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COLLEGE OF HEALTH
A CASE STUDY
ON
ACUTE GASTROENTERITIS
(AGE)
Last July 05, 2007, we encountered a patient with such kind of infection. This
patient has caught our attention and has given the opportunity to study his case. The
objective of this study is to help us understand the disease process of gastroenteritis and
to orient ourselves for appropriate nursing interventions that we could offer to the patient.
This approach enables us to exercise our duties as student nurses which is to render care.
I was given the chance to improve the quality of care I can offer and to pursue our chosen
profession as future nurses.
PATIENT’S PROFILE
Gender: Male
Nationality: Filipino
Dialect: Ilocano
Date of Admission: July 5, 2007
Two days prior to admission (July 3, 2007 in the evening), the patient had
vomiting for 3 times associated with abdominal pain and passage of watery
stool due to his intake of ice-cold coke and water according to his mother. A
day prior to admission (July 4, 2007), the patient still attended his classes but
still with vomiting and passage of watery stool. And last July 5, 2007, he was
rushed to St. Paul Hospital due to weakness and severe abdominal pain.
According to the patient’s mother, the patient has his complete immunizations.
He is taking his vitamin supplements but still he is very slim and never liked
vegetables. The patient was first hospitalized due to asthma. His second
hospitalization was due to bronchopneumonia and the latest was due to AGE.
Before his hospitalization, the patient perceives health in a way that he is not
suffering from any disease. He takes vitamins for him to improve his health
and to protect him from acquiring any disease.
Nutritional-Metabolic Pattern
Before his hospitalization, the patient takes his meal three times a day without
any restrictions. According to his mother, he has food preferences on fatty and
oily foods. Her mother even shared that when they eat adobo, he prefers to eat
the fat rather than the muscle because he gets irritated with foods between his
teeth. He has no difficulty in swallowing and he usually eat junk foods when
its snack time. He drinks 4-5 glasses of water a day and takes Clusivol to
improve his appetite.
Elimination Pattern
Before his hospitalization, the patient used to eliminate once a day every
morning before going to school with a semi-solid consistency and is brownish
in color. He usually urinates 2 times a day with the normal light yellow color
and aromatic odor. He also perspires every time he plays.
Activity-Exercise Pattern
Sleep-Rest Pattern
During his hospitalization, the patient sleeps early but has sleep disturbances
when the nurses take his vital signs, administer medicines and also due to the
environment.
Cognitive-Perception Pattern
According to the patient’s mother, he’s a good son though sometimes he tends
to disobey his parents. She said this is normal for his age. He is the eldest but
according to her mother he acts as if he is the youngest.
Role-Relationship Pattern
The patient has a close relationship with his family, but he is closer to his
father. He has a 2 year old sister, but according to his mother, he does not play
the role of an elder brother. His mother even added that his sister ie more
obedient than he is. But during his confinement, he is more obedient because
he wanted to get well immediately.
Sexual-Reproductive Pattern
Prior to his age, the patient is not yet oriented with any sexual matters.
According to hid mother, he has not yet undergone circumcision.
