INTRODUCTIONAcute Gastroenteritis Acute Gastroenteritis is inflammation of the gastrointestinal tract , involving both the stomach and the small intestine and resulting in acute diarrhea . The inflammation is caused most often by infection with certain viruses , less often by bacrteria or their toxins , parasites or adverse reaction to something in the diet or medication.
Different species of bacteria can cause gastroenteritis, including Salmonella , Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia , and others. Each organism causes slightly different sympto ms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present. Some types of acute gastroenteritis will not resolve without antibiotic treatment, especially when bacteria or exposure to parasites are the cause. Physicians may want to diagnose the cause by analyzing a stool sample, when stomach symptoms remain
PATIENT’S PROFILE: Name : A. P. Age : 26 years old Sex : Male Nationality : Indian Status : Single Religion : Hindu Weight : 71Kg. Date Admitted : 2012/11/18 Chief Complaint: abdominal pains, nausea and vomiting, watery stools Admitting Diagnosis: Acute Gastroenteritis
PAST HEALTH HISTORY The patient use to have typical cough, colds and fever and never had experienced major illness that required hospitalization. He does not have any known allergies to food or drugs.PRESENT HEALTH HISTORY Two days prior to admission, the patient experienced persistent loose watery bowel movement accompanied by vomiting, abdominal pains and fever.
ANATOMY AND PHYSIOLOGY The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body has to break the food down into smaller molecules that it can process; it also has to excrete waste. Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body. The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store digestive chemicals.
The Digestive Process: The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller molecules).
On the way to the stomach: the esophagus After being chewed and swallowed, the food enters the esophagus. The esophagus is a long tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat into the stomach. This muscle movement gives us the ability to eat or drink even when were upside-down.
In the stomach The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the stomach that is partly digested and mixed with stomach acids is called chyme.In the small intestine After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.
In the large intestine After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water and electrolytes (chemicals like sodium) are removed from the food. Many microbes in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon.
The end of the process Solid waste is then stored in the rectum until it is excreted via the anus.
Pathophysiology: The mechanisms potentially responsible for viral diarrhea include lysis of enterocytes, interference with the brush border function that leads to malabsorption of electrolytes, stimulation of cyclic adenosine monophosphate (CAMP), and carbohydrate malabsorption. For bacterial gastroenteritis, the pathophysiology involves the elaboration of toxin by enterotoxigenic pathogens and the invasion and inflammation of mucosa by invasive pathogens. Parasitic organisms invade epithelial cells and cause villus atrophy and eventual malabsorption.
Signs and Symptoms Low grade fever to 100°F (37.8°C) Nausea with or without vomiting Mild to moderate diarrhea Crampy and painful abdominal bloatingMore serious symptoms include: Blood in vomit or stool Vomiting more than 48 hours Fever higher than 40°C Swollen abdomen or abdominal pain Dehydration that is manifested by weakness, light-headedness, decreased and concentrated urination, dry skin and poor turgor, and dry lips and mouth
Diagnostic Tests: Blood test Physical examination to rule other existing conditions such as appendicitis
Nursing implications: Monitor therapeutic effectiveness. Discontinue if there is no improvement after 48 hours of therapy for acute diarrhea. Monitor fluid and electrolyte balance. Notify physician promptly if the patient with ulcerativecolitis develops abdominal distention or other GI symptoms
2. Generic Name: Hyoscine ButylBromide Brand Name: Buscopan Classification: Antispasmodic Uses: Spastic states and to prevent nausea and vomiting
Adverse Effects: Overdose may produce temporary paralysis of ciliary muscle; papillary dilation; tachycardia; palpitations; hot, dry, or flushed skin; absence of bowel sounds; hyperthermia; increased respiratory rate; EKG abnormalities; nausea; vomiting; rash over face or upper trunk; CNS stimulations; and psychosis (marked by agitation, restlessness, rambling speech, visual hallucinations, paranoid behavior, and delusions, followed by depression).
Nursing implications: Use cautiously in patients with autonomic neuropathy, hyperthyroidism, coronary artery disease, arrhythmias, heart failure, hypertension, hiatal hernia with reflux esophagitis, hepatic or renal disease, known as suspected GI infection, or ulcerative colitis. Use cautiously in children. Use cautiously in patients in hot or humid environments; drug can cause heat
Assessment Nursing Planning Interventions Evaluation DiagnosisSubjective: Acute After 4 hours of 1. Place patient on After 4 hours of“My abdomen is pain related nursing a comfortable nursingvery painful!” as to abdominal interventions, position interventions, the patient will the patientpatient claimed. distension. 2. Monitor and report a relief reported relief-with pain scale of from pain as record VS from abdominal6/10 manifested by a 3.Assess patient’s pains calm facial level of pain - no facialObjective: expression. 4. Provide warm grimace abdominal compress over the - calm facial cramping abdominal area expression irritability 5. Administer -Pain scale of holds medications as 0/10 abdomen ordered facial grimace
Assessment Nursing Planning Interventions Evaluation DiagnosisObjective: Deficient fluid After 8 hours of 1. Establish rapport After 8 hours of passage of loose volume RT excessive nursing 2. Monitor and nursing watery stool losses through interventions, record VS interventions, the patient will the patient nausea normal routes AMB 3.Assess patient’s report reported Vomiting frequent passage of understanding of condition understanding of abdominal loose watery stool causative factors 4. Monitor Input causative factors cramping for fluid volume & Output balance for fluid volume Poor skin turgor deficit 5. Maintain deficit adequate - good skin turgor weakness hydration, - no vomiting noted increase fluid intake. 6. Provide frequent oral care 7. Administer Intravenous fluids as prescribed 8 Restrict solid food intake, as indicated