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Acute Gastroenteritis
A Case Study
In Partial Fulfillment of the Requirements in

2. Related Learning Experience 3

3. INTRODUCTION
The mucosal surface of the gastrointestinal tract is composed of a highly dynamic
population of epithelial cells that are specialized for transmembrane absorption and secretion.
This secretory and absorptive ability facilitates digestion and nutrient uptake, which must b
accomplished while keeping potentially harmful pathogens and mutagens in the lumen. The
barrier function is accomplished through both the physical integrity of the mucosal surface and
the extensive population of resident immune cells. (Harrison’s 5th
edition Principles of Internal
Medicine)
Diseases of the GI tract produce clinical consequences through physical disruption of
the mucosal layer (eg blood loss, fluid loss, pathogenic invasion) or nutritional derangements
caused by impaired digestion and nutrient absorption. Focal or localized disease processes are
more likely to disrupt mucosa ; diffuse processes are more likely to alter absorption. (Harrison’s
5th
edition Principles of Internal Medicine)
Acute Gastroenteritis Gastroenteritis is inflammation of the gastrointestinal tract,
involving both the stomach and the small intestine and resulting in acutediarrhea. The
inflammation is caused most often by infection with certain viruses, less often by bacteria or
their toxins, parasites, or adverse reaction to something in the diet or medication. Worldwide,
inadequate treatment of gastroenteritis kills 5 to 8 million people per year,and is a leading cause
of death among infants and children under 5. Acute gastroenteritis accounts for millions of
deaths each year in young children Harrison's Principles of Internal Medicine estimates the
current total figure to be 2.4 to 2.9 million per year. The global death rate has now come down
significantly to approximately 1.5 million deaths annually, mostly in developing communities. In
developed countries is as high as 1-2.5 cases per child per year and a major cause of
hospitalization in this age group. It is a common reason for presentation to general practice or
emergency departments and for admission to hospital.
The researchers of this case study have chosen to indulge in such illnesses like acute
gastroentetitis for the reasons that they would like to increase the depth of their knowledge on
this disease. As acute gastroenteritis is a common disease among children. The group have
decided to take such topic for the case study because it focused in the care for children since
they are the vulnerable persons, this would enable the student nurse to perform the
comprehensive and precise care for the patient.

4. II. NURSING ASSESSMENT
A. Personal History
To secure confidentiality, the patient would be referred as “Choy” throughout the study.
Tabatina , the mother of choy is the primary source of information. Choy is 9 months old baby
boy and a naturally born Filipino citizen affiliated to the Roman Catholic religion who lives in a
barrio in Arayat, Pampanga along with his parents and 1 sibling. He was born on June 28, 2008.
He is the youngest among two siblings. Choy was admitted on February 22, 2009 at 4pm in a
district hospital in Magalang with complaints of vomiting 5 -7 times upon admission and likewise
the day beforeadmission to the hospital. The admitting diagnosis is Acute Gastroenteritis (AGE)
and was discharged on February 24, 2009 with a final diagnosis of AGE.
B. Pertinent Family History
Choy a 9 month old baby, comes from a nuclear family composed of 4 members the
father, mother and 2 children. His parents Mrs Tabatina And Mr. Arnee has no history of AGE
his sister has likewise no history of AGE. Mrs. Tabatina has 2 children the first one is a girl who
is 5 years old and Choy. She delivered both the first and second child through normal
spontaneous delivery.
Choy lives in a barrio which has limited accessibility to the hospital. His father Bitoy work
as a precast maker to sustain the needs of their family. The family is affiliated to the Roman
Catholic Church and they don’t attend mass regularly. At present, they live in a house which has
concrete walls, sawali for the roof and flooring which is still not cemented. Her mother describes
their community as a peaceful one and her neighbours are hospitable. The family of Tabatina do
not rely on cultural practices when it comes to their health, they readily consult for medical
assistance. They have a Kapampangan culture which means most of their diet is mostly high in
salt and fat since they are known for cooking food increasing the risk in acquiring disease of the
heart and kidney problems.

5. B. Pertinent Family Health-Illness History
Legend:
(+) – deceased
(-) - not specified by the mother of the pt, none
There are no significant influences of the diseases/ illnesses of Choy’s grandparents and parents to his present condition
which is AGE and UTI. Except for the diet of the family which most likely contributes to the said condition of baby Choy.
Popeye (+) (accident) Wilma( stigmatism) Brutos Lulu
Nowei (-) Neree
(asthma)
Nina(-) Tabatina(measles,edema,
fever,cconvulsions)
Bitoy (-) Arnold
(tonsillitis)
Chay (cough and
colds, fever)
Choy (AGE & UTI)

6. Theories of Growth and Development (Client-centered)
Erik Ericson
Psychosocial Development
Trust VS Mistrust
(0-9 months)
The major emphasis for the first months of life of the infant is positive and loving care for
the child, with a big emphasis on visual contact and touch. The significant person in this stage is
the mother that responds to the infants needs and provides a secure environment for the infant,
in this stage the infant also learns to love and be loved. If he pass successfully through this
period of life, he will learn to trust that life is basically okay and have basic confidence in the
future. If he fail to experience trust and are constantly frustrated because her needs are not met,
he may end up with a deep-seated feeling of worthlessness and a mistrust of the world in
general he may view a very dangerous world. A 1-8 months old infant first year of life is vital to
be able to gain trust sin order to fulfil this the mother the significant person should be a able to
promptly respond to the infants need like feeding and sleep, he must also provide a predictable
environment in which routines is establihed and provide a secure environment.
Jean Piaget
Cognitive development
Sensorimotor
(1-12 months)
Infants as soon as they are born, they begin learning to use their senses to explore the
world around them and their behavior is entirely reflexive. Most newborns can focus on and
follow moving objects, distinguish the pitch and volume of sound, see all colors and distinguish
their hue and brightness, and start anticipating events such as sucking at the sight of a nipple. A
three months old infants can recognize faces, imitate the facial expressions of others such as
smiling and frowning and respond to familiar sounds.
A six months of age babies are just beginning to understand how the world around them
works. They imitate sounds, enjoy hearing their own voice, recognize parents, fear strangers
and base distance on the size of an object. They also realize that if they drop an object they can
pick it up again. A four to seven months infants can recognize their names.

7. A nine months, infants can imitate gestures and actions, experiment with the physical
properties of objects, understand simple words such as "no" and understand that an object still
exists even when they cannot see it. They also begin to test parental responses to their
behaviour such as throwing food on the floor they remember the reaction and test the parents
again to see if they get the same reaction.
During this period it is important to develop the senses and motor skills of an infant this
could be accomplihed through interacting and playing with the infant, it’s also important to
provide good toys like colour plastic blocks and rings etc. for sesorimotor development
Sigmund Freud
Psychosexual development
Oral Phase
(1-12 months)
Oral phase occupies the 1-12 months of a child's life. The source of pleasure in this
stage is the mouth, the infant seek the enjoyment or relief of tension as well as nourishment
during this stage the child derives pleasure initially from breast-feeding and later from sucking
things-a child in. If he is hungry it sucks, when food is not immediately available it will then cry
until its needs are satisfied. During this stage the infant should be provided oral stimulation by
giving a pacifier and do not discourage thumb sucking If a child were locked into or fixated at
this stage, he would continue to engage in behavioral activities related to oral stimulation like
thumb sucking, being talckative etc.
Anna Freud
Ego Psychology
Defense mechanisms are psychological strategies brought into play by various entities
to cope with reality and to maintain self-image. Healthy persons normally use different defenses
throughout life. ego defense mechanism becomes pathological only when its persistent use
leads to maladaptive behavior such that the physical and/or mental health of the individual is
adversely affected. The purpose of the Ego Defence Mechanisms is to protect the mind/self/ego
from anxiety, social sanctions or to provide a refuge from a situation with which one cannot
currently cope. A 1-9 month old infant show fear of strangers and usually cries when other hold
them, also in this stage a increase of separateness infant experiences anxiety when the
mothers leavesThey also begin to test parental responses to their behaviour such as throwing

8. food on the floor they remember the reaction and test the parents again to see if they get the
same reaction.
Immunization
Baby Choy is already vaccinated with 1 BCG, 3 OPV, 3 DPT, 3 Hepa B and measles.
His mother makes sure that Choy is vaccinated on schedule and goes to the health center to
avoid the preventable diseases.
4. HISTORY OF PAST ILLNESS
Baby Choy has been hospitalized for three times already with the same chief complaint
which is vomiting. For the minor conditions such as fever, mild diarrhea, cough and colds which
were managed at home by his mother such as having bed rest and increasing fluid intake and if
necessary goes to the nearby Barangay health center for medical assistance and checkups.
5. HISTORY OF PRESENT ILLNESS
February 21, 2009 Baby Choy vomited 5 to 7 times and on the next day February 22,
2009 he started to have diarrhea, also which impelled her mother to confine her to the nearest
Hospital in their place because of frequent vomiting and diarrhea that could not be manage. He
was admitted at 4 pm on the same day and there was given the initial interventions in the
hospital and further examination and diagnostic procedures like complete blood count and stool
exam and urinalysis were done which led to the admitting medical diagnosis of acute
gastroenteritis and UTI.

