course materials

1. Gastroenteritis Discussion
Gastroenteritis DiscussionGastroenteritis DiscussionThe purpose of this paper is to define
Gastroenteritis and its involvement in the health and wellness of patient Baby K. Baby K is
14 months of age and presents with vomiting, diarrhea, and severe abdominal pain. On
assessment it is noted that the patient ingested improperly stored milk custard.
Staphylococcus aureus is suspected.Gastroenteritis effects both the gastric mucosa of the
stomach and the intestines in the inflammatory process causing each to appear red,
inflamed, and edematous (Hubert & VanMeter, 2018). Anorexia, nausea, vomiting, and
diarrhea are present with Gastroenteritis and vary in severity. Anorexia, or loss of appetite,
often precedes nausea which is stimulated by inflammation or irritation of the digestive
tract. The sensation of nausea often is paired with increase sweating and salivation. It is said
that the increase in salivation helps lubricate the esophagus before vomiting occurs.
Vomiting, or emesis, is the forceful expulsion of stomach and sometimes intestinal contents
to include stomach acids and ingested materials. Diarrhea is an excessive number of
frequent stools that are usually thin consistency. The loss of fluids in the stool can
contribute to dehydration, electrolyte imbalances, acidosis, and malnutrition. Diarrhea is
typically associated with nausea and vomiting with inflammation and irritation is present in
the digestive tract (Hubert & VanMeter, 2018). Gastroenteritis DiscussionCausative
FactorsMultiple causative agents exist for acute onset of Gastroenteritis, but most causes
are of infectious etiology. A foodborne infection typically manifests as a combination of
nausea, vomiting, diarrhea, and abdominal discomfort. If a foodborne illness is suspected,
identifying the particular food exposure and timing of symptoms can be informative in
determining the pathogen. Foodborne pathogens such as Staphylococcus aureus cause
illness within hours of ingestion whereas other pathogens may take up to seven days to
show symptoms (LaRocque & Harris, 2019).Patient Baby K presents with vomiting,
diarrhea, and severe abdominal pain. It is believed that the patient ingested poorly kept
custard. The suspicion of Staphylococcus aureus is plausible because foods not cooked after
handling such as custards, pastries, and sandwiches are highly susceptible to be
contaminated with Staph (CDC, 2020). As mentioned, the incubation period is 2-4 hours on
average and manifests as sudden severe nausea, vomiting, abdominal cramps, and diarrhea
(Hubert & VanMeter, 2018). Knowing that baby K ingested custard and the time in which
the food was ingested will help solidify Staphylococcus aureus as a causative
agent.Hypovolemia/DehydrationThe APRN working in pediatrics will often come in contact
with patients experiencing gastrointestinal upset such as with Gastroenteritis like baby K

2. due to the increase risk of hypovolemia (dehydration) in infants and children. This
increased risk is due to the higher prevalence of Gastroenteritis in children versus adults,
the infant’s higher volume of insensible losses, and the infant’s inability to communicate
their need for increased fluids (Somers, 2020). Severe nausea, vomiting, and diarrhea need
to be corrected quickly to avoid severe dehydration and other clinical complications
associated with extreme fluid loss. Signs of dehydration in an infant can be measured as
mild, moderate, or severe and will need to be determined as part of the initial assessment
plan. Signs of dehydration that will need to be assessed for severity will include pulse,
systolic blood pressure, rate of respirations, buccal mucosa, anterior fontanelle (if age
appropriate), eyes, skin turgor and temperature, urine output, and systemic signs such as
activity level, increased thirst, and tear production (Somers, 2020). Gastroenteritis
DiscussionFluid ReplacementAssessment of volume depletion aids in determining the
appropriate route to rehydrate and replenish volume. Laboratory testing will include serum
sodium, serum potassium, serum bicarbonate, and urine concentration levels.
Hypernatremia levels may be present due to insensible water losses causing greater loss of
fluids than sodium often found in infants; however, diarrhea cause by gastroenteritis may
lead to isonatremia as fluid and sodium are normally lost equally. Infants with
gastroenteritis will commonly experience hypokalemia due to the loss of potassium in the
diarrheal stool as well as a low serum bicarbonate concentration for the same reason. A
higher urine concentration is present in hypovolemic patients due to most fluid loss taking
place through the gastrointestinal tract (Somers, 2020).Whether the rehydration takes
place as oral rehydration therapy (ORT) or via intravenous (IV) therapy (depending on
severity), the electrolytes will need to be replaced. More severe cases will require 2-step IV
therapy for fluid replenishment. The first step is to increase volume alone through the use
of isotonic solution or 0.9% normal saline. This therapy is more rapid to increase volume. It
is recommended that isotonic solution is used for fluid replacement in infants and children
with hypovolemia due to Gastroenteritis that have normal sodium levels. The second step of
rehydration will be to focus on volume and on electrolytes and may be done via IV or ORT.
Hypertonic solutions will be more appropriate for patients with lower serum levels and
should be given at a slower rate as to avoid rebound effects. If ORT is being used, fluids such
as Pedialyte are recommended for use until the patient can return to normal volume and
electrolyte status (Somers, 2020). Gastroenteritis DiscussionResponse 2Hepatitis B and
CirrhosisHepatitis is the inflammation of the liver which can be idiopathic such as with a
fatty liver, local infection due to viral hepatitis, an infection at various locations within the
body, or can be caused by chemicals or drug toxicity. The effects of hepatitis on the body
varies, and can result in mild or severe inflammation and necrosis. Mild inflammation
impairs hepatocyte function and severe inflammation may lead to obstruction of blood and
bile flow in the liver, causing an impairment of liver cell function (Hubert and VanMeter,
2018). The case study that will be discussed is J.B., a 35 year old with chronic hepatitis B for
nine years, with an unknown origin of acute infection.ORDER NOW FOR ORIGINAL,
PