CHAPTER II

REVIEW THE THEORY

A. Definition of gastroenteritis (GE)
Gastroenteritis is a state where the frequency of bowel movements more
than 4 times in infants and more than 3 times in children with watery stool
consistency, can be green or it can be mixed with mucus and blood / mucus only
(Sudaryat Suraatmaja.2005).
Gastroenteritis is an inflammation of the stomach and intestines are on the
symptoms of diarrhea with or without vomiting (Sowden, et all.1996).
Gastroenteritis is an inflammation of the stomach and intestinal area are
caused by bacteria that assortment, viral and parasitic pathogens (Whaley &
Wong's, 1995).
Gastroenteritis is kondisis with the characteristics of their vomiting and
diarrhea caused by infection, allergy or poisoning of food substances (Marlenan
Mayers, 1995).
Of the four terms of the above authors to conclude that:
Gastroenteritis is an inflammation of the stomach, colon and small
intestine caused by infection of foods that contain bacteria or viruses that produce
symptoms of diarrhea with more frequency with watery consistency and is
sometimes accompanied by vomiting. From usually caused by bacteria, viruses
and parasitic pathogens.
Gastroenteritis can affect all ages, because it is caused by microorganisms
that are part of the flora that inhabit places across the earth's surface.

B. Etiology
Causes of acute diarrhea include:
1. Factors Infection
v Virus Infection
Retavirus

The most common causes of acute diarrhea in infants, often didahulu or

accompanied by vomiting.
Incurred during the year, but usually in winter.
Can be found fever or vomiting.
In get a decrease in HCC.

enterovirus

It usually arises in the summer.

Adenovirus

Incurred during the year.

causing symptoms in the digestive tract / respiratory.

Norwalk

Epidemic
Can heal themselves (within 24-48 hours).

v bacteria
Stigella

Annuals, peak in July-September

The incidence is highest in the age of 1-5 years

Can be linked to febrile seizures.

Vomiting that does not stand out
Cells plain in feces
Stem cells in the blood

Salmonella

All ages but higher under the age of 1 year.

Penetrate the intestinal wall, bloody stool, mucoid.
There may be an increase in temperature
Vomiting does not stand out
Cells plain in feces
The incubation period of 6-40 hours, 2-5 days duration.
The organism can be found in feces for months.

Escherichia coli

Good penetrating mucosal (bloody stool) or that generate entenoksin.

Patients (usually infants) can look very sick.

Campylobacter

Its invasis (bloody stool and mucus mixed) in infants can cause bloody

diarrhea without other clinical manifestations.

Abdominal Cramps great.
Vomiting / dehydration rare

Yersinia Enterecolitica

Stool mucosal
Often found innocent cells in the stool.
There may be severe abdominal pain
Diarrhea for 1-2 weeks.
Often resembling apendicitis.

2. Factor Non Infeksiosus

v malabsorption
disaccharide carbohydrate malabsorption (intolerance, lactose, maltose, and
sucrose), non saccharides (glucose intolerance, fruktusa, and galactose). In infants
and children the most important and most common is lactose intolerance.

malabsorption of fat: long chain triglyceride.

malabsorption of protein: amino acids, B-lactoglobulin.

v Dietary factors
Stale food, toxic, food allergies (milk alergy, alergy food, dow'n senditive milk
protein enteropathy / CMPSE).
v Psychological Factors
Fear, anxiety.
C. Pathophysiology
The cause of acute gastroenteritis are viral entry (Rotravirus, Adenovirus
enteris, Norwalk virus), bacteria or toxins (Compylobacter, Salmonella,
Escherihia

coli,

Yersinia,

and

others),

parasites

(Biardia

Lambia,

Cryptosporidium).
Some pathogens causing infections in cells, produce enterotoxin or
Cytotoksin which damage cells, or attached to the intestinal wall in acute
gastroenteritis.
Gastroenteritis usual transmission through the faecal - oral from one
patient to another. Some cases of spread of the pathogen encountered due to
contaminated food and drink.
The basic mechanism is a disorder causing osmotic diarrhea (food which
is not absorbed will cause osmotic pressure in the intestinal cavity increases so
that a shift of water and electrolytes into the intestinal cavity, intestinal cavity

contents excessive causing diarrhea). Besides causing impaired secretion due to

toxins in the intestinal wall, thereby increasing the secretion of water and
electrolytes

diarrhea

ensued.