Coping Stress- Tolerance Pattern
Value-Belief Pattern
Mouth and
Pharynx
Lips Inspection Pink, moist Pink, moist Normal
symmetric symmetric
Buccal mucosa Inspection Glistening pink soft Glistening pink soft Normal
moist moist
Gums Inspection Slightly pink color, Slightly pink color,
moist and tightly fit moist and tightly fit Normal
against each tooth against each tooth
Tongue Inspection Moist, slightly Moist, slightly
rough on dorsal rough on dorsal Normal
surface medium or surface medium or
dull red dull red
Teeth Inspection Firmly set, shiny Firmly set, shiny Normal
No tooth decay
Hard and soft Inspection Hard palate- dome- Hard palate- dome-
palate shaped shaped Normal
Soft Palate- light Soft Palate- light
pink pink
Neck
Symmetry of Neck is slightly Neck is slightly
neck muscles, Inspection hyper extended, hyper extended, Normal
alignment of without masses or without masses or
trachea asymmetry asymmetry
Neck Rom Inspection Neck moves freely, Neck moves freely, Normal
without discomfort without discomfort
Thyroid gland Palpation Rises freely with Rises freely with Normal
swallowing swallowing
Trachea Inspection Midline Midline Normal
Thorax and Auscultation Clear breath sounds Clear breath sounds Normal
Lungs
Abdomen Inspection Skin same color Skin same color Normal
with the rest of the with the rest of the
body body
HEMATOLOGY RESULTS
FECALYSIS
Method used: Direct Smear
Results Analysis
Physical properties:
Color Light brown Normal
Consistency Watery d/t profuse secretion of
water and electrolytes
Remarks:
No oral intestinal parasite seen
URINALYSIS
Results Analysis
Color Yellow Normal
Transparency Slightly turbid d/t increased urine
concentration
Reaction 6.0 Normal
Specific gravity -1.020 Decreased: d/t
dehydration
Sugar Negative Normal
Protein Trace Normal
MICROSCOPIC EXAM
Result Analysis
Round epithelial cells Occasional Normal
Mucus thread Many Normal
RBC 0-1 Normal
Pus cells 1-2 Normal
Amorp urates/phosphates Few Normal
ANATOMY AND PHYSIOLOGY
The digestive system is made up of the alimentary canal and the other abdominal
organs that play a part in digestion, such as the liver and pancreas. The alimentary canal
(also called the digestive tract) is the long tube of organs — including the esophagus, the
stomach, and the intestines — that runs from the mouth to the anus. An adult's digestive
tract is about 30 feet long.
Digestion begins in the mouth, well before food reaches the stomach. When we
see, smell, taste, or even imagine a tasty snack, our salivary glands, which are located
under the tongue and near the lower jaw, begin producing saliva. This flow of saliva is set
in motion by a brain reflex that's triggered when we sense food or even think about
eating. In response to this sensory stimulation, the brain sends impulses through the
nerves that control the salivary glands, telling them to prepare for a meal.
As the teeth tear and chop the food, saliva moistens it for easy swallowing. A
digestive enzyme called amylase, which is found in saliva, starts to break down some of
the carbohydrates (starches and sugars) in the food even before it leaves the mouth.
From the throat, food travels down a muscular tube in the chest called the
esophagus. Waves of muscle contractions called peristalsis force food down through the
esophagus to the stomach. A person normally isn't aware of the movements of the
esophagus, stomach, and intestine that take place as food passes through the digestive
tract.
At the end of the esophagus, a muscular ring called a sphincter allows food to
enter the stomach and then squeezes shut to keep food or fluid from flowing back up into
the esophagus. The stomach muscles churn and mix the food with acids and enzymes,
breaking it into much smaller, more digestible pieces. An acidic environment is needed
for the digestion that takes place in the stomach. Glands in the stomach lining produce
about 3 quarts of these digestive juices each day.
Most substances in the food we eat need further digestion and must travel into the
intestine before being absorbed. When it's empty, an adult's stomach has a volume of one
fifth of a cup, but it can expand to hold more than 8 cups of food after a large meal.
By the time food is ready to leave the stomach, it has been processed into a thick
liquid called chyme. A walnut-sized muscular tube at the outlet of the stomach called the
pylorus keeps chyme in the stomach until it reaches the right consistency to pass into the
small intestine. Chyme is then squirted down into the small intestine, where digestion of
food continues so the body can absorb the nutrients into the bloodstream.
The inner wall of the small intestine is covered with millions of microscopic, finger-
like projections called villi. The villi are the vehicles through which nutrients can be
absorbed into the body.
The liver (located under the ribcage in the right upper part of the abdomen), the
gallbladder (hidden just below the liver), and the pancreas (beneath the stomach) are
not part of the alimentary canal, but these organs are still important for healthy digestion.
The pancreas produces enzymes that help digest proteins, fats, and carbohydrates. It
also makes a substance that neutralizes stomach acid. The liver produces bile, which
helps the body absorb fat. Bile is stored in the gallbladder until it is needed. These
enzymes and bile travel through special channels (called ducts) directly into the small
intestine, where they help to break down food.