9. DIAGNOSTIC AND LABORATORY PROCEDURES
The CBC is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a
panel of tests that examines different parts of the blood and includes the following:
 White blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood. Both increases and
decreases can be significant.
 White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells,
each with its own function in protecting us from infection. The differential classifies a person's white blood cells into each type:
neutrophils (also known as segs, PMNs, grans), lymphocytes, monocytes, eosinophils, and basophils.
 Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and
decreases can point to abnormal conditions.
 Hemoglobin measures the amount of oxygen-carrying protein in the blood.
 Hematocrit measures the percentage of red blood cells in a given volume of whole blood.
 The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal
conditions of excess bleeding or clotting. Mean platelet volume (MPV) is a machine-calculated measurement of the average
size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being
produced. MPV gives your doctor information about platelet production in your bone marrow.
 Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs
are larger than normal (macrocytic), for example in anemia caused by vitamin B12 deficiency. When the MCV is decreased,
your RBCs are smaller than normal (microcytic) as is seen in iron deficiency anemia or thalassemias.
 Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red
blood cell. Macrocytic RBCs are large so tend to have a higher MCH, while microcytic red cells would have a lower value.
 Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin inside a red
cell. Decreased MCHC values (hypochromia) are seen in conditions where the hemoglobin is abnormally diluted inside the

10. red cells, such as in iron deficiency anemia and in thalassemia. Increased MCHC values (hyperchromia) are seen in
conditions where the hemoglobin is abnormally concentrated inside the red cells, such as in burn patients and hereditary
spherocytosis, a relatively rare congenital disorder.
 Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs. In some anemias, such as
pernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes
an increase in the RDW.

11. Diagnostic
Laboratory
Procedures
Date ordered:
Date results in:
Indication or
Purpose
Results Normal
Values
Analysis &
Interpretation
Of Results
Complete Blood
Count
Hemoglobin
`
Date ordered:
February 23. 3009
Date results in:
February 23, 2009
 This was used to
evaluate the pt.’s
hemoglobin content
(and thus the iron
status and oxygen-
carrying capacity).
 Measures grams of
hemoglobin found in
deciliter of whole
blood. Hemoglobin
concentration
correlates closely
with RBC count
.
12.6 mg% 12-16 mg% Client’s hemoglobin level is
within the normal range
which indicates that there is
an enough oxygenation on
the blood.

12. White blood cells
Date ordered:
February 23. 3009
Date results in:
February 23, 2009
 This blood test
evaluates a number
of conditions and
differentiates causes
of alteration in total
WBC count
including
inflammation and
infection since
immune system of
the patient is
compromise. It is
done to evaluate
presence of
infection.
5,700/cu.mm 10,000-
25,000/cu.mm
Client’s WBC is below
normal. This indicates
presence of infection.
.

13. Hematocrit
Date ordered:
February 23. 3009
Date results in:
February 23, 2009
 Measures the volume
of RBCs in whole
blood expressed in
%.
 Value also tells
whether the blood is
too thick or too thin.
 Aid in diagnosis of
abnormal states of
hydration
38 vol% 37-47 vol%
Client’s Hematocrit level is
within normal range which
indicates there is enough
RBC in patient’s body and
there is no presence of
dehydration

14. Diagnostic
Laboratory
Procedures
Date ordered:
Date results in:
Indication or
Purpose
Results Normal
Values
Analysis &
Interpretation
Of Results
Lymphocytes Date Ordered:
February 23, 2009
Date results in:
February 23, 2009
Used to determine
viral infection which
may be caused by
opportunistic
microorganisms due
to decrease
immunity of the
patient. This test is
also use to
determine if the
body is producing
antibodies against
the infection.
33 % 25-40 The result shows
that there is
increase number of
lymphocytes, thus
increasing the
number of
antibodies to be
use as body
defenses. Viral
infection is present.

15. Diagnostic
Laboratory
Procedures
Date ordered:
Date results in:
Indication or
Purpose
Results Normal
Values
Analysis &
Interpretation
Of Results
Segmenters Date Ordered:
February 23, 2009
Date results in:
February 23, 2009
Measures
percentage of
neutrophils to the
total number of
leukocytes
responsible for
phagocitisizing
foreign bodies.
20% 50-70% Neutrophils, being
the first line of
defense of wbc’s
have already
decreased from
normal level which
may indicate that
infection is taking
place.

16. Diagnostic
Laboratory
Procedures
Date ordered:
Date results in:
Indication or
Purpose
Results Normal
Values
Analysis &
Interpretation
Of Results
Eosinophils Date Ordered:
February 23, 2009
Date results in:
February 23, 2009
 Eosinophils are
used to test for
allergic reactions
and the body’s
response to
parasitic
diseases.
2% 1-4% The result is within
normal range and
indicates that there
are enough
eosinophils in the
patient’s body.

17. NURSING RESPONSIBILITIES (Complete Blood Count)
Before the test:
 Check Doctors order
 Explain the purpose and procedure of CBC to the SO of the patient
 Tell the SO that the patient may feel discomfort from the needle puncture and blood is withdrawn into a capillary tube.
 Ensure the specimen/blood sample is not taken from the hand or arm that has an intravenous line in the vein because of the
dilution effect on the red blood cells concentration.
 Plan to obtain the specimen when the patient is calm and physically still.
 Refer to the other member of the Health Care team
During the test:
 Use aseptic technique when obtaining the sample
 Send the sample to the laboratory as soon as possible to avoid stasis and to allow early separation of the serum from the
clotted blood.
 Send the sample to the laboratory as soon as possible to avoid stasis and to allow early separation of the serum from the
clotted blood.
After the test:
 Apply pressure or a pressure dressing to the venipuncture site to prevent bleeding.
 Check the venipuncture site for bleeding
 Immediately label the specimen.

18. Diagnostic
Laboratory
Procedures
Date ordered:
Date results in:
Indication or
Purpose
Results Normal
Values
Analysis &
Interpretation
Of Results
Fecalysis Date Ordered:
February 23, 2009
Date results in:
February 23, 2009
 Help to diagnose
certain conditions
affecting the
digestive tract
 Help find the cause
of symptoms
affecting the
digestive tract
 To determine the
presence of
parasitic worm in
the GI tract of the
patient
Color : Yellowish
Consistency:
Soft
Fat Globulin:
Few
No OVA /
Amoeba seen
Color: brown
Consistency: formed
Bacteria: none
Fat Globulin:
Normal
Bacteria:
Normal
No OVA / Amoeba
seen:
Normal

19. NURSING RESPONSIBILITIES (Fecalysis)
Before the test:
 Check doctors order
 Explain to the SO the purpose and the procedure of fecalysis
 Usual aseptic technique
 Try to collect the freshest stool possible
 Take a small piece of stool with the wooden applicator
 Provide clean specimen cup
 Refer to the other member of the Health Care team
During the test:
 Collect the stool in a clean specimen cup
 Report the consistency of the stool sample: Formed, semi-formed, soft or watery.
 Report the visible presence of blood, mucus or parasites. Look for adult worms of Ascaris lumbricoides or Trichuris trichuria.
After the test:
 Immediately label the specimen.
 Remove gloves and wash hands.
 Record the client’s name, the test performed and disposition of the specimen collected criteria.