Multilitas

intestinal

disorders

that

result

Hiperperistaltik and hipoperistaltik. As a result of diarrhea itself is the loss of

water and electrolytes (dehydration) resulting in acid-base disorders (metabolic
acidosis and HipokalemiaN), nutritional disorders (intake less, excessive output),
hypoglycemia, and blood circulation disorders.
Normally the food or feces to move along the intestines due to movements
of intestinal peristalsis and segmentation. However, due to infection by bacteria,
then the digestive tract will arise nuts excessive bowel and sometimes cause full
feeling in the stomach, so people always want BAB and watery stools patients.
Dehydration is a frequent complication occurs when the fluid secreted by
the body exceeds the incoming fluid, the liquid that comes out with the
electrolyte.
At first microorganism Salmonella, Escherichia coli, Vibrio dysentery and
entero virus gets into the gut, where the breed toxin, then an increase in intestinal
peristalsis, intestinal fluid and electrolyte losses and then dehydrates.
D. Signs and Symptoms
1. Salmonella
Body temperature rises, liquid stool consistency / watery and foul
smelling, sometimes containing mucus and blood, prodomal stage lasts for 2-4
days with symptoms of headache, pain and flatulence.
2. The bacteria Escherichia Coli
Weakness, weight loss is difficult to rise, persistent heartburn in infants.
3. The bacteria Vibrio

Watery consistency and unnoticed mules in a short time happens, it will

turn into a cloudy white liquid is not malodorous fishy, that if the diarrhea will
change to mixtures of white, nausea and muscle spasms in the legs.
4. Germs Dysentery
Abdominal pain, vomiting, headache, Chapter slimy and reddish, varying
body temperature, rapid pulse.
5. Germs Viruses
Do not like to eat, defecate in the form of liquid, scarce blood, lasts 2-3
days.
6. Gastroenteritis Choleform
The main symptoms of diarrhea and vomiting, diarrhea occurs without
heartburn and nausea, the form of feces like rice water and often lead to
dehydration.
7. Gastroenteritis Desentrium
Toxic symptoms are diarrhea, feces containing blood and mucus called
dysentery syndrome, rarely resulting in dehydration and very clear signals that
arise 4 days febrile, flatulence, anorexia, nausea and vomiting.
E. Clinical Manifestations

Abdominal pain (abdominal discomfort)

The pain in the pit of the stomach
Nausea, sometimes vomiting
Decreased appetite
Rasa early satiety
Bloated
Burning sensation in the chest and abdomen
Regurgitation (discharge from the hull of a sudden).
Diarrhea.

Fever.
Mucous membranes of the mouth and lips dry
Weak
Diarrhea.
Sunken Fontanel

F. Complications.

Dehydration
hypovolemic shock
convulsions
bacteremia
malnutrition
hypoglycemia
Intolerance secondary to intestinal mucosal damage.

G. Level Degree of Dehydration

From complications of gastroenteritis, dehydration can be classified as
follows:
a. mild dehydration
Fluid loss 2-5% of body weight with the clinical picture is less elastic skin
turgor, hoarseness, patients do not fall in a state of shock, crown and sunken eyes,
drinking normal, normal urination.
b. dehydration Medium
Fluid loss 5-8% of body weight with a clinical picture of poor skin turgor,
hoarseness, patients with pre shock pulse falling fast and deep. agitated, very
thirsty, breathing rather quickly, crown and sunken eyes, a little pee and drink
normally.
c. dehydration weight

