Case Study

Gastroenteritis is an inflammation of the stomach and intestinal tract that primarily affects the small bowel. The major clinical manifestations are diarrhea of varying degrees and abdominal pain and cramping. Associated clinical manifestations are nauseas, vomiting, fever, anorexia, distention, tenesmus (straining on defecation) and borborygmi (hyperactive bowel sounds) (Black, Joyce M. , Hawks Jane Hokanson. , (2009). Medical-Surgical Nursing: A clinical Management for Positive Outcomes (8th ed. ), pp. 679). Gastroenteritis occurs throughout the world, often in epidemic outbreaks.

Contaminated food and water are major causes of these diseases and cause thousands of deaths yearly. The incidence of infections caused by food-borne diseases is rising. These diseases cost society billions of dollars each year. According to the Centers for Disease Control and Prevention (CDC), 33,000,000 cases of food-borne diseases occur annually in the United States, about 1 of every 10 Americans; about 9000 die. Salmonella and related strains cause an estimated 4 million cases of food-borne illnesses each year, and Campylobacter causes an estimated 2 million illnesses each year.

Another bacterium, Escherichia coli 0157:H7 causes an estimated 30,000 infections and 250 deaths annually. In July 22, 2004, the Department of Health (DOH), Philippines declared an epidemic of a water/food-borne disease called acute gastroenteritis in 45 towns in Central Pangasinan. Acute gastroenteritis is a human enteric (intestinal) disease primarily caused by ingestion of spoiled or bacterial contaminated water or food. According to the DOH Secretary, Dr. Manuel Dayrit, a total of 2,778 cases of the said intestinal infection were recorded in just 45 days (from May 31 to July16, 2004).

From the studies on the medical diagnoses of 81 cases, Dayrit concluded that infectious cholera disease was the main cause of the epidemic (www. doh. gov. ph). Locally, here in Tagum City, at Davao Regional Hospital pediatric department acute gastroenteritis was considered number 3 among the most common pediatric cases. It is common because some of the people are not aware regarding the proper handling and preparation of food. We chose to study this case because of its prevalence that is continuously arising each year. By studying this disease, we can help people to be educated by reading ur data and alleviate the same situation in the future. II. OBJECTIVES The objective of this study is to present all the accumulated information we gathered and studied about our patient’s case, a patient who had a final diagnoses of Acute Gastroenteritis with Dehydration and to use this information as a tool to extend quality nursing care to alleviate the same situation in the future. Specific Objectives: •To trace the underlying pathophysiology of Acute Gastroenteritis with Dehydration and in the process will unravel facts on how this certain condition could hinder the normal functioning of the body. To present a patient need assessment in different nursing theorist. • To discuss the physical assessment of the patient in different systems. •To show its daily summary activities in the hospital through nurse’s assessment with nursing intervention and medical management.

•To show the importance of nurse’s therapeutic and interpersonal communication skills in establishing and developing a trusting patient-nurse relationship that will facilitate gathering of data and formulation of an effective plan of care. To present the actual and ideal laboratory results, diagnostic examinations and its implication. •To present the personal data, family background, socio-economic background and the medical and health history of the patient. •To present and discuss thoroughly the anatomy and physiology related to the disease process. •To present and enumerate the drugs given to the patient; its uses, pharmacologic effects and clinical significance. •To present the actual and ideal medical and nursing management. •To prioritize and formulate nursing care plans applicable to the identified health problems. To identify ideal and actual prognosis of the case. •To summarize and evaluate the case study. ASSESSMENT A. BIOGRAPHICAL DATA Name: Lejuu NaspoAge: 7Y, 7M & 23D Address: Mangga, Tagum City, Davao del Norte Sex: Male Birthday: December 03, 2002Birthplace: Davao City Religion: Roman CatholicNationality: Filipino Admission Date/ Time: July 26, 2010 @ 2:25 AM Height:120 cmWeight: 22 kgs Agency:Bishop Joseph Regan Memorial Hospital – St. Anne Attending Physician:Dr. Jim Osorio Admitting Diagnosis:SVI Final Diagnosis:Acute Gastroenteritis with Dehydration

B. CHIEF COMPLAINT Abdominal Pain, Vomiting, LBM C. HISTORY OF PRESENT ILLNESS Two days prior to admission, Lejuu Naspo was suffering from an on and off fever, LBM and vomiting. Since Friday, he defecated for five times and vomited twice. He was then taking Paracetamol (Tempra) and Loperamide (Immodium) as a remedy at home but still, his condition continued to worsen. So, his parents decided to seek medical attention at Bishop Joseph Regan Memorial Hospital. In the emergency room of the institution, he was assessed and attended by the medical team.

His admitting diagnosis was systemic viral infection (SVI) with vital signs: Temp = 36. 7 °C, BP = 85/50 mmHg, PR = 127 bpm and RR = 25 cpm. D. PAST MEDICAL HISTORY According to his father, Lejuu Naspo was hospitalized due to urinary tract infection when he was around eighteen months old. Two years later, he was confined because of asthma. Last January 2010, he was again admitted due to the same complaint but accompanied with fever. E. PERSONAL, FAIMLY AND SOCIO-ECONOMIC HISTORY Lejuu Naspo belongs to a lower class of family.

He is the only child among the household and is currently studying at Mangga Elementary School as a first grader. He is currently residing at the urban area of Mangga, Visayan Village, Tagum City together with his parents. His father is a tricycle driver while his mother works in the cafeteria of Bishop Joseph Memorial Hospital as a helper. They have an income of around six thousand pesos per month to attend their basic needs. Their family relationship is at good state and tends to interact to each other with respect and courtesy. G.