20. Diagnostic
Laboratory
Procedures
Date ordered:
Date results in:
Indication or
Purpose
Results Normal
Values
Analysis &
Interpretation
Of Results
Urinalysis Date Ordered:
February 23, 2009
Date results in:
February 23, 2009
This was order
for the patient in
order to screen
for renal or
urinary tract
diseases and to
determine
metabolic or
systemic disease
related to renal
disorder.
Color:
yellowish
Transparency:
Clear
Sugar:
Negative
Albumin:
Trace
pH:
Acidic
Specific Gravity: 1
Pus Cells:
Color: Pale yellow
to deep amber
Transparency:
Clear
Sugar: Negative
Albumin: Negative
pH: 5.5-6.5
Specific Gravity:
1.001-1.025
Pus Cells:
0-1/hpf
Mucus Thread: few
Concentrated
Transparency:
Normal
Sugar:
Normal
Albumin:
Normal
pH:
Normal
Pus Cells:
Few
Mucus thread:

21. 2-5/hpf
Mucus Thread:
Few
Normal
NURSING RESPONSIBILITIES (Urinalysis)
PRIOR
 Check the doctor’s order.
 Determine the prescribed test and other restrictions prior to the test.
 Get the laboratory requisition slip.
 Explain to the patient what the procedure to be done is.
 Inform the patient that this requires a urine sample.
 Inform the patient how the procedure is performed, the equipment to be used.
DURING
 Explain to the patient what test should be done.
 Prepare all the equipments to be used.
 Encourage the patient to remain calm during the test.
 Assist the patient.
 Ensure a urine sample from the patient.

22. AFTER
 Send the urine sample to the laboratory immediately.
 Prevent contamination to the samples.
 Secure it properly and label it before giving to the laboratory.
 Proper documentation.

23. Physical Examination:
February 22, 2009 (Day of admission)
Vital Signs:
T=37.1°C
PR=150bpm
RR=46bpm
Physical Examination lifted from the chart: 2 days PTA (+) intractable vomiting
1 day PTA (-) vomiting persisted
also with body malaise
weight: 10.5 kg
Skin: (-) pallor
HE ENT: Dry lips and buccal mucousa
C/L: Clear B.S
Heart: (-) murmurs
Abd: (-) organomegaly
Full pulse
February 24, 2009--First day of Nurse-Patient Interacion
Vital Signs:
T=36.9°C
PR=120bpm
RR=38bpm

24. SKIN
He has a white complexion with evenly distributed hair. He has a good skin
turgor as evidenced by when the skin was lifted at the abdomen, the skin goes back to
its previous state.
HAIR
He has short-hair, black in color, uncombed, dry, and equally distributed on
scalp area, there is no infestation noted.
NAILS
He has untrimmed dirty fingernails. His nails are quite rough and but have a
good curvature. The nail base is firm and adhises to the bed capillary refill time of
approximately 2 seconds upon performing Blanch test.
SKULL AND FACE
His skull is round and normocephalic with no tenderness, lumps, nodules and
masses noted upon palpation. He also has symmetrical facial features and movements
as evidenced by his ability to raise eyebrow, smile. Anterior and posterior fontanels are
already closed.
EYES AND VISION
The eyebrows and eyelahes are evenly distributed and are symmetrically aligned
with equal movements. Eyelids have intact skin with discharges (morning glory) and
no discoloration noted. They also close symmetrically. The bulbar conjunctivas are
transparent and capillaries are sometimes evident but no presence of nodules or lesions.
The sclera also appears clear. His palpebral conjunctiva is slightly pale. No edema or
lesions noted upon the inspection of lacrimal sac and nasolacrimal duct. Cornea is
transparent, shiny and smooth and details of iris are visible. The client blinks when
cornea is touched by cotton which means that he has an intact cranial nerve 5

25. (trigeminal). Iris is round, brown in color and equal in size. Illuminated and non-
illuminated pupils are equally round and reactive to light accommodation (PERRLA).
EARS AND HEARING
His tip of ears is aligned to the outer cantus of the eye. There is presence of wet
cerumen which is dark brown in color inside the ear canal. No deformities or
inflammation noted and auricles are smooth, firm and not tender upon palpation. The
pinna recoils after it is folded and normal voice tone audible as evidenced by responding
when called by his name.
NOSE
Client’s nasal septum is intact and at the midline with no tenderness and lesions
noted upon inspection. Each nostril is not occluded by discharges and doesn’t have
difficulty of breathing.
MOUTH AND OROPHARYNX
The lips are moist and slightly dark in color with no lesions noted. The client was
able to purse his lips which indicate an intact cranial nerve 7 (facial) function. He has no
gingivitis and no evidence of dehydration. His teeth have spaces in between and are
not yet complete. The tongue is slightly pink in color and moist with thin whitish coating.
Both the hard and soft palates are light pink on color and the uvula is positioned in
midline of soft palate upon inspection.Tonsils are pink and smooth with no discharges
noted and are normal in size. Gag reflex is present upon pressing the posterior tongue
with tongue depressor.
NECK
Head is on the center upon inspection and no swelling or enlargement of lymph
nodes. The trachea is in the midline of neck and spaces are equal on both sides. The

26. thyroid gland is not visible on inspection and ascends during swallowing but not still
visible. Lobes are small, smooth, centrally located, painless, and rise freely with
swallowing upon palpation. He was able to flex, hyperextend, laterally flex and laterally
rotate the head and can move side to side, up and down.
THORAX AND LUNGS
The spine is vertically aligned and straight. Chest is uniform in color and has a
warm temperature. It expands symmetrically and no tenderness or masses upon
palpation. There is no presence of abnormal breath sounds and with regular rate and
rhythm.
HEART
He hasnormal heart rate, no murmurs noted upon auscultation.
ABDOMEN
He has unblemihed skin, rounded abdomen. With normal bowel sounds.
UPPER AND LOWER EXTREMITIES
The skin is uniform in color with no contractures or deformities. Muscles on both
sides of the body are equal in size. There are no lesions, tenderness or swelling and no
jaundice and cyanosis. He has dry skin and uniform temperature upon palpation.

27. III. ANATOMY AND PHYSIOLOGY
The Digestive System
The gastrointestinal system (GI) system is a long, hollow tube that passes through the
body providing an isolated environment for digestion and absorption of the nutrients.
Ingested contents pass sequentially through the mouth, esophagus, stomach, small
intestine and large intestine before exiting the body at the anus.

28. A. The Oral Cavity
Plays a role in digestion, speech, and breathing. Digestion begins when food
enters the mouth. Teeth break down food and the muscular tongue pushes food back
toward the pharynx, or throat. Three salivary glands- sublingual, submandibular and
parotid gland secrete enzymes that partially digest food into a soft, moist, round lump.
Muscles in the pharynx swallow the food, pushing into the esophagus, a muscular tube
that passes food into the stomach. The epiglottis prevents food from entering the
trachea, or windpipe during swallowing.
B. The Esophagus
The presence of food in the pharynx stimulates swallowing, which squeezes the
food into the esophagus. The esophagus, a muscular tube about 25 cm long, passes
behind the trachea and heart and penetrates the diaphragm before reaching the
stomach. Food advances through the alimentary canal by means of rhythmic muscle
contractions known as peristalsis. The process begins when circular muscles in the
esophagus wall contract and relax one after the other, squeezing food downward toward
the stomach. Food travels the length of the esophagus in two or three seconds.
C. The Stomach
•Anatomy of the Stomach
The stomach is an enlarged segment of the
digestive tract in the left superior part of the abdomen.
The opening from the esophagus into the stomach is
called the cardiac opening because it is near the heart.
The region of the stomach around the cardiac opening
is called the cardiac region. The most superior part of
the stomach is the fundus. The largest part of the
stomach is the body, which turns to the right, forming a
greater curvature on the left, and a lesser curvature on
the right. The opening from the stomach into the small

