admission after IV left over food
Unsettled crying
No history of vomiting
 Past medical history:
 Delivery at term via emergency C-section due to severe fetal distress, with a birth weight of
11 kg
 APGAR score was 0-1 at one and five minutes, respectively, after delivery requiring tracheal
intubation and transfer into neonatal intensive care unit
 Extubated on the fourth day of life, followed by reestablishment of enteral nutrition by day 5
 Fed exclusively on formula milk from birth
 Family health history:
 No family health history
 Personal and socioeconomic history:
None
 Psychological data:
Baby Elsa is alert but irritable and she cried at times
IV. Physical Examination
A. Vital Signs:
Temperature: 39.9°C
Heart rate: 170-190 bpm
Respiratory rate: 40-80 cpm
Blood pressure: 102/55 mmHg
Oxygen saturation: 100%
B. General Assessment:
Alert
Irritable
Ill-appearing infant
C. Assessment of the integumentary system:
Pale grey skin
Tenting skin turgor
When a person’s skin is pinched and released, the skin does not flatten back to normal right
away
D. Assessment of the head:
Dry lips
Dry buccal mucosa
Sunken eye
Soft fontanelle
E. Assessment of the abdomen:
Swollen
Slightly painful upon palpation
F. Assessment of the extremities:
Capillary refill time of 3 seconds
4 seconds or less is considered normal

V. Symptoms Manifested

Symptoms presented by the patient:

 Watery diarrhea
 Pain or cramping in the abdomen
 Fever
 Dry mouth
 Decreased skin turgor
 Sunken eyes or cheeks

Other possible symptoms:

 Urinating less than usual

 Feeling tired
 Dark coloured urine
 Light headedness or fainting
 Vomiting
 Severe pain in the rectum
 VI. Pathophysiology

VII. Diagnostic and Laboratory

For our patient Baby Elsa, Stool exam was ordered by the physician and revealed the presence of Salmonella typhi.

Salmonella causes a mild to severe gastrointestinal illness called gastroenteritis, which is also known commonly as stomach flu.

Healthcare providers often can diagnose gastroenteritis from your symptoms. But your provider may want to rule out other
illnesses with some tests:

1. Stool samples
 Stool exam: Stool specimens may be collected for culture and sensitivity testing to determine the causative
infectious organism, if there is one.
  Stool Samples Tests look for bacteria, viruses or parasites in your stool
2. Sigmoidoscopy
 A doctor inserts a thin, flexible tube with a tiny camera from the anus into the lower large intestine to look for
signs of inflammatory bowel disease. The sigmoidoscopy is a 15-minute procedure that doesn’t usually require
sedation.
VIII. Medical and Surgical Management
Medical Management

 When gastroenteritis is caused by a virus, usually there is no medical treatment needed. It just takes time for the viral
infection to run its course. You can treat the symptoms of vomiting and diarrhea at home by staying hydrated. Drink a
lot of clear liquids, including sports drinks or oral rehydration solutions such as Pedialyte.
 Antidiarrheal medications include drugs that alter intestinal secretion (bismuth subsalicylate [e.g., Pepto-Bismol]) or
intestinal motility (loperamide [Imodium]), adsorbents (kaolin/pectin [e.g., Kaopectate]) and preparations containing
“beneficial bacteria” (Lactobacillus [e.g., yogurt]). These agents are generally not indicated in children with acute
gastroenteritis because of lack of convincing evidence that they are effective and because of concerns that adverse
effects may outweigh any benefits.
 Diarrhea in children should not be treated with opiate-anticholinergic combinations or opiates other than loperamide
because of the high potential for toxic side effects. Antidiarrheal medications also have the potential to worsen the
course of inflammatory bacterial enteritis, leading to toxic megacolon and colonic hemorrhage.
 Antiemetics. Ondansetron is commonly used when needed to prevent vomiting while drinking the ORS. In a Cochrane
review, children who received an antiemetic were less likely to need intravenous rehydration but it was associated with
increased risk of diarrhea.
 Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms
resolve generally without specific therapy.