PATIENT NEED ASSESSMENT Date: July 13, [email protected] 2:00 PM Name of Patient: DAVID GARCIA Age: 7 years old Sex: Male Status: Child Admission Date/Time: July 26, 2010 @ 2:25 AM Admitting Medical Diagnosis: SVI Arrived on Unit by: wheelchair From: Emergency Room Accompanied by: Mother and ER Nurse Admitting weight / v/s: W – 22kg BP – 85/50 PR – 128bpm RR – 25cpm T – 36. 7oC Client’s Perception of Reason of Admission: “Nag-suka, kalibang man gud siya sugod pa byernes.

Mawala-wala pud iyang kalintura” as verbalized by the father. How has the problem been managed by the client at home? “Gipa-inom namo siya ug Paracetamol para sa iyang kalintura ug Immodium para sa iyang kalibanga”, as verbalized by the father. Allergies: None. Medication at Home/Hospital: @home – Seretide 25 mcg/50 mcg Metred dise inhaler (Anti-Asthma), Dicloverine Hcl (Relestal) 10mg/5mL syrup (Anticholinergic/Antispasmodic), Loperamide (Immodium); @hospital – Paracetamol, Ranitidine, Zinc Syrup, Domperidone. PHYSIOLOGICAL NEEDS I. Oxygenation BP: 90/60 mmHg PR: 88 bpm RR: 20 cpm TEMP: 37. 1 oC * Lungs (per auscultation: character, lung sound, symmetry of chest expansion, breathing character and pattern): symmetrical rise and fall of chest; with clear, uninterrupted breath sound heard upon auscultation. *Cardiac Status (per auscultation: sounds, character, chest pain: With loud and rhythmic normal cardiac sound of ‘lub-dub’ heard upon auscultation; no complaints of chest pain. *Capillary Refill: Promptly turns to original color before 3 seconds upon blanching fingernails. Skin Character and Color: with soft, warm, fair in complexion and generally uniform in color with slightly dark exposed areas; good skin turgor noted *Life-supporting Apparatus: IVF # 2 D5 NM 1L @ 80 cc/hr, infusing well @ left metacarpal vein, @ 350cc level. *Other observations (related): none. II. Temperature Maintenance Temperature: 37. 1oC Skin Character: skin is soft and warm to touch with good skin turgor Other Observations (related): none III. Nutritional Fluid *Height/Weight: 120 cm / 22kg Amount of Food Consumed: Able to consume ? of food served. *Prescribed Diet: Diet as tolerated *Problem (nausea, vomiting: no. of times and frequency, amount, character): Vomited once within our shift with yellowish undigested foods noted in moderate amount *Eating Pattern: Three (3) times a day plus snacks (sometimes) *Skin Character: soft and warm to touch with good skin turgor. *Intake (IVF; Fluid / Water): IVF- 450cc, H20-900cc IV. Elimination *Last Bowel Movement (frequency, amount, character): defecated thrice within our shift with yellowish brown, foul smelling, semi-solid stool in relatively large amount. Normal Pattern: Once every day either upon waking up or before sleeping *Urination (frequency, amount, character, sensation) 7 times, in moderated amount approximately 750cc, yellow in color with no pain felt upon micturation. *Other Observations (related): -none V. Rest-Sleep *Bed Time: Home: 8-9pm; Hospital: 7-8pm Waking up Time: Home: 6-7am; Hospital: 7-8am *Sleep (pattern, amount of sleep): with disturbed sleeping pattern of 8-10 hours amount of sleep. *Problems (as verbalized): “Maka-mata ko usahay inig musakit akong tiyan”, as verbalized. *Other Observations (related): -none-

VI. Pain Avoidance *Rate Pain: 7 out of 10 (moderate) *Time Started: on demand *Duration: 1-2 minutes *Location: upper abdominal area *Frequency: occurs intermittently *Character: excrutiating pain (“murag gina-kumot”, as verbalized *Other Observations (related): grimaced face; guarding behavior and diaphoresis noted VII. Sexuality-Reproductive *LMP: N/A *AOG: N/A *Gravida / Parity: N/A *Prenatal: N/A *Menstrual Cycle: N/A *Gynecologic Problems: N/A *EDC: N/A *Family Planning Method Used: N/A *Children (number): N/A *Menarche: N/A VIII.

Stimulation-Activity *Work: none *Recreation/Past time: At home: watching T. V, playing games with neighbors *Hobbies/Vices: playing computer games SAFETY-SECURITY NEED *Neuro V/S: Eye opening: Left/right=spontaneous, pupil size: 2mm; handgrip: Left= strong Right = strong; Leg movement: Left/Right = brisk; GCS = 15 *Mental Status (Coherent, Responsive, Conscious, Unconscious): Conscious, Responsive to stimuli and coherent to verbal communication. *Emotional Problem (Diaphoretic, Trembling, Restless, Other objective cues): diaphoresis noted.

LOVE-BELONGING NEED *Children (Living with? ) None. *Parents (Living with? ) Yes. He lives harmoniously with his parents under one roof. SELF-ESTEEM NEED: Able to socialize and be with family members with confidence of functioning his role. Present medical condition affects the said role but compensation in many ways still realized. SELF-ACTUALIZATION NEED: Based on the developmental task, has almost achieved the things that he is ought to be. However, what impeded him to grasp his aspiration in life is his belief that he cannot attain things that he would want to do because he’s just a kid.

REVIEW OF SYSTEMS (PHYSICAL ASSESSMENT) GENERAL SURVEY At BJRMH – St. Anne: Lejuu Naspo, a 7 y/o male admitted under the service of Dr. Osorio; came in due to LBM, vomiting and abdominal pain; on DAT. Received flat on bed, conscious, oriented to time and place, responsive to stimuli and coherent to verbal communication. With IVF of #2 D5NM 1L @ 80 cc/°, infusing well @ left metacarpal vein, @350 cc level. Skin is dry, warm to touch with good skin turgor. Moist, pinkish lips and mucous membrane noted. Conjunctiva and sclera appears bright and normal in color.