29. intestine is the pyloric opening, which is surrounded by a relatively thick ring of smooth
muscle called the pyloric sphincter. The region of the stomach near the pyloric opening
is the pyloric region.
The muscular layer of the stomach is different from other regions of the digestive
tract in that it consists of three layers: an outer longitudinal layer, a middle circular layer,
and an inner oblique layer. These muscular layers produce a churning action in the
stomach, important in the digestive process. The submucosa and mucosa of the
stomach are thrown into large folds called rugae when the stomach is empty. These
folds allow the mucosa and submucosa to stretch, and the folds disappear as the
stomach is filled.
The stomach is lined with simple columnar epithelium. The mucosal surface
forms numerous tubelike gastric pits which are the openings for the gastric glands. The
epithelial cells of the stomach can be divided into five groups. The first group consists of
surface mucous cells on the inner surface of the stomach and lining the gastric pits.
Those cells produce mucus, which coats and protects the stomach lining. The remaining
four cell types are in the gastric glands. They are mucous neck cells, which produce
mucus; parietal cells, which produce hydrochloric acid and intrinsic factor; endocrine
cells, which produce regulatory hormones; and chief cells, which produce pepsinogen, a
precursor of the protein-digesting enzyme pepsin.
•Secretions of the Stomach
The stomach functions primarily as storage and mixing chamber for ingested
food. As food enters the stomach, it is mixed with stomach secretions to become a semi
fluid mixture called chyme. Although some digestion and a small amount of absorption
occur in the stomach, they are not its principal functions.
Stomach secretions from the gastric glands include mucus, HCl, pepsinogen,
intrinsic factor, and gastrin. A thick layer of mucus lubricates and protects the epithelial
cells of the stomach from the damaging effect of the acidic chyme and pepsin. Irritation
of the stomach mucosa stimulates the secretion of a greater volume of mucus.
Hydrochloric acid produces a pH of about 2.0 in the stomach. Pepsinogen is converted
by HCl to the active enzyme pepsin. Pepsin breaks covalent bonds of protein to form

30. smaller peptide chains. Pepsin exhibits optimum enzymatic activity of a pH of about 2.0.
The low pH kills microorganisms. Intrinsic factor binds with Vitamin B12 and makes it
more readily absorbed in the small intestine. Vitamin B12 is important in DNA synthesis
and is important in RBC production. Gastrin is a hormone that helps regulate stomach
secretions.
D. The Small Intestine
•Anatomy of the Small Intestine
The small intestine is about 6
meters long and consists of three
parts: the duodenum, jejunum and
ileum. The duodenum is about 25 cm
long. The jejunum is about 2.5 m
long and makes up two-fifths of the
total length of the small intestine. The
ileum is about 3.5 m long and makes up three-fifths of the small intestine.
The duodenum nearly completes a 180-degree arc as it curves within the
abdominal cavity. Part of the pancreas lies within this arc. The common bile duct from
the liver and the pancreatic duct from the pancreas join each other and empty into the
duodenum.
The small intestine is the major site of digestion and absorption of food, which
are accomplished by the presence of a large surface area. The surface of the small
intestine has three modifications that increase surface area about 600-fold: the circular
folds, villi and microvilli. The mucosa and submucosa form a series of circular folds that
run perpendicular to the long axis of the digestive tract. Tiny fingerlike projections of the
mucosa form numerous villi, which are 0.5-1.5 mm long. Most of the cells composing the
surface of the villi have numerous cytoplasmic extensions called, microvilli. Each villus is
covered by simple columnar epithelium. Within the loose connective tissue core of each
villus is a blood capillary network and a lymphatic capillary called lacteal. The blood
capillary network and the lacteal are very important in transporting absorbed nutrients.

31. The mucosa of the small intestine is simple columnar epithelium with four major
cell types: (1) absorptive cells, which have microvilli, produce digestive enzymes and
absorb digested food; (2) goblet cells, which produce a protective mucus; (3) granular
cells, which may help protect the intestinal epithelium from bacteria; and (4) endocrine
cells, which produce regulatory hormones.
The epithelial cells are produced within tubular glands of the mucosa, called
intestinal glands, at the base of the villi. Granular and endocrine cells are located in the
bottom of the glands. The submucosa of the duodenum contains mucous glands, called
duodenal glands, which open into the base of the intestinal glands.
The duodenum, jejunum and ileum are similar in structure except that there is a
gradual decrease in the diameter of the small intestine, in the thickness of the intestinal
wall, in the number of the circular folds, and in the number of villi as one progresses
through the small intestine. Lymph nodules are common along the entire length of the
digestive tract. Clusters of lymph nodules, called Peyer’s patches, are numerous in the
ileum. These lymphatic tissues in the intestine help protect the intestinal tract from
harmful microorganisms.
The junction between the ileum and the large intestine is the ileocecal junction. It
has a ring of smooth muscle, the ileocecal sphincter, and ileocecal valve, which allows
material contained in the intestine to move from the ileum to the large intestine, but not
in the opposite direction.
•Secretions and Absorption in the Small Intestine
Secretions from the mucosa of the small intestine mainly contain mucus, ions
and water. Intestinal secretions lubricate and protect the intestinal wall from the acidic
chime and the action of the digestive enzymes. They also keep the chime in the small
intestine in the liquid form to facilitate the digestive process. Most of the secretions
entering the small intestine are produced by the intestinal mucosa, but the secretions of
the liver and the pancreas also enter the small intestine and play important roles in the
digestive processes.

32. The epithelial cells in the walls of the small intestine have enzymes to their free
surfaces that play a significant role in the final steps of digestion. Peptidases break the
peptide bonds in proteins to form amino acids. Disaccharidases break down
disaccharides into monosaccharides. The amino acids and monosaccharides can be
absorbed by the intestinal epithelium.
Mucus is produced by duodenal glands and by goblet cells, which are dispersed
throughout the epithelial lining of the entire small intestine and within intestinal glands.
Hormones released from the intestinal mucosa stimulate liver and pancreatic secretions.
Secretion by duodenal glands is stimulated by the vagus nerve, secretin release, and
chemical or tactile irritation of the duodenal mucosa.
A major function of the small intestine is the absorption of nutrients. Most
absorption occurs in the duodenum and jejunum, although some absorption also occurs
in the ileum.
E. The Large Intestine
•Anatomy of the Large Intestine
The large intestine
consist of cecum, colon, rectum
and anal canal.
Cecum
The cecum is the
proximal end of the large
intestine and is where the large
and small intestines meet at the
ileocecal junction. The cecum is
located in the right lower
quadrant of the abdomen near
the iliac fossa. The cecum is a sac that extends inferiorly about 6 cm past the ileocecal
junction. Attached to the cecum is a tube about 9 cm long called the appendix.

33. Colon
The colon is about 1.5-1.8 m long and consists of four parts: the ascending
colon, the transverse colon, the descending colon, and the sigmoid colon. The
ascending colon extends superiorly from the cecum to the right colic flexure, near the
liver, where it turns to the left. The transverse colon extends from the right colic flexure
to the left colic flexure near the spleen, where the colon turns inferiorly; and the
descending colon extends from the left colic flexure to the pelvis, where it becomes the
sigmoid colon. The sigmoid colon forms an S- shaped tube that extends medially and
the inferiorly into the pelvic cavity and ends at the rectum.
The mucosal lining of the colon contains numerous straight tubular glands called
crypts, which contain many mucus-producing goblet cells. The longitudinal smooth
muscle layer of the colon does not completely envelope the intestinal wall but forms
three bands called teniae coli.
Rectum
The rectum is a straight, muscular tube that begins at the termination of the
sigmoid colon and ends at the anal canal. The muscular tunic is smooth muscle and it is
relatively thick in the rectum compared with the rest of the digestive tract.
Anal Canal
The last 2-3 cm of the digestive tract is the anal canal. It begins at the inferior
end of the rectum and ends at the anus. The smooth muscle layer of the anal canal is
even thicker than that of the rectum and forms the internal anal sphincter at the superior
end of the anal canal. The external anal sphincter at the inferior end of the anal canal is
formed by skeletal muscle.
•Functions of the Large Intestine
Normally 18-24 hours is required for material to pass through the large intestine
in contrast to the 3-5 hours required for movement of chyme through the small intestine.