Medical treatment for gastroenteritis includes:

 Oral rehydration solution

 NG feeding
 IV rehydration. IV access should be obtained in severe dehydration and patients should be administered a bolus of 20-
30 mL/kg lactated Ringer (LR) or normal saline (NS) solution over 60 minutes.
 Diet. In general, children with gastroenteritis should be returned to a normal diet as rapidly as possible; early feeding
reduces illness duration and improves nutritional outcome.

Surgical Management

Surgical intervention is not necessary for gastritis, except in the case of phlegmonous gastritis or acute necrotizing gastritis. With
the latter entity, surgical intervention with resection of the affected area may be the most effective form of treatment. Consult a
gastroenterologist in complicated cases

IX. Drug Study

Drug Name Classification and Indication and Side Effects and Adverse Nursing responsibilities
Mechanism of contraindications Effects
Action
Generic Name: Classifications: Indications: Appetite Loss Diarrhea Before:
Metronidazole Antibiotic, Susceptible anaerobic Dizziness Headache Nausea Assess type, location and
antiprotozoal infections, including and Vomiting Dark urine Furry intensity of pain before
Trade/Brand Name: intraabdomin al, skin tongue Disulfiramtype reaction starting drug therapy.
Flagyl Action: and skin structures, with ethanol Neutropenia
Diffuses into the gynecologic, bacterial Metallic taste Neuropathy Assess BP and RR before
Dosage: organism, inhibits septicemia, bone and Pancreatitis Seizures Blood clot drug administration. Record
1 tsbp protein synthesis by joint, CNS, lower Dry mouth Brain Disease number and characteristics
interacting with DNA respiratory tract, Aseptic Meningitis Optic of stools.
Route: and causing a loss of endocarditis neuropathy
PO helical DNA Inform patient’s parents
structure and strand Contraindications: about the drug therapy.
Frequency and breakage. Therefore, Susceptible anaerobic
timing: it causes cell death infections, including During:
TID for 7 days (8-1- in susceptible intraabdomin al, skin Administer drug with food
6) organisms and skin structures, or milk to minimize GI
gynecologic, bacterial distress.
septicemia, bone and
 joint, CNS, lower Assess BP and RR
respiratory tract, periodically during
endocarditis administration. Don’t skip
doses or double up on
missed doses. If dose is
missed, let patient take as
soon as remembered.

Don’t let patient take

preparations or beverages
that contains alcohol, severe
reactions may occur.

After:
Assess the patient’s skin for
severity areas of adverse
reactions. Inform parents
that the patient’s urine may
turn dark in color.

Inform parents that patient

may experience side effects
such as dry mouth, furry
tongue, nausea, vomiting,
and diarrhea.
Drug Name Classification and Indication and Side Effects and Adverse Nursing responsibilities
Mechanism of contraindications Effects
Action
Generic Name: Classification: Indication: Headache Dizziness Before:
PARACETAMOL Aminoglycoside, Fever reduction Somnolence Insomnia Fatigue Assess patient’s
Anti-infective Tiredness Tinnitus Rash temperature before drug
Brand names: Contraindication: Pruritus Ophthalmol ogic administration.
DYMADON, Action: Contraindicated with effects Sweating Dry mucous
PANADOL, TYLENOL, Anti-inflammatory allergy to Paracetamol, Stomatitis Nausea, Dyspepsia Liquid form must be used as
PANAMAX, LEMSIP analgesic, and salicylates or NSAIDs, CV GI pain Diarrhea Vomiting children have difficulty
antipyretic activities dysfunction, Constipatio n Flatulence GI swallowing drugs in tablets
Route: PO largely related to hypertension, peptic bleeding Dysuria and capsules.
inhibition of ulceration, GI bleeding,
Form: Syrup prostaglandin pregnancy, lactation. Don’t exceed 5 doses in 24h,
synthesis, exact in children.
Dosage: 25mg mechanism is
unknown. Do not use drug for fever
higher than 39.5C (103.1F)
that lasts longer than 3 days.

Warn parents that high

doses and unsupervised long
- term use can cause liver
damage.

During:
Administer drug with food
or or after meals if GI upset
occurs. Give tepid sponge
bath. I

Increase fluid intake.

Keep patient cool by

providing a fan or nurse
patient in an air conditioned
room.

After:
Assess if patient’s fever has
reduced.

Discontinue drug if eye

changes, symptoms of liver
 dysfunction, renal
impairment occur.

Institute emergency
procedures if overdose
occurs: gastric lavage,
induction of emesis,
supportive therapy

X. Nursing Care Plan

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: Diarrhea related Short-term goal: Assess general For baseline data Goals met as
‘Gina lupot ang to bacterial, After 24hours of condition and evidenced by
akon bata” as viral, parasitic nursing vital signs passage of semi-
verbalized by infections as intervention, the solid stools and
the mother patient’s mother Discuss the For patient’s understanding of
evidenced by
different mother education causative factors
client’s will verbalize
causative factors and rationale for
Objective: frequency of understanding of and rationale for treatment
Poor skin turgor watery stools causative factors treatment regimen.
Dry lips 10x in a small to and rationale for regimen
Dry buccal moderate treatment
mucosa approximately regimen. Restrict solid food To allow for bowel
Sunken eyeball one full glass. intake rest and reduce
Dehydration Long-term goal: intestinal
After 3 days of workload
Rationale:
Diarrhea is an nursing
intervention, Provide for To prevent
increase in the changes in dietary foods/substances
frequency, patient will
intake that precipitate
volume and fluid reestablish and
diarrhea
content of stool. maintain normal
Rapid propulsion pattern of bowel Encourage oral For fluid
of intestinal functioning as fluid intake of replacement
contents evidence by fluids containing
through the passage of semi- electrolyte
small bowel sol
Emphasize To prevent spread
results in
importance of of infectious
diarrhea. handwashing disease
Diarrhea is a
hallmark sign of
gastroenteritis.

XI. Discharge Plan and Health Teachings

 MEDICATION
Instruct the mother to give medication regularly as prescribed, on exact dosage, time, &
frequency.
Make sure that the purpose of medications is fully disclosed by the health care provider
 HOME CARE
Advised the mother to have her child adequate rest and sleep.
Instruct the mother to increase fluid intake of her child to avoid dehydration.
Encourage the mother to boil drinking water / buy mineral or distilled water.
Advised the mother to always wash child’s hands thoroughly with soap and water before
and after handling food and after using the comfort room.
Teach the mother to wash her child's clothes and towels separately from the rest of the
laundry. Clean surfaces with antibacterial cleaner or bleach.
Advised the mother to keep their surroundings clean.
 FOLLOW UP CHECK UP
Regular follow-up check-up with Pediatrician should be greatly encouraged to clients to
ensure the continuing management and treatment.
 PREVENTION ON HOW TO PREVENT THE SPREAD OF GASTROENTERITIS:
Gastroenteritis can spread easily. Keep yourself, your family, and your surroundings clean to
help prevent the spread of gastroenteritis:
1. Wash your hands often. Use soap and water. Wash your hands after you use the
bathroom, change a child's diapers, or sneeze. Wash your hands before you prepare
or eat food.
2. Clean surfaces and do laundry often. Wash your clothes and towels separately from
the rest of the laundry. Clean surfaces in your home with antibacterial cleaner or
bleach.
3. Clean food thoroughly and cook safely. Wash raw vegetables before you cook. Cook
meat, fish, and eggs fully. Do not use the same dishes for raw meat as you do for
other foods. Refrigerate any leftover food immediately.
4. Be aware when you camp or travel. Drink only clean water. Do not drink from rivers
or lakes unless you purify or boil the water first. When you travel, drink bottled
water and do not add ice. Do not eat fruit that has not been peeled. Do not eat raw
fish or meat that is not fully cooked.