Ears are symmetrical with color same as facial skin, no discharges noted and able to hear words in short and long distance upon calling his name and while having nurse-patient conversation. Symmetrical rise and fall of chest noted with clear and uninterrupted breath sound heard upon auscultation. Capillary refill of less than 3 seconds upon blanching, clubbing of finger not noted. VITAL SIGNS Date/ Shift/ TimeTempBPPRRRIntakeOutput 7/26/10 7/26/10-117 04:00 73 8:00 AM 10:00 AM 12:00 NN 2:00 PM 311 4:00 PM 8:00 PM 7/27/10-117 12: 00 MN 4:00 AM 73 8:00 AM 12:00 NN 36. 7 37. 38. 5 37. 5 37. 1 36. 3 36. 3 36. 3 36. 5 36. 4 36. 6 85/50 100/60 110/90 90/60 110/80 110/80 90/60 90/60 127 106 108 88 118 100 90 88 90 87 90 25 28 16 20 20 30 26 24 24 23 IVF- 450cc H2O- 900cc 1350 cc IVF- 450 cc H2O- 250 cc 700 cc U = 750 cc S = 1 U= 200 cc S= 1 U=900 cc S=0 NUTRITIONAL STATUS Lejuu Naspo is 120 cm in height and weighs 22 kg. He was on DAT as ordered by the attending physician. Within our shift, he was able to eat ? of food served with good appetite. Hooked with IVF or #2 D5NM 1L @ 80cc/hr, infusing well at left metacarpal vein. NEUROLOGICAL STATUS

Lejuu Naspo is conscious, oriented to time and place, and responsive to environmental stimuli. He was able to respond coherently; with GCS of 15/15; with normal sensory functions towards pain, temperature and touch; with average/normal reflexes; motor function of 5, interpreted as active movements against full resistance without fatigue. Cerebral Function Test: stands straight up, on tandem walking motion during ambulation. INTEGUMENTARY SYSTEM Skin is soft and warm to touch. Fair in complexion with generally uniform in color and slightly dark exposed areas. Good skin turgor with no masses noted on extremities. HEENT HEAD – Head is symmetrically round, neck is non tender with full range of motion. Head position is normal, normocephalic. Fine, black hair noted in all areas. Free from masses, lumps, nits & lesions, with no areas of tenderness upon palpation. Moist, pinkish lips and mucous membranes. Facial movement is symmetrical. Facial expressions are appropriate. Involuntary facial muscle movements not noted. *EYES- symmetrical and non-protruding, both pupils are brown & clear. Sclera and conjuctiva appears clear and normal in color. Eyebrows are black in color, symmetrical, and thick; both can be raised symmetrically & without difficulty.

Eyelashes are distributed & slightly bended outward. Upper eyelids cover a small portion of the iris, cornea & the sclera when the eyes are open but when the eyes are closed the lids meet completely, symmetrical & the color is the same as the surrounding skin. Lid margins are clear, without scaling or secretions. Lower palpebral conjunctiva is shiny, moist, transparent & pink in color. Irises are proportional to the size of the eye, round & symmetrical. Pupils are 3mm in size, brisk, round, symmetrical and constricts upon introduction of light.

Able to move eyes in full range of direction and the patient is able to follow the movement of the penlight upward, downward, laterally, and medially. *EARS- Ears are parallel, symmetrical and proportional to the size of the head, bean-shaped, helix is in line with the outer canthus of the eye, skin color is the same as the surrounding area. Lesions, redness, inflammation and discharges are not noted. Cerumen noted on external ear in minimal amount. *NOSE- In midline, symmetrical and patent with no deformities, discharges and inflammation noted. Nasolabial folds are symmetrical.

Internal nares are clean with nasal septum in midline. Patient is able to identify smell of the food and drinks. *NECK- No presence of palpable lesions and mass noted. Appropriate to head and body’s shape and size. *THROAT- In midline with no deviation noted in the throat. Hoarseness of voice is not observed. ASSESSMENT OF THE LUNGS AND THORACIC REGION Moves symmetrically on breathing with no obvious masses, no fail chest which is suggestive of rib fracture, no chest retractions noted, and the spine is straight, with slightly curvature in the thoracic area, expiration is longer than inspiration.

Both lung fields are clear with symmetrical rise and fall of chest noted. ASSESSMENT OF THE HEART Murmurs were not noted; high pitched “lub” sounds, and low pitched “dub“ sound was clearly heard upon. Chest pain not noted. ASSESSMENT OF THE ABDOMEN Abdomen is not distended. Abdominal cramping not noted. Defecated thrice within our shift with yellowish brown, semi-solid, foul smelling stool in relatively large amount. ASSESSMENT OF THE EXTREMITIES No deformities at skeletal structure and is capable of performing simple tasks appropriate for his age.

Has no complains of painful joints or muscle pain and able to move independently. Limited range of motion of both upper and lower extremities was observed. ASSESSMENT OF THE GENITO-URINARY SYSTEM Lejuu Naspo was able to urinate seven times within our shift; urine appears yellow in color with no pain felt upon micturation. DEVELOPMENTAL TASKS *BASED ON MASLOW’S HEIRARCHY OF NEEDS According to Abraham Maslow, people are innately motivated toward psychological growth, self-awareness, and personal freedom. Basic needs must be met before a person can advance to higher needs.

Lejuu Naspo was able to satisfy his physiologic, safety and security, and love and belonging needs by fulfilling the basic life requirements such as air, food, water, shelter, rest, sleep and activity. He also felt safe in the physical environment and in his relationship with his parents. He was able to interact with other people and maintain the feeling of belongingness in his family. *BASED ON ERIKSON’S STAGES OF DEVELOPMENT Erikson (1963) theorized that a person’s life consists of eight stages, each stage representing a crucial turning point in the life span stretching from birth to death with its own developmental conflict to be resolved.