34. While in the colon the chyme is converted to feces. Absorption of water and salts, the
secretion of the mucus, and extensive action of microorganisms are involved in the
formation of feces. The colon stores the feces until they are eliminated by the process of
defecation.
DEFENITION OF THE DISEASE
Gastroenteritis
Gastroenteritis is a condition that causes irritation and inflammation of the stomach and
intestines (the gastrointestinal tract). An infection may be caused by bacteria or
parasites in spoiled food or unclean water. Some foods may irritate your stomach and
cause gastroenteritis. Lactose intolerance to dairy products is one example.
Many people who experience the vomiting and diarrhea that develop from these types of
infections or irritations think they have “food poisoning," which they may, or call it
"stomach flu," although influenza has nothing to do with it.
Travelers to foreign countries may experience “traveler's diarrhea" from contaminated
food and unclean water.
The severity of infectious gastroenteritis depends on your immune system’s ability to
resist the infection. Electrolytes (these include essential elements of sodium and
potassium) may be lost as you vomit and experience diarrhea.
Most people recover easily from a short bout with vomiting and diarrhea by drinking
fluids and easing back into a normal diet. But for others, such as babies and the elderly,
loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening
illness unless the condition is treated and fluids restored.
Gastroenteritis has many causes. Viruses and bacteria are the most common. The
infectious agents can come from outside your body or internally from some abnormal
condition. For example, both normal and disease-causing intestinal bacteria may grow
when antacids or other medication alter the stomach acidity.
Viruses and bacteria are very contagious and can spread through contaminated food or
water. In up to 50% of diarrheal outbreaks, no specific agent is found. Improper
handwashing following a bowel movement or handling a diaper can spread the disease
from person to person.
Gastroenteritis caused by viruses may last 1-2 days. On the other hand, bacterial cases
can last a week or more.
 Bacteria: These are the most common bacterial causes: Escherichia coli -
Traveler’s diarrhea, food poisoning, dysentery, colitis, or uremic syndrome,
Salmonella - Typhoid fever; handling poultry or reptiles such as turtles that carry

35. the germs, Campylobacter - Undercooked meat, unpasteurized milk, Shigella –
Dysentery.
 Viruses: Viral outbreaks (30-40% of cases in children) can spread rapidly
through close contact among children in day care and schools. Poor
handwashing habits can spread viruses. Common viral causes include the
following: Adenoviruses, Rotaviruses, Caliciviruses, Astroviruses, Norovirus
(formerly called Norwalk-like virus or NLV) and Norwalk virus, Norovirus.
 Parasites and protozoans: These tiny organisms are less frequently
responsible for intestinal irritation. You may pick up one of these by drinking
contaminated water. Swimming pools are common places to come in contact
with these parasites. Common parasites include these: Giardia - The most
frequent cause of waterborne diarrhea causing giardiasis, Cryptosporidium -
Affects mostly people with weakened immune systems, causes watery diarrhea
 Other common causes: Chemical toxins most often found in seafood, food
allergies, heavy metals, antibiotics, and other medications also may be
responsible for bouts of gastroenteritis that are not infectious to others.
Medications
 Aspirin
 Nonsteroidal anti-inflammatory medicines (such as Motrin or Advil)
 Antibiotics
 Caffeine
 Steroids - Excessive use or a sudden change in frequency or
dosage
 Laxatives
Inability to tolerate the sugar lactose in milk and milk products such as
cheese and ice cream
Exposure to heavy metals sometimes present in drinking water
 Arsenic
 Lead
 Mercury

36. IV. PATHOPHYSIOLOGY
(Book-Centered)
Non- Modifiable Modifiable
Age- children below 5y/o & elderly Environment
Antibiotic Therapy
Food Handling
Increase motility Microorganisms attach and enter mature enterocytes serotonin release
of intestines at the tips of small intestinal villi
stimulates chemoreceptor
PAIN Structural changes to the small bowel mucosa and trigger zone
& BORBORYGMIA inflammation of the lamina propria
VOMITING
BACTEREMIA Bacteria invades blood stream across lamina propria INCREASE WBC

37. Mucosal Cell Destruction Bacteria releases endotoxin Releases pyrogens that stimulates
hypothalamus
BLOODYSTOOLS Increase amount of diarrheal Fluid FEVER
Active Secretion of Chloride Inhibition of Na & water reabsorption
& Bicarbonate Ions
DIARRHEA

38. SCHEMATIC DIAGRAM (Client Centered)
Non- Modifiable Modifiable
> Age (5 years old) >Environment
> Eating Habits
Stimulates trigger zone Microorganisms attach and enter mature enterocytes
at the tips of small intestinal villi
Vomiting (2/22/09) Structural changes to the small bowel mucosa and
inflammation of the lamina propria
M.O. invades blood stream across lamina propria INCREASE LEUCOCYTES
(02/23/09)
Bacteria releases endotoxin

39. Increase amount of diarrheal Fluid
Active Secretion of Chloride Inhibition of Na & water reabsorption
& Bicarbonate Ions
Soft, yellowish DIARRHEA
(4 diapers a day) (2/22/09, 2/23/09)

40. PREDISPOSING & PRECIPITATING FACTORS
PREDISPOSING FACTORS:
a.) Age
Different body systems mature as age increases. Infants and adults are more
likely to develop such diseases since their body processes are either immature or
degenerating.
b.) Sex
Male toddlers are more prone to have acquired gastroenteritis. Males usually
play outside their house compare to girls who usually stay at home.
PRECIPITATING FACTORS:
a.) Poor Environmental Sanitation
The environment plays a vital role in our health. An unhygienic or poor
environmental condition is not conducive to live in because it may lead to acquiring such
disease.
b.) Eating Habits
A person who frequently eats street foods and junk foods is at risk of having
Gastroenteritis thus it can also be acquired by eating unwashed fruits and vegetables,
raw eggs and those that are contaminated by the fecal oral route.
c.) Lack of Education
Due to lack of education, buyers are no longer thinking whether the food that
they buy are nutritious or not and the no longer care whether the food they are eating
are clean or not
SIGNS AND SYMPTOMS WITH RATIONALE
a.) Diarrhea
Pathogens cause gastric inflammation by releasing enterotoxins that stimulate the
mucosal lining of the intestines, resulting in greater secretion of water and electrolytes in
the intestinal lumen which may cause fluid and electrolyte imbalance.
c.) Nausea or vomiting
In intestinal disorders, nausea results from the distention of the duodenum.
Vomiting occurs from changes in the integrity of the intestinal wall or from changes in the
motility of the bowel (such as caused by an obstruction). Vomitus that contains fecal
matter usually indicates a distal obstruction in the small intestines.
g.) Dehydration

41. Dehydration happens when there is frequent vomiting, diarrhea and excessive
sweating.
h.) Dry skin and Buccal Mucosa
Because of frequent vomiting and dehydration, the membranes and skin tends to
be dry.
Enterotoxin

42. MEDICAL MANAGEMENT
MEDICAL
MANAGEMENT/
TREATMENT
DATE ORDERED
DATE
PERFORMED
DATE CHANGED
GENERAL
DESCRIPTION
INDICATION(s)
PURPOSE(s)
CLIENT’S
RESPONSE TO
TREATMENT
D5,0.3NaCl
500ml
DO: February 22,
2009
DP: February 22,
2009
Intravenous Fluids are sterile.
Introduced directly into the
vein. The type of which and
regulation depends upon the
fluid needs of the patients.
D5, 0.3 NaCl is a solution in
5% dextrose and 0.3 % NaCl
in 500ml of water
It is given to the patient to
maintain the fluid status and
serves as a route for
administration of IV medications.
Primarily it is given to replace
lost fluids in the body.
The patient maintained a
normal hydration status as
evidence by good skin
turgor and moist skin.
NURSING RESPONSIBILITIES

43. BEFORE:
 When inserting an IV line to the patient, always prepare all the materials to be used.
 Wash hands thoroughly before performing the procedure.
 Identify the correct patient by checking the name on the chart or by asking directly the patient.
 Explain the procedure to the patient.
 Prepare the materials needed.
DURING:
1. Count drops per minute in drip chamber.
2. Adjust IV clamp as needed and recount drop per minute.
3. Inspect for any inflammation.
4. Provide comfort during insertion.
AFTER:
 Monitor patient’s therapeutic response to treatment.
 Check the IV infusion site for signs of infiltration: bulging, heat, pain, and redness.