Fluid loss 8-10% of body weight with clinical features such as signs of
dehydration are being coupled with the general decline, apathy to coma, muscle
stiffness until cyanosis, rapid heart rate, weak pulse, blood pressure drops, the
color of urine pale, breathing fast and deep, very ugly turgor, crown and sunken
eyes once, and did not want to drink.
Or said dehydration if:
1. Mild dehydration: fluid loss of 2-5% or an average of 25ml / kg.
2. Dehydration were: loss of fluids 5-10% or an average of 75ml / kg.
3. Severe dehydration: fluid loss 10-15% or an average of 125ml / kg.
Gastroenteritis based group is divided into:
1. In infants and children.
Infants and children are said to diarrhea when more than three times per
day BAB, whereas neonatal diarrhea when it is said to be more than four times per
day BAB.
2. In adults.
In adults said diarrhea when more than seven times in 2 hours Chapter.
The types of diarrhea:
1. acute watery diarrhea
Exit watery stool and often no blood visible, which ended less than 14
days.
2. Dysentery.
Diarrhea with blood in the stool, stool frequency, and often a little.

3. Persistent diarrhea.
Diarrhea ended dlm 14 days or more, starting from acute diarrhea or
dysentery.
H. Investigations.
Laboratory tests which include:
1. Examination of Feces

macroscopic and microscopic.

pH and sugar levels in the feces with litmus paper and tablet dinistest,

when there is a suspected sugar intolerance.

If necessary, do as culture and resistance tests.

2. Examination of Blood

blood pH and reserve multiplied and electrolytes (sodium, potassium,

calcium, and phosphorus) in serum to determine the balance asama bases.

Levels of urea and kreatmin to determine kidney function.

3. The duodenum intubation (intubation Doudenal)

To know the microorganism or parasite qualitatively and quantitatively,
mainly conducted in patients with chronic diarrhea.
I. Medical Management.
a. Giving fluids to replace lost fluids.
b. Diatetik: feeding and specialty drinks in patients with the goal of healing and
maintaining health as for the things to note:
1. Provide ation.

2. Provide foods that contain calories, protein, vitamins, minerals, and clean
food.
c. Monitor and correction of input and output electrolyte.
d. Drugs. Give antibiotics.
e. Correction of metabolic acidosis.

ASKEP THEORETICAL

PRESENTATION FORMAT
NURSING CLIENT An.A
IN THE KEP. CHILDREN ROOM 6
A. ASSESSMENT
I.Biodata

- The identity of the client

Name / nickname: An.A
Place and date of birth / age: Makassar 05 - 05-2006
Female gender
Religion: Isalam
Education: Address: Sinasara
No. RM: 126 636
Date of entry MRS: 16-12, 2006.
Date of assessment: 18 - 12-2006
Dx.Medik: GEA
Treatment plan: - Infusion KA EN 3 B
Contrmoxzole syrup 3 x 1 + Injection PP
- The identity of the parents
1. father
Name: Arifin
Age: 39 yrs
Education: Elementary
Religion : Islam
Address: Sinasara
2. mother
Name: Marlina
Age: 25 yrs
Education: Elementary
Religion : Islam
Address: Sinasara

The main II. complain / reason enter in hospital

Clients enter the house because the house vomiting - vomiting,
abdominal pain and bowel 5x a day with hot then the elderly client
decides to bring clients to the hospital and then referred for
hospitalization.
III. history health now
CHAPTER msih clients and accompanied by vomiting - vomiting 2 times
a day
Other medical history:
- The client has experienced Ispa disease at the age of 5 months and
treated in hospital pelamonia.
- The client never fall / crash
- The client never poisoned food / drug / allergy
- Capital clients say p [Indonesia Economic clients rather slow in
comparison with his brother.
Family medical history
Mother said client in the client's family yuang experiencing severe
illness / severe kidney disease that only grandparents and mother's
heart is the client's own allergy to cold.

CLASSIFICATION OF DATA
A. DS:

- Capital clients tell her stool and vomit 5 times a day

- The mother says her son lazy meal
- Mom says her client never shower
- Capital clients say anxious and worried with the state of his

son.
B. DO: - client appears weak
- Sunken eyes
- Face looked pale

- Peristaltic 36 x / i
- Vital sign : pulse: 128 x / i
Temparature: 36.5 C
Respiratory : 30 x / i
- The client's mother seemed anxious and worried
- Weight K 5.2 g (before the illness 7 Kg)
- Less elastic skin turgor
DATA ANALYSIS
No
.
1.