According to Erikson, the major developmental task of a school ager is to either achieve the sense of industry or suffer inferiority. If children are prevented from achieving a sense of industry or do not receive rewards for accomplishment, they can develop a feeling of inferiority or become convinced they cannot do things they actually can do. As what we have observed in our patient, Lejuu Naspo was able to achieve the developmental task accounted to his stage. He was able to develop competence in doing things such as activities of daily livings that provided an avenue for his faster recovery.

He was very participative in any procedures given because he believed that after his recovery, he will be able to attend classes again in order make up for those lessons he missed. *BASED ON HAVIGHURST’S AGE PERIODS AND DEVELOPMENTAL TASKS Havighurst (1972) also suggested a list of developmental tasks that occur during a lifetime. The tasks for a school ager include the development of physical skills, positive self-image, personal independence, relationship with peers, cognitive skills of reading, writing and calculations, etc.

Lejuu Naspo was able to attain his developmental task designated to him because he already developed physical and cognitive skills needed for the accomplishment of his tasks. Personal independence and relationships with peers were also noticed on him. COURSE IN THE WARD Date/ShiftNursing AssessmentNursing InterventionsRationaleMedical ManagementRationale 7/26/10 2:25 AM 3:00 AM 7/26/10 73 8:00AM 7/26/10 117 7/27/10 73 •Admitted this 7-year old patient in due to LBM, Vomiting and abdominal pain •Ushered to room and placed to bed comfortably, endorsed to NOD. UA and SE as ordered •Temp. = 38. 5 oC Patient on bed; awake, with IVF #2 D5NM 1L @ 80 cc; intact •Terminated IVF •Started with D50. 3NaCl 500 cc @ 80 cc/hr, Regulated well. •Provided with specimen bottles, water instruction or proper collection •Referred to ROD, paracetamol prescribed, medication administered, observed adverse reaction to medication •IVF regulated well •Pressure applied to the site

•Hypertonic solutions increase the dissolution and absorption of the drug by absorbing water from the surrounding tissues. •The purpose of obtaining a urine sample is to test for any abnormalities that may be present, such as bacteria Some studies have shown that high dose-usage (greater than 2,000 mg per day) does increase the risk of upper gastrointestinal complications such as stomach bleeding so adverse reactions should be monitored •Proper regulation will maintain the normal equilibrium in the body. •It indicates independence from IVF in maintaining balance of fluids in the body •DAT •VS q4o •Given Domperidone 5 mL PO now •Ranitidine 35 mg IVTT now •For CBC, Platelet request forwarded for U/A and S/E requested •Paracetamol 250/5 1 tbsp q 40 for fever •IVF follow with D5NM 1L @ SR x2 •May go home Meds: Zinc syrup 5 mL OD PO x2 weeks •Domperidone blocks the action of dopamine. It has strong affinities for the D2 and D3 dopamine receptors, which are found in the chemoreceptor trigger zone, located just outside the blood brain barrier, which – among others – regulates nausea and vomiting. •Ranitidine is a histamine H2-receptor antagonist that inhibits stomach acidproduction. It is commonly used in treatment of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). • The complete blood count can be done as part of routine health exam and general screening by a doctor.

It may be ordered if an infection or anemia is suspected. •It is commonly used for the relief of headaches, and other minor aches and pains, and is a major ingredient in numerous cold and flu remedies •Hypertonic solutions increase the dissolution and absorption of the drug by absorbing water from the surrounding tissues. •Zinc is necessary for the functioning of more than 300 different enzymes and plays a vital role in an enormous number of biological processes. III – LABORATORY AND DIAGNOSTIC EXAMINATIONS HEMATOLOGY REPORT Laboratory ExamNormal ValueResultInterpretation

Hemoglobin134-160 g/L127Decreased – It indicates hemorrhage, anemia, leukemia, dietary deficiency. Hematocrit0. 40-0. 540. 38Decreased – It indicates hemorrhage, anemia, leukemia, dietary deficiency. Leukocytes no. concentration5. 0-10. 0 x 10^ g/L12. 07Increased – It indicates leukaemia, severe sepsis, bacterial infection •Segmenters0. 40-0. 600. 76Increased – It indicates a viral infection •Lymphocytes0. 25-0. 400. 17Decreased – It indicates some form of anemia •Monocytes0. 02-0. 060. 04NORMAL •Eosinophils0. 01-0. 050. 02NORMAL •Basophils0. 0050. 1Decreased – It indicates some forms of anemia •Stabs0. 01-0. 05———NO RESULT Thrombocytes150-440 x 10^ g/L425. 6NORMAL URINALYSIS Laboratory ExamNormal ValueResultInterpretation ColorYellow or ClearYellowNORMAL SugarNegativeNegativeNORMAL AlbuminNegativeNegativeNORMAL SP-Gravity1. 005-1. 0301. 025NORMAL Pus Cells00-2 hpfIncreased – It indicates infection CrystalsNo CrystalsAmorphous urates The alkaline pH that decreases the solubility of the calcium phosphate and entails a precipitation of the former FECALYSIS Laboratory ExamNormal ValueResultInterpretation

ColorLight Yellow- Dark BrownYellowNORMAL Parasitic Ova No OvaNo ova foundNORMAL Pus Cells0 2-5 hpfIt indicates sign of infection in the GI tract ConsistencySoft and Peanut butter-like textureWateryIt is caused by infection, side effects of medication, and food intolerance. IV – REVIEW OF ANATOMY AND PHYSIOLOGY OF DIGESTIVE SYSTEM The Structure and Function of the Digestive System The primary function of the digestive system is to break down the food we eat into smaller parts so the body can use them to build and nourish cells and provide energy.