44. B. DRUGS
Name of drugs Date ordered/ date
stopped/ date given/ date
change
Route of administration/
dosage and frequency of
administration
General action/
classification/ mechanism
of action
Indication/ initial reaction/
purpose
Cefuroxime
Paracetamol
DO: February 22, 2009
DP: February 22, 2009
DO: February 22, 2009
DP: February 22, 2009
1gm IV q 8 ANST
150mg IV if temp is >38.5
Antibiotic
Inhibits bacterial cell wall
synthesis by binding to
one or more of the
penicillin-binding proteins
antipyretic/analgesic
Inhibits the synthesis of
prostaglandins in the
central nervous system
and peripherally blocks
pain impulse generation;
produces antipyresis from
inhibition of hypothalamic
For prophylaxis against
the occurrence of
secondary infections
Indicated if pt temp
reaches >38.5

45. heat-regulating center

46. Nursing Responsibilities for Medication:
Preparing the client:
 Check the written order for completeness. It should include the drugs name, dosage, frequency and duration of the therapy.
 Check to see if there are any official circumstances surrounding
 Perform sensitivity teting
 Administration of the dose to the patient
 Know the expected action, safe dosage range, special instruction for administration and adverse effects associated with drug effect
 Prepare the need equipment like the medication card and water. Wash your hands
 Prepare the dosage as ordered
 Check the label on the medication three times before administering any drug
 Do not prepare a dosage of medication which is discarded precipitate is contaminated
Performing the procedure
 Administer slowly as the medication may cause burning sensation
 Check the proper dosage
After the procedure
 Watch out for side effects

47. Name of Drugs Date Ordered Route Dosage and
Frequency of
Administration
General Action Indication(s) or
Purpose(s)
Client’s response to
the medication with
actual side effects
Generic Name:
Metoclopramide
Brand Name:
Plasil
Date Ordered:
February 22, 2009
DP: February 22,
2009
150 mg IV q 6 hours (-
) ANST
Action:
Metoclopramide, a
dopamine antagonist,
stimulates motility of the
upper gastrointestinal
tract without stimulating
gastric, biliary or
pancreatic secretions.
Its mode of action is
unclear. It seems to
sensitize tissues to the
action of acetylcholine.
The effect of
metoclopramide on
motility is not dependent
on intact vagal
innervation but it can be
abolished by
To stop the vomiting of
the pt
The patient side
effects such as:
headache
and restlessness
Response of the
patient:
There was a change in
the patient’s
Gastrointestinal tone.

48. anticholinergic drugs.
Metoclopramide
increases the tone and
amplitude of gastric
(especially antral)
contractions, relaxes
the pyloric sphincter
and the duodenum and
jejunum, resulting in
accelerated gastric
emptying and intestinal
transit. It increases the
resting tone of the lower
esophageal sphincter
General Classification:
Antiemetic and
Antivertigo

49. Nursing Responsibilites: Plasil
Prior:
 Check for the doctor’s order.
 Assess if the patient has hypersensitivity to drug.
 Tell the patient to avoid activities that require alertness for 2 hours after doses.
During:
 Urge patient to report persistent or serious adverse reactions promptly.
 Monitor the patient’s bowel sounds.
 Assess and monitor the patient’s heart rate.
After:
 Monitor if there is a decrease in the patient’s neutrophil and granulocyte count.
 Check if there is an increase in the aldosterone levels.

50. C. DIET
During the Date of Admission, patient is for NPO temporarily.
NURSING RESPONSIBILITIES
PRIOR:
• Check doctor’s order to determine the kind of diet
• Identify patient, instruct S.O. or mother when diet is changed.
Type of Diet
Date Ordered
Date Started
Date Changed
General
Description
Indication or
Purpose
Specific Foods
Taken
Client’s Response
DAT
Pt. is allowed to
drink and eat
soups. Essential
nutrients may be
taken.
To help the patient
have a strong body
while it is
compensating with
the disease.
Breastfed and
bottle-feeding was
indicated
The client was able to
have strong body while
trying to cope up with
the current situation.

51. DURING:
• Explain to S.O. the prescribed diet
• Educate the S.O. on the purpose of the diet and it’s implication
D. EXERCISE
TYPE OF EXERCISE
DATE ORDERED
DATE PERFORMED
DATE CHANGED
GENERAL
DESCRIPTION
INDICATION CLIENT’S RESPONSE
TO ACTIVITY
Rest periods with
accompaniment from
SO
DO: February 22, 2009 Pt. Should be with the
SO to prevent falls and
help recover from illness
To promote wellness
and recovery
Pt. SO complied with the
order.
NURSING RESPONSIBILITIES:
1. Explain the reason to the SO, rationale and aims of the said exercise.

52. NURSING CARE PLANS
Problem #1: Diarrhea
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTIONS
RATIONALE EXPECTED
OUTCOME
S:Ø
O:The patient
manifested:
-Passed loose
stools 5-7
times
-changes
diapers about
4-5 times a
day
The patient
may manifest:
-Dehydration
Diarrhea r/t
infectious
processes
Diarrhea may result
from a variety of
factors, including
intestinal absorption
disorders, increased
secretion of fluid by
the intestinal mucosa,
and hypermotility of
the intestine.
Problems associated
with diarrhea, which
when acute includes
fluid and electrolyte
imbalance, and
altered skin integrity.
Short term:
After 2-4 hours
of nursing
interventions
the patient or
the SO will
verbalize
understanding
on ways to
manage
resolution of
causative
factors
Long term:
After 2-3 days
of nursing
interventions
the patient will
re-establish
improvements
in bowel
functioning
-Assess for
frequency and
urgency of loose or
liquid stools and
hyperactive bowel
sensations.
- Assess hydration
status, I&O, skin
turgor and the
moisture of
mucous
membrane.
-Change diapers
immediately after
the infant has
defecated.
-Wash the skin of
the diaper area
well after each
-To ascertain
onset and pattern
of diarrhea noting
whether acute or
chronic. To be
able to report
pain associated
with episode.
-Diarrhea can
lead to profound
dehydration and
electrolyte
imbalance.
- Diarrheal stool is
extremely irritating
to the skin.
- To prevent it
from further
irritation.
Short term:
After 2-4 hours
of nursing
interventions
the patient or
the SO shall
have
verbalized
understanding
on ways to
manage
resolution of
causative
factors
Long term:
After 2-3 days
of nursing
interventions
the patient
shall have re-
established
improvements
in bowel
functioning

53. stool.
-increase the
client’s fluid intake
- Limit foods
containing
insoluble fiber,
such as whole
wheat and whole
grain breads and
cereals. Limit fatty
and spicy foods.
- Restrict solid food
intake or eating
small amounts can
be done.
-Ingest foods with
sodium and
potassium. Most
foods contain
sodium. Potassium
is found in meat
and many
vegetables and
- To prevent
dehydration.
-Certain foods
are difficult to
digest. This
inability results in
digestive upsets
and in some
instances the
passage of
watery stool.
- This allows
bowel rest and
reduces intestinal
workload.
- To maintain
electrolyte
balance.

54. fruits.
-Review results of
laboratory listings
on stool specimen.
- Explain
importance of
maintain proper
nutrition and
hydration. Teach
importance of fluid
replacement during
diarrheal episodes.
Explain rationale
and intended effect
of treatment
program.
-To asses if there
is the presence of
blood, infection
and to determine
the causative
factors.
-Patients need to
understand the
importance of
drinking extra fluid
during hours of
diarrhea, fever
and other
conditions
causing fluid
deficits. Fluid
prevents
dehydration.