2.

DATA

ETIOLOGY

DS:
- The client's mother said
her son and vomiting
CHAPTER 5 x / day
- The client's mother says
her son lazy eat.
DO:
- Less elastic skin turgor
- Client appears weak
- Face looked pale
- Sunken eyes
- Peristaltic 36 x / i
- Inserted infusion RL. 20
tts / i
- TTV: N: 128 x / i
S: 36.5 C
P: 30 x / i

Intestinal
metabolism disorders
Hipoperistaltik /
Hiperperistaltik
Germs multiply in the
intestine
Stimulation of the
intestine to remove
toxins
Increased bowel
mobility
Increased intestinal
peristalsis
Diarrhea
The volume of fluid
and electrolyte
deficits

DS:
- Mom says her clients are
lazy meal
DO:
- Clients seem tired
- Eating is not in spend
each meal

The decline in the

volume of fluid
Increased intestinal
peristalsis
Stimulate the gastric
mucosa
Increased gastric
acid
Nauseous vomit

PROBLEM
Deficits volume of
fluid

Disorders of
nutrition lack of
demand

Lack of appetite
Intake Inadequate
Increased bowel
motility

Nursing diagnosis
1. Disorders of fluid and electrolyte balance b / d lose cairanyang
excessive mark with:
DS:
- His mother mengataka client CHAPTER 5 x / day.
- Mom says her clients are lazy meal
DO:
- Less elastic skin turgor
- Client namp [ak weak
- The client's eyes appear sunken
- Peristaltic 36 x / i
- Inserted infusion RL 20 tts / i
- vital signs: pulse: 128 x / i
temperature: 36.5 C
respiration: 30 x / i
Disorders of nutrition lack of demand b / d intake that is not adequately
marked with:
DS:
- The client's mother says her son lazy meal
DO:
- Client appears weak
- Portions not in spend

- weight: 5.2 Kg previous 7 Kg.

INTErVENTION
Disorders of fluid and electrolyte balance b / d lose cairanyang
excessive
1. Assess client's level of dehydration
2.Observation:
- Vital signs
- Intake and output
- Signs of dehydration
3. give to the client's mother to continue giving drinks / ASI as often as
possible
4. Management of liquid giving
5. manajement giving drugs
- Injection
Disorders of nutrition lack of demand b / d intake that is not adequately
1. Assess client's diet
2. give eat and drink / ASI little but often in warm
3. weight weigh every day
4. giving maternal clients by giving food to taste varied.

CHAPTER III
COVER

1. Conclusions
Gastroenteritis is an inflammation of the stomach, colon and small
intestine caused by infection of foods that contain bacteria or viruses that produce
symptoms of diarrhea with more frequency with watery consistency and is
sometimes accompanied by vomiting. From usually caused by bacteria, viruses
and parasitic pathogens Norwalk.
And is characterized by small intestinal mucosa infiltration by eosinophils,
with edema but no vasculitis and by peripheral blood eosinophilia.
2. Suggestions
for Nurses
We recommend that nurses in providing nursing care should pay more
attention to factors that cause or precipitant of illness of children and provide
health education to the elderly client and the client so that the problem that caused
the client being treated can be overcome so that no treatment is repeated
For Parents Clients
Keeping the environment clean house, and get used to wash hands before
and after feeding children as well as maintaining personal hygiene and give toys
that are clean and can be washed, and in case of diarrhea in children before under
to the hospital, given a sugar solution of salt.

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Ngastiyah, 2005. Sick Child Care. Jakarta; EGC.
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Suzanne C. Smeltzer, Brenda G Bare, Medical Surgical Nursing, Book Medical
Publishers, Jakarta; EGC.
Sudoyo, Aru W., et al., Medicine. Volume 2 Issue IV, Publishing Center
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Wong, Donna L. 2003. Clinical Guidelines Pediatric Nursing. Jakarta; EGC