The digestive system is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Inside this tube is a lining called the mucosa. In the mouth, stomach, and small intestine, the mucosa contains tiny glands that produce juices to help digest food. Two solid organs, the liver and the pancreas, produce digestive juices that reach the intestine through small tubes. In addition, parts of other organ systems (for instance, nerves and blood vessels) play a major role in the digestive system. When we eat things like bread, meat, and vegetables, they are not in a form the body can use as nourishment.

Our food and drink must be changed into smaller molecules of nutrients before they can be absorbed into the blood and carried to cells throughout the body. Digestion is the process by which food and drink are broken down into their smallest parts so that the body can use them. Mouth The mouth is the beginning of the digestive tract; and, in fact, digestion starts here when taking the first bite of food. Chewing breaks the food into pieces that are more easily digested, while saliva mixes with food to begin the process of breaking it down into a form your body can absorb and use. Esophagus

Located in your throat near your trachea (windpipe), the esophagus receives food from your mouth when you swallow. By means of a series of muscular contractions called peristalsis, the esophagus delivers food to your stomach. Stomach The stomach is a hollow organ, or “container,” that holds food while it is being mixed with enzymes that continue the process of breaking down food into a usable form. Cells in the lining of the stomach secrete a strong acid and powerful enzymes that are responsible for the breakdown process. When the contents of the stomach are sufficiently processed, they are released into the small intestine.

Small intestine Made up of three segments — the duodenum, jejunum, and ileum — the small intestine is a 22-foot long muscular tube that breaks down food using enzymes released by the pancreas and bile from the liver. Peristalsis also is at work in this organ, moving food through and mixing it with digestive secretions from the pancreas and liver. The duodenum is largely responsible for the continuous breaking-down process, with the jejunum and ileum mainly responsible for absorption of nutrients into the bloodstream. Contents of the small intestine start out semi-solid, and end in a liquid form after passing through the organ.

Water, bile, enzymes, and mucous contribute to the change in consistency. Once the nutrients have been absorbed and the leftover-food residue liquid has passed through the small intestine, it then moves on to the large intestine, or colon. Pancreas The pancreas secretes digestive enzymes into the duodenum, the first segment of the small intestine. These enzymes break down protein, fats, and carbohydrates. The pancreas also makes insulin, secreting it directly into the bloodstream. Insulin is the chief hormone for metabolizing sugar. Liver

The liver has multiple functions, but its main function within the digestive system is to process the nutrients absorbed from the small intestine. Bile from the liver secreted into the small intestine also plays an important role in digesting fat. In addition, the liver is the body’s chemical “factory. ” It takes the raw materials absorbed by the intestine and makes all the various chemicals the body needs to function. The liver also detoxifies potentially harmful chemicals. It breaks down and secretes many drugs. Gallbladder The gallbladder stores and concentrates bile, and then releases it into the duodenum to help absorb and digest fats.

Colon The colon is a 6-foot long muscular tube that connects the small intestine to the rectum. The large intestine is made up of the cecum, the ascending (right) colon, the transverse (across) colon, the descending (left) colon, and the sigmoid colon, which connects to the rectum. The appendix is a small tube attached to the cecum. The large intestine is a highly specialized organ that is responsible for processing waste so that emptying the bowels is easy and convenient. Stool, or waste left over from the digestive process, is passed through the colon by means of peristalsis, first in a liquid state and ultimately in a solid form.

As stool passes through the colon, water is removed. Stool is stored in the sigmoid (S-shaped) colon until a “mass movement” empties it into the rectum once or twice a day. It normally takes about 36 hours for stool to get through the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several useful functions, such as synthesizing various vitamins, processing waste products and food particles, and protecting against harmful bacteria. When the descending colon becomes full of stool, or feces, it empties its contents into the rectum to begin the process of elimination. Rectum

The rectum (Latin for “straight”) is an 8-inch chamber that connects the colon to the anus. It is the rectum’s job to receive stool from the colon, to let the person know that there is stool to be evacuated, and to hold the stool until evacuation happens. When anything (gas or stool) comes into the rectum, sensors send a message to the brain. The brain then decides if the rectal contents can be released or not. If they can, the sphincters relax and the rectum contracts, disposing its contents. If the contents cannot be disposed, the sphincter contracts and the rectum accommodates so that the sensation temporarily goes away.

Anus The anus is the last part of the digestive tract. It is a 2-inch long canal consisting of the pelvic floor muscles and the two anal sphincters (internal and external). The lining of the upper anus is specialized to detect rectal contents. It lets you know whether the contents are liquid, gas, or solid. The anus is surrounded by sphincter muscles that are important in allowing control of stool. The pelvic floor muscle creates an angle between the rectum and the anus that stops stool from coming out when it is not supposed to. The internal sphincter is always tight, except when stool enters the rectum.

It keeps us continent when we are asleep or otherwise unaware of the presence of stool. When we get an urge to go to the bathroom, we rely on our external sphincter to hold the stool until reaching a toilet, where it then relaxes to release the contents. V – SYPTOMATOLOGY SymptomsActual SymptomsImplications •Nausea? Nausea is the body’s way of reacting to an infection or condition. Nausea is that queasy feeling of unease with which everyone is familiar. •Vomiting? Complications of vomiting can occur from the irritation of acidic gastric contents on the esophagus and mouth.

The underlying disorder, disease or condition that is causing vomiting can also cause complications. •Diarrhea? It is commonly caused by infectious diarrhea (usually a gastrointestinal virus) and also parasitic conditions such as giardia or crypto. Diarrhea can indicate a serious condition and can itself be potentially serious if it leads to dehydration. •Abdominal Pain? Abdominal pain can result from infection, malignancy, inflammation, trauma, obstruction and other abnormal processes. •Weakness? Weakness may also occur due to numbness or paresthesias in the affected area. •Loss of appetite?