55. Problem #2: Presence of infection
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTIONS
RATIONALE EXPECTED
OUTCOME
S = ø
O = The
patient
manifested the
following:
-urinalysis
results of:
Albumin: trace
Pus cells: 2-
5/hpf
PRESENCE
OF
INFECTION
related to the
disease
condition
SHORT TERM:
After 2-3 hours
of Nursing
Interventions,
the SO will
verbalize
understanding
of the
interventions to
reduce risk of
infection
LONG TERM:
After 1-2 days
of Nursing
Interventions,
the So will
demonstrate
techniques and
-Assess patient’s
condition
-monitor and
record VS
-note risk factors
for the occurrence
of infection
-stress proper
hand washing
techniques
-instructed to
maintain adequate
hydration
-to assess
causative factors
-to have a
baseline data
-to assess
contributing
factors
-to reduce
existing causative
factors
-to avoid
SHORT
TERM:
After 2-3 hours
of Nursing
Interventions,
the SO shall
have
verbalized
understanding
of the
interventions to
reduce risk of
infection
LONG TERM:
After 1-2 days
of Nursing
Interventions,
the So shall

56. lifestyle
changes to
promote a safe
environment for
the patient
-encourage to
provide regular
perineal care
-administer
medications as
ordered
dehydration
-to avoid irritation
of the child’s
genitals and
decrease the risk
for secondary
infection
-to counteract the
presence of
infection
have
demonstrated
techniques and
lifestyle
changes to
promote a safe
environment
for the patient

57. Problem #3: Risk for bowel incontinence
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTIONS
RATIONALE EXPECTED
OUTCOME
S= As
verbalized by
the S.O. “6
times neng
megbawas
kanyan.”
O= The patient
manifested the
ff:
- Reddened
perineal area
-Passed
loosed and
watery stool for
6 times
-Fecal odor
Risk for
bowel
incontinence
related to
chronic
diarrhea
Normal control of
bowel movements
depends on proper
functioning of the
colon and rectum, the
muscles surrounding
the anus (anal
sphincter muscles),
the brain and the
body's nerves (the
nervous system), plus
the amount and
consistency of waste
products produced.
Bowel or fecal
incontinence is the
loss of voluntary
control of stool, or
bowel movements.
This condition can
vary from being
partial, in which a
person loses only a
Short term:
After 4 hours of
nursing
interventions
the SO will
demonstrate
ways to
prevent bowel
incontinence
Long term:
After 3 days of
nursing
interventions
the patient will
maintain a
regular pattern
of bowel
functioning.
-Note stool
characteristics,
color, odor,
consistency,
amount and
frequency.
- Encourage
increase in fluids.
- Palpate
abdomen.
- Provide perineal
care.
- Record times at
which
incontinence
-Provides
comparative
baseline.
- To prevent
dehydration.
- To monitor
abdominal
distention,
masses and
tenderness.
- To prevent
excoriation of the
area.
- To note
relationship to
meals, activity
Short term:
After 4 hours
of nursing
interventions
the SO will
demonstrate
ways to
prevent bowel
incontinence
Long term:
After 3 days of
nursing
interventions
the patient will
maintain a
regular pattern
of bowel
functioning.

58. small amount of liquid
waste, to complete, in
which the entire solid
bowel movement
cannot be controlled.
occur.
-Inquire
medications
patient is taking.
- Inquire about
tolerance to milk
and other dairy
products.
- Give
antidiarrheal drugs
and clients’
behavior.
-Laxatives and
antibiotics may
cause diarrhea.
- Patients with
lactose
intolerance have
insufficient
lactase, the
enzyme that
digests lactose.
The presence of
lactose in the
intestines
increases
osmotic pressure
and draws water
into the intestinal
lumen.
- Most
antidiarrheal

59. as prescribed.
-Test stool for
blood.
- Culture stool
drugs suppress
GI motility thus
allowing for more
fluid absorption.
- To determine
presence of
bleeding.
- Testing will
identify causative
organisms.

60. Problem #4: Risk for deficient fluid volume
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTIONS
RATIONALE EXPECTED
OUTCOME
S=ø
O> The patient
manifested the
ff:
- -slightly pale
palbebral
conjunctiva
-diarrhea with
a frequency of
5-7 times a day
-Vomited more
than four times
upon
admission
Risk for
deficient fluid
volume
related to
active fluid
loss
The composition of
body fluids remains
relatively constant
despite the many
demands placed on
the bodyeach day. On
occasion, these
demands cannot be
met,and electrolytes
and fluids must be
given in an attemptto
restore equilibrium.
If the body is
becoming fluid-
deficient, there will be
an increase in the
secretion of these
hormones, causing
fluid to be retained by
the kidneys and urine
output to be reduced.
In illness, the situation
is more complex. Fluid
Short term:
After 4 hours of
nursing
interventions
the SO will
verbalize
understanding
on ways to
prevent
deficient fluid
volume
Long term:
After 3 days of
nursing
interventions
the patient will
demonstrate
maintenance of
hydration
status thus
- Obtain patient
history to ascertain
the probable
cause of the fluid
disturbance.
- Assess and
monitor weight
daily and
consistently,
preferably at the
same time of the
day.
- Evaluate fluid
status in relation to
dietary intake.
- This can help to
guide
interventions.
- Facilitates
accurate
measurement
and follow trends.
- Most fluid enters
the body through
drinking, water in
foods, and water
formed by
oxidation of
foods.
Short term:
After 4 hours of
nursing
interventions
the SO shall
have
verbalized
understanding
on ways to
prevent
deficient fluid
volume
Long term:
After 3 days of
nursing
interventions
the patient
shall have
demonstrated
maintenance of

61. may also be lost
through vomiting and
diarrhea. An individual
is at an increased risk
of dehydration in
these instances, as
the kidneys will find it
more difficult to match
fluid loss by reducing
urine output (the
kidneys must produce
at least some urine in
order to excrete
metabolic waste.)
decreasing the
risk for
deficient fluid
volume
- Assess skin
turgor and mucous
membrane.
- Assess color and
amount of urine.
- Monitor
temperature.
- Teach
interventions to
prevent future
episodes of
inadequate intake.
- For signs of
dehydration.
-Concentrated
urine denotes
fluid deficit.
- Febrile states
decrease body
fluids through
perspiration and
increased
respiration.
- To understand
the importance of
drinking extra
fluid during bouts
of diarrhea, fever,
and other
conditions
causing fluid
deficits.
hydration
status thus
decreasing the
risk for
deficient fluid
volume

62. - Monitor serum
electrolytes and
urine osmolality.
- For hypovolemia
due to severe
diarrhea or
vomiting
administer
antidiarrheal or
antiemetic
medications as
prescribed.
- Administer
parenteral fluid as
ordered.
- Elevated
hemoglobin and
elevated blood
urea nitrogen
suggest fluid
deficit.
- This allows
more effective
fluid
administration
and monitoring.
- Parenteral fluid
replacement is
indicated to
prevent shock.

63. Problem #5: Risk for imbalanced nutrition: less than body requirements
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTIONS
RATIONALE EXPECTED
OUTCOME
S=ø
O> The patient
manifested the
ff:
-slightly pale
palbebral
conjunctiva
-Passed
loosed and
watery stool for
6 times
-decreased
appetite
-always cry
Risk for
imbalanced
Nutrition:
less than
body
requirements
related to
inability to
digest food
and absorb
nutrients
Poor nutrition includes
both dietary excesses
and imbalances.
Imbalanced nutrition
can result from eating
less food, eating an
unbalanced diet, or
from a disease. Any
illness or long term
condition affect how
often, how much, and
what foods we eat.
Short term:
After 4 hours of
nursing
interventions
the patient will
have
demonstrate
changes in
behavior to
regain weight.
Long term:
After 3 days of
nursing
interventions
the patient will
have
demonstrate
progressive
weight gain.
- Determine ability
to chew, taste and
swallow food.
-Assess weight,
age, body build,
strength, and
activity.
- Note total daily
intake. Maintain
diary of caloric
intake, patterns
and times of
eating.
-Promote
adequately and
timely fluid intake.
- To monitor
factors that may
affect ingestion or
digestion of
nutrients.
- To evaluate
degree of deficit.
-To reveal
changes that
should be made
in client’s dietary
intake.
-Limiting fluids
one hour prior to
meal decrease
possibility of early
satiety.
Short term:
After 4 hours of
nursing
interventions
the patient
shall have
demonstrated
changes in
behavior to
regain weight.
Long term:
After 3 days of
nursing
interventions
the patient
shall have
demonstrated
progressive
weight gain.