The liver also plays a major role in the handling and processing of nutrients. These
nutrients are carried to the liver in the blood from the small intestine.
From the small intestine, food that has not been digested (and some water) travels to
the large intestine through a valve that prevents food from returning to the small intestine.
By the time food reaches the large intestine, the work of absorbing nutrients is nearly
finished. The large intestine's main function is to remove water from the undigested
matter and form solid waste that can be excreted. The large intestine is made up of three
parts:
1. The cecum is a pouch at the beginning of the large intestine that joins the small
intestine to the large intestine. This transition area allows food to travel from the
small intestine to the large intestine. The appendix, a small, hollow, finger-like
pouch, hangs off the cecum. Doctors believe the appendix is left over from a
previous time in human evolution. It no longer appears to be useful to the
digestive process.
2. The colon extends from the cecum up the right side of the abdomen, across the
upper abdomen, and then down the left side of the abdomen, finally connecting to
the rectum. The colon has three parts: the ascending colon and transverse colon,
which absorb water and salts, and the descending colon, which holds the resulting
waste. Bacteria in the colon help to digest the remaining food products.
3. The rectum is where feces are stored until they leave the digestive system
through the anus as a bowel movement.
PATHOPHYSIOLOGY
(GASTROENTERITIS)
¤ Diet
Ingestion of Pathogens
Abdominal cramps
Diarrhea Excretion of Access to
General weakness Interstitial fluids Systemic circulation
Objective data: Risk for At the end of 30 Note risk factors Identifying the
Decreased infection r/t IV minutes, the for the occurrence possible causative
immunity therapy client will of infection. factors helps
verbalize prevent/control the
understanding of occurrence of
individual infection.
causative and risk
factors.
Observe for Visible sings of
localized sings for infection enable the
infection at management of
insertion sites. more severe
infections.
Assess skin The skin is our
conditions around primary defense
insertion sites of against infectious
pins, wires, and diseases.
tongs, noting
inflammation and
drainage.
METRONIDAZOLE
Action:
Effective against anaerobic bacteria and protozoa. Specifically inhibits
growth by binding to DNA, resulting in loss of helical structure, strand breakage,
inhibition of nucleic acid synthesis and cell death.
Side Effects:
GI: nausea, dry mouth, metallic taste, vomiting,
abdominal discomfort, andominal pain
CNS: headache, dizziness
Nursing Responsibilities:
Monitor stool number and character.
With IV therapy, assess for sodium retention.
METOCLOPRAMIDE
Action:
Dopamine antagonist that acts by increasing sensitivity to acetylcholine;
results in increased motility of the upper GI tract and relaxation of the pyloric sphincter
and duodenal bulb.
Side Effects:
GI: nausea, bowel disturbances
CNS: restlessness, drowsiness, fatigue, headache, dizziness
Nursing Responsibilities:
Inject slowly IV to prevent transient feelings of anxiety and restlessness.
Assess abdomen for bowel sounds and distention.
AMPICILLIN
Action:
Synthetic, broad-spectrum antibiotic suitable for gram-negative bacteria.
Side Effects:
GI: diarrhea, abdominal distention
CNS: fatigue, headache
GU: dysuria, urinary retention
At the site of infection: pain and thrombo-phlebities
Nursing Responsibilities:
Note history of sensitivity/reactions to these or related drugs.
Monitor CBC, liver, and renal function
Monitor urinary output and serum potassium levels
RANITIDINE
Action:
Competitively inhibits gastric acid secretion by blocking the effect of histamine
on histamine H2 receptors.
Side Effects:
GI: constipation, diarrhea, abdominal pain
CNS: dizziness, headache, insomnia, anxiety
Nursing Responsibilities:
Assess patient GI condition before starting therapy and regularly thereafter to
monitor the doing effectiveness.
Be alert for adverse reaction and drug interaction.
Assess patient’s and family knowledge of the drug therapy.