Poor appetite usually results because of the presence of almost any stomach or intestinal problem; all such intestinal problems tend to disturb appetite. •Fever? A fever usually means the body has raised its temperature to fight an infection or condition. A fever is one of the body’s immune responses that attempt to neutralize a bacterial or viral infection. •Muscle aches? The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections. •Headache? The pain is caused by disturbance of the pain-sensitive structures around the brain. Dehydration? Abnormal condition in which the body’s cells are deprived of an adequate amount of water. VI – ETIOLOGY EtiologyActual SymptomsImplication •VirusesViruses routinely infect the cells of both eukaryotes (such as animals, insects, and plants) and prokaryotes (such as bacteria). They can reproduce only by entering a host cell and commandeering its reproductive capacities to reproduce the virus. The susceptibility to viruses reflects the need for those individuals and societies with means to help those without means. •Bacteria (Staphylococcus aureus, Escherichia coli, salmonella, Shigella, Campylobacter)?

It may cause gastroenteritis directly by infecting the walls of the stomach and intestine. Staphylococcus aureus can form a toxin that is the cause of symptoms. Staph is a common type of food poisoning. Escherichia coli can cause significant problems, and one type of the bacteria, E. coli O157:H7 can also affect kidney function. Salmonella – the cause of typhoid fever is contracted from handling poultry or reptiles such as turtles that carry the germ. Campylobacter – from the consumption of undercooked meat, unpasteurized milk. Shigella typically spread from person to person. •Parasites and Protozoans?

These tiny organisms are less frequently responsible for intestinal irritation. You may become infected by one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. •Chemical Toxins (seafood, food allergies, heavy metals, antibiotics) ? It is caused by hypersensitivity of the immune system leading to a misdirected immune response. When an allergen enters the body of a person with a sensitized immune system, it triggers antibody production. Histamine and other chemicals are released by body tissues as part of the immune response. Age Young or children are more susceptible because the immune system is not yet boast fully. •Lifestyle Unhealthy lifestyle such as not doing the proper preparation of foods where bacteria and viruses is present they could easily penetrate in the body. •Environment Dirty environment is a good place for the bacteria and viruses wherein they could easily multiply. VII – A. PATHOPHYSIOLOGY B. WRITTEN PATHOPHYSIOLOGY Gastroenteritis has many causes ;Viruses and bacteria are the most common. Viruses and bacteria are very contagious and can spread through contaminated food or water.

The pathologic process starts with ingestion of focally contaminated food and water. The organism affects the body through direct invasion and by endotoxin being released by the organism. Through these two processes the bowel mucosal lining is stimulated and destroyed the eventually lead to attempted defecation or tenesmus as the body tries to get rid of the foreign organism in the stomach. The client with acute gastroenteritis may also report excessive gas formation that may leads to abdominal distention and passing of flatus due to digestive and absorptive malfunction in the system.

Feeling of fullness and the increase motility of the gastrointestinal tract may progress to nausea and vomiting and increasing frequency of defecation. Abdominal pain and feeling of fullness maybe relieved only when the patient is able to pass a flatus. As the destruction of the bowel continues the mucosal lining erodes due to toxin, direct invasion of the organism and the action of the hydrochloric acid of the stomach. As the protective coating of the stomach erodes the digestive capabilities of the acid helps in destroying the stomach lining. Pain or tenderness of the abdomen s then felt by the patient.

When the burrows or ulceration reaches the blood vessels in the stomach bleeding will be induced. Dysentery may be characterized by melena or hematochezia depending on the site and quantity of bleeding that may ensue. Signs of bleeding may be observed also through hematemesis. As the bowel is stimulated by the organism and its toxin, the intestinal tract secretes water and electrolytes in the intestinal lumen. The body secretes and therefore lost Chloride and bicarbonate ions in the bowel as the body try to get rid of the organism by increasing peristalsis and number of defecation.

Sodium and water reabsorption in the bowel is inhibited with the lost of the two electrolytes. If the condition left unmanaged it continue to progress, protein in the body is excreted to the lumen that further decreases the reabsorption and the body become overwhelmed that leads to intense diarrhea with more than 10 watery stools. And it will lead to fluid and electrolyte imbalance and hypernatremia. Serious fluid volume deficit may lead to hypovolemic shock and eventually death. On the other hand if it can be managed through the following; treatment is primarily supportive and is directed at preventing or treating dehydration.