64. -Avoid foods that
cause intolerances
and may increase
gastric motility.
-To prevent
occurrence of
diarrhea.

65. Problem #6: Rediness for enhanced fluid volume
ASSESSMENT NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTION
S
RATIONALE EXPECTED
OUTCOME
S=ø
O= Pt
manifested:
-Good skin
turgor
-Food and
intake
adequate for
daily needs
Readiness
for enhanced
fluid volume
Good skin turgor
is one of the
manifestation of
improved fluid
status of a patient
and was able to
increase fluid
intake. Thus an
improved fluid
status is a
manifestation for
readiness for
enhanced fluid
volume.
SHORT TERM
After 3 hours of
NI, SO will be
able to verbalize
understanding on
the health
teachings given.
LONG TERM
After 2 days of
NI, SO will be
able to
demonstrate
behavior to
monitor child’s
fluid balance.
-Assessed Pt
condition
-Monitor I/O
-Weigh Pt and
compare with
recent weight
history
-Encourage
regular oral
intake
-Administered
medication as
ordered
-To gain baseline
data
-To ensure
accurate picture of
fluid status
-Provides baseline
for future
monitoring
-To maximize
intake and maintain
fluid balance
-Medication is
indicated to prevent
fluid imbalance if
individual becomes
sick.
SHORT TERM
After 3 hours of
NI Pt SO shall
have verbalized
understanding on
the health
teachings given.
LONG TERM
After 2 days of
NI Pt SO shall
have
demonstrated
behavior to
monitor fluid
balance.

66. CLIENT’S DAILY PROGRESS CHART
DAYS 2-22-09 2-23-09 2-24-09
NURSING PROBLEMS
 Diarrhea
 Presence of infection
 Risk for deficient fluid
volume
 Risk for imbalanced
Nutrition: less than body
requirements
 Risk for bowel
incontinence
 Readiness for enhanced
fluid volume
*
*
*
*
*
*
*
*
*
* *
VITAL SIGNS
Temperature
Heart Rate
Resp. Rate
37.1 °C
150bpm
46bpm
36.9°C
120bpm
38bpm

67. DIAGNOSTICS / LABORATORY
PROCEDURES
 Complete Blood Count
(CBC)
 Fecalysis
 Urinalysis
*
*
*
MEDICAL MANAGEMENT
IVF’S
 D5 0.3 NaCl
DRUGS
 Cefuroxime
 Paracetamol
 Metoclopramide
*
*
*
*
*
*
*
DIET
 NPO Temp.
 DAT
*
* *
ACTIVITY/EXERCISE
(no precautions)

68. DISCHARGE PLANNING
a. General Condition of the Client upon Discharge
Lifted from the physician’s discharge notes were: MGH, he patient is active,
playful, has normal body temperature; and the stool is soft and formed in appearance
and no vomiting. Generally, he is afebrile and prepared for home management and
maintenance.
b. method
S - Ǿ
O – received pt. lying on bed, conscious and awake, with an IVF of D5, 0.3NaCl, 500cc,
at 100cc level, regulated at 23-24 ugtts/min, infusing well on the right foot, with vital
signs taken and recorded as follows: T = 36.9 °C, PR = 120, RR = 38
A – Readiness for enhanced therapeutic regimen management
P – After 4 hours of NI, pt. SO will verbalize understanding of health teachings given and
assume responsibility of managing treatment regimen
I –
M – No medications prescribed
E – Encouraged pt. SO to provide adequate rest periods after play
T – No medications prescribed
H – Encouraged pt. SO to provide safe environment to prevent accidents
O – Instructed pt. SO for follow up checkup after a week
D – Instructed pt. SO to provide a well balanced diet

69. CONCLUSION
The success of preventing and treating child with AGE depends largely with
patient’s significant person, their mothers since they are the one who is taking care of
their child, it is important to educated and equip them with basic knowledge to manage
AGE. Thus it is essential for the nurse’s to provide knowledge and give health teachings
on how to take care of the children and to perform procedures to manage.
Moreover, the role of the mother facing an illness and disease is vital they are
usually to provide the first treatment such as home remedies. Active participation of the
patients significant others accompanied by adequate knowledge on the disease process
and therapeutic management is a vital component in the effectiveness of the treatment
regimen and assists the child to restoration of health.
The nurse’s role in the maintenance of health can make a difference even if
burdened and preventing illness and promotion of health. In this time where in health
care is expensive that we sometimes could not be afford, a simple but effective solution
is promotion of health and preventing disease.
As student nurses, we are tasked to learn the different interventions that should be
given in a client who has acute gastroenteritis in order for us to provide our clients with
the necessary care that they need. Furthermore, we must raise the awareness of the
public regarding this disorder in order to lessen the possible occurrence of such
condition.

70. RECOMMENDATION
We may be too young to do such extensive research, yet it does not follow that we
are excused of the responsibility. We, as student nurses should take part in knowing
what we ought to know, in teaching what we know and more in doing what we teach.
The group would like to recommend this case study, to mothers to have a broaden
understanding of the disease condition, update with the current information and help
reflect upon the mothers daily habits and there children
To all nurses, proper nursing management must be administered to help patient
cope with his/her condition. Health teachings should be given in order for a patient to
realize the effects of his/her disease/condition. Nurse, therefore, should also check and
correct the lifestyle of the patient to lessen the occurrence of such disease.
The student nurses also recommend that nurses should also master the use of
effective communication skill in order to provide health teachings. We must always bear
in mind that as nurses, the heart and soul of nursing is the promotion of health which can
only be done through educating the people. But health education would be impossible
without effective communication.
LEARNING DERIVED
“Prevention is better than cure”. This quote shows that each of us should take the
responsibility of taking care of the child health by adhering in the treatment regimen that
is given and by directly consulting to the health care providers in times of the occurrence
of disease. From this case study, we have learned that the practices and management
of the parents mostly mothers affects the health of their children since they are the one
to uncharged of taking care of the child. There must be proper health maintenance in
order to alleviate or improve one’s condition. It will not only rely on the care given by the
health care providers but also the care given by mothers.
As what we all know that the prevalence of acute gastroenteritis among chlidren.
AGE being a cause of serious consequences, had a very complicated processing and

71. with that we should exert an extraordinary effort in order to fully understand it and at the
same time, we are able to practice analytical thinking and reasoning as well. Upon doing
this case study, we are able to develop a student nurse-patient relationship and be able
to understand different life situations. Aside from that, this study helps us in entertaining
a new perspectives regarding the disease condition and developing our nursing and
managerial skills for the interventions. It also gave us the opportunity to widen our
clinical skills that would contribute to the development of the quality of nursing rendered
to patients and be globally competitive enough.
VI. BIBLIOGRAPHY
Books:
Diagnostic Tests. Lippincott Williams and Wilkins: Philadelpia, 2006
Pilliteri, Adel, Maternal and Child Health Nursing 5th
Edition. Lippincott, 2007
Seeley, Stephens, Tate. Essential Anatomy and Physiology6th edition. New York: Mc
Graw Hill.
Brunner, L. and Suddarth, B. 2008Textbook of Medical-Surgical Nursing. (11th
edition).
J.B. Lippincott Company; Philadelphia.
Meg Gunlanick, PhD,RN Judith L. Myers, MSN, RN Audrey KloppPhD, RN,CS, ET NHA,
DeidraGradishar, RNC BS Nursing Care Plans Nursing Diagnosis and
Interventions Mosby Company fifth edition
Internet
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http://en.wikipedia.org/wiki/Ondansetron

72. http://www.businessballs.com/erik_erikson_psychosocial_theory.htm
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http://ourworld.compuserve.com/homepages/pete_wren/freud.htm#oral
http://www.medscape.com/ anti-emetics for vomiting children and adolescent with acute
gastroenteritis
http://en.wikipedia.org/wiki/ Defence mechanism
http://www.surgeryencyclopedia.com/Ce-Fi/Complete-Blood-Count.html
http://www.drgecko.com/fecalexams.htm
http://www.answers.com/topic/gastroenteritis
http://www.answers.com/topic/gastroenteritis-causes-and-symptoms
http://www.answers.com/topic/gastroenteritis-prevention
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