When possible, an age-appropriate diet and fluids should be continued. Oral rehydration therapy using a commercial pediatric oral rehydration solution is the preferred approach to mild or moderate dehydration. There were drugs also that prevent for further complication in our patient case the drugs were followed: Domperidone syrup 5 ml, Ranitidine 35 mg IVTT, Paracetamol 250/5 1 tbsp, Zinc Syrup. Hence, these management will give avenue to the alleviation of his condition. VIII. PLANNING A. Nursing Care Plan DATE/ SHIFTASSESSMENTDIAGNOSISPLAN OF CARENURSING INTERVENTIONEVALUATION 07 / 7 / 10 Subjective Cues: Objective Cues: Risk for deficient fluid volume related to excessive losses through normal routes secondary to diarrheaAfter 8hrs of thorough nursing care, deficient fluid volume will be prevented as evidenced by: ? Normal pattern of bowel functioning ?(-) watery stool•Establish rapport ® to gain cooperation and reduce apprehension. •Provided with cool and quiet environment ® to reduce workload of the heart and promote comfort •Placed in a comfortable position ® to promote comfort •Health teachings impart, such as: -increase fluid intake in small frequent amount avoid irritating foods -importance of handwashing -prompt diaper change and gentle cleansing -proper positioning •Monitored intake and output balance ® to have baseline data-Within our shift defecated 3x -Yellowish semi-formed stool noted DATE/ SHIFTASSESSMENTDIAGNOSISPLAN OF CARENURSING INTERVENTIONEVALUATION 07 / 27 / 10 Subjective Cues: “sakit ako tiyan” as verbalized Objective Cues: -pain scale 7 moderate in (1-10 pain scale) -guarding behavior -grimace face -diaphoreticAcute pain r/t gastrointestinal distentionAfter 6hrs of nursing care pain will be relieved as evidenced by: a. )Verbalization b. Pain scale (1-3)mild•Establish rapport ® to gain cooperation and reduce apprehension •Linens stretch and tuck ® to promote comfort •Vital signs check and record ®to have a baseline data •Provide comfort measure, quiet environment and calm activities ® to promote non pharmacological pain management •Encourage use of relaxation technique ®to distract attention and reduces tension •Encourage adequate rest periods ® to prevent fatigue DATE/ SHIFTASSESSMENTDIAGNOSISPLAN OF CARENURSING INTERVENTIONEVALUATION 07 / 27 / 10 Subjective cues: “ lain man akong gibati” as verbalized Objective cues: •Warm to touch Vital signs T-38. 5 BP-110/90 PR-108 RR-16Hyperthermia related to dehydration ® the infectious agent specifically the pyrogens stimulate the monocytes to release pyrogenic cytokinase to stimulate the anterior hypothalamus as a result in it elevate the thermoregulatory set point that leads to increased heat conservation in which the vasoconstriction behavior changes and increased heat production in which there is involuntary muscular contraction as a result to fever. •After 4 hrs. of nursing interventions the patient will maintain core temperature within normal range Independent: •Monitor heart rate and rhythm Dysrhythmias and ECG changes are common due to electrolyte imbalance and dehydration and direct effect of hyperthermia on blood and cardiac tissues •Record all sources of fluid loss such as urine, vomiting and diarrhea ® To monitor or potentiates fluid and electrolyte loses •Promote surface cooling by means of tepid sponge bath ® To decrease temperature by means through evaporation and conduction •Wrap extremities with cotton blankets ®To minimize shivering •Provide supplemental oxygen ® To offset increased oxygen demands and consumption •Administer replacement of fluids and electrolytes To support circulating volume and tissue perfusion •Maintain bed rest ® To reduce metabolic demands and oxygen consumption •Provide high calorie diet, tube feedings, and parenteral nutrition ® To increased metabolic demands •Administer antipyretics orally or rectally as prescribed by the physician ®To facilitate fast recovery•After 4 hours of nursing interventions, was able to maintain core temperature within normal range. MEDICATIONS 1. Present all medications to the patient. Orient with drug’s name (brand and generic), therapeutic effects, as well as adverse reactions/side effects.

Include the exact dose, time and frequency the drug should be taken. Also, give emphasis to the importance of taking the medications on time, not skipping meals and completing the whole drug course. R: To ensure that the patient receives the right medications and to guarantee compliance to the drug therapy. ?Zinc syrup 5ml OD POX 2weeks. 2. Instruct not to take medications that are not prescribed by the physician and encourage seeking medical opinion if experiencing unusualities prior from taking other medications. R: To ensure that drug effectiveness is not interfered by the actions of other drugs taken. . Instruct to inform physician immediately if suffering from any unusualities perceived as caused by taking other medications. R:Enables the physician to intervene immediately with proper interventions in order to lessen the possibility of developing further complications. 4. Encourage family members to help patient in complying medical regimen properly. R:To avoid non-compliance to drug regimen and facilitate fast recovery. 5. Instruct patient to take medications exactly in time. R:To ensure drug effectiveness and prevent further unusualities. EXERCISE 1.

Advise patient to attend daily exercise routine, if not contraindicated. R:To facilitate proper blood circulation for faster recovery. TREATMENT 1. Emphasize importance of proper compliance of treatment regimen. R:To hasten recovery and achieve optimal body functioning. 2. Encourage regular/proper check-up with the physician. R:To monitor progress of patient’s condition. HEALTH TEACHING 1. Encourage to take adequate rest and sleep. 2. Encourage family to be supportive and responsible to the treatment. 3. Instruct to avoid vigorous activities. 4. Instruct to report any signs of unusualities. . Encourage to verbalize feelings and thoughts. 6. Encourage patient and family members to do daily hygiene and proper hand washing. OUT PATIENT ORDERS 1. Instruct patient to follow medical treatment regimen. 2. Instruct patient and family to have follow-up check-up for the continuity of care. DIET 1. Encourage to increase oral fluid intake and eat nutritious foods. Promote avoidance of eating foods that may contribute to the severity of the condition. R:To promote good health and boost immune system. 2. Instruct patient not to skip meals and follow prescribed diet. SPIRITUALITY . Emphasize the importance of keeping strong faith in God. Date Generic NameBrand NameClassificationDosage/RouteIndicationMechanism of actionAdverse ReactionNursing Consideration Domperidone Motilium GI Regulators Anti- inflammatory antimetic 5 ml PODomperidone blocks the action of dopamine. It has strong affinities for the D2 and D3 dopamine receptors which are found in the chemoreceptor trigger zone, located just outside the blood brain barrier, which – among others – regulates nausea and vomiting (area postrema on the floor of the fourth ventricle and rhomboid fossa).

Drowsiness, extrapyramidal reactions, galactorrhoea, gynaecomastia; constipation or diarrhoea, lassitude, decreased libido, skin rash, itch. Potentially Fatal: Convulsions, arrhythmias and cardiac arrest, dysrrhythmias in patients with CV diseaseShould be taken on an empty stomach. (Take 15-30 mins before meals. ) DateGeneric NameBrand NameClassificationDosage/ RouteIndicationMechanism of actionAdverse ReactionNursing Consideration Ranitidine Zantac Anti-ulcer 35 mg IVTT

It is used to treat and prevent ulcers, to treat gastroesophageal reflux disorder (GERD), and to treat conditions associated with excessive acid secretion. Ranitidine blocks the action of histamine on stomach cells, and reduces stomach acid production. Ranitidine is useful in promoting healing of stomach and duodenal ulcers, and in reducing ulcer pain. Ranitidine has been effective in preventing ulcer recurrence when given in low doses for prolonged periods of timeMinor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting.

Major side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyesefore using this medication, tell your doctor or pharmacist your medical history, especially of: heartburn combined with lightheadedness or sweating or dizziness, chest pain or shoulder/jaw pain especially with shortness of breath, pain spreading to arms or neck or shoulders, unexplained weight loss, liver or kidney problems, porphyria, other stomach problems (e. g. , tumors), any allergies (including drug allergies).

Smoking helps cause ulcers and can prevent healing. Smoking should be avoided. Alcohol can irritate the stomach and cause bleeding. Consult your doctor. Tell your doctor if you are pregnant before taking this drug. DateGeneric NameBrand NameClassificationDosage/ RouteIndicationMechanism of actionAdverse ReactionNursing Consideration Paracetamol Calpol Anti-inflammatory Antypyretic 250/5mg 1tbspindicated in diseases manifesting with pain and fever: headache, toothache, mild and moderate postoperative and injury pain, high temperature, infectious diseases and chillsParacetamol possesses prominent antipyretic and analgesic effects.

Its anti-inflammatory activity is weak and has no clinical significance. The mechanism of action is related to depression of the prostaglandin synthesis by inhibition of the specific cell cyclooxygenase, and depression of the thermoregulatory center in the medulla oblongata. In rare cases hypersensitivity reactions, predominantly skin allergy (itching and rash), may appear. Long-term treatment with high doses may cause a toxic hepatitis with following initial symptoms: nausea, vomiting, sweating, and discomfort. Occasionally a gastrointestinal discomfort may be seen.

The preparation should be used with care in patients with liver and renal diseases. The treatment with Paracetamol may change the laboratory tests of uric acid and blood glucose analysis. In severe renal failure the interval between two consecutive takings should not be shorter than 8 hours. The treatment with the preparation is not advisable during the first trimester of the pregnancy. In nursing women the preparation should be used with strictly observation of the therapeutic dose and duration of the treatment. X. SYNTHESIS OF CLIENT’S CONDITION/STATUS FROM ADMISSION TO PRESENT

Patient’s Prognosis CRITERIA POOR 1 FAIR 2 GOOD 3 JUSTIFICATION Duration of illness v Lejuu Naspo has been diagnosed with acute gastroenteritis with dehydration and it was detected early before it leads to further complication. Onset of illness v Lejuu Naspo’s illness has detected early. Age ? Gastroenteritis is common esp. in children. Willingness to take medications vLejuu Naspo religiously takes his medication. Lifestyle ? Lifestyle is fair in the sense that Lejuu Naspo is still eating foods even he hasn’t know how the food was prepared (canteen etc… ) Family Support Family support is extensive during the hospitalization even in monetary matters Computation: Poor – 1 x 1= 1 Fair – 1 x 2= 2 Good – 4 x 3 = 12 1 + 2+ 12= 15/6 = 2. 5; Good Prognosis The general prognosis of our patient case study is considered to be good because summing up to all the given categories base in judgment, most of them was under in good category. Although there is fair duration of diagnosis, it is countered by the outlook and willingness to take medications. The family support, we ranked it as good because his family is always on his side supporting on his needs. A. Recommendations

We recommend further investigation on this case of a patient with Acute Gastroenteritis with Dehydration, in relation to the disturbances in fluid and electrolytes. With this, we recommend that the future researchers will exert more effort in discovering means of helping a client of the same situation not just for the sake of nursing care but for showing that truly, Marian student nurses are the heart of health care. A more thorough assessment is recommended to be able to come up with a more precise care plan. Health teachings are also recommended to be emphasized with a client that was experiencing the same situation with our client. XI.

EVALUATION OF THE OBJECTIVES OF THE STUDY B. Conclusion Throughout the study, we the presenters were able to present most of the accumulated information we have about our patient’s case, a patient with Acute gastroenteritis with dehydration and use this information as a tool to extend quality nursing care to be able to alleviate the present situation of the client. The conclusion is evidenced by: •Presentation of the importance of nurse’s therapeutic and interpersonal communication skills in establishing and developing a trusting patient-nurse relationship that will facilitate gathering of data and formulation of an effective plan of care. Presentation of the personal data, family background, socio-economic background and the medical and health history of the patient. •Presentation and discussion of the anatomy and physiology thoroughly related to the disease process. •Tracing the underlying pathophysiology of Acute Gastroenteritis with Dehydration and in the process will unravel facts on how this certain condition relate to each other and how this affect the normal functioning of the body. •Presentation of the actual and ideal laboratory results, diagnostic examinations and its clinical significance. Presentation and enumeration of the drugs given to the patient; its uses, pharmacologic effects and clinical significance. •Presentation of the actual and ideal medical and nursing management. •Prioritization and formulation of nursing care plans applicable to the identified health problems. •Identification of the ideal and actual prognosis of the case. •Summarization and evaluation of the case study.

XII. BIBLIOGRAPHY A. BOOKS Black, Joyce M. , Hawks, Jane Hokanson. Medical – Surgical Nusing: Clinical Management for Positive Outcomes. 8th Ed. Elsevier (Singapore) Pte Ltd. 2009. Doenges, Marilynn E. Moorhouse, Mary Frances, and Murr, Alice C. Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. 11th Ed. F. A. Davis Company, Philadelphia, Pennsylvania. 2008. Dillon, Patricia M. Nursing Health Assessment: A Critical Thinking, Case Studies Approach. 2nd Ed. F. A. Davis Company, Philadelphia. 2007. Pillitteri, Adele. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 5th Ed. Vol. 2. Lippincott Williams & Wilkins. 2007. B. INTERNET www. doh. gov. ph C. OTHERS Deglin, Judith Hopfer, Vallerand, April Hazard. Davis’s Drug Guide for Nurses. 11th Ed. F. A. Davis Company. 2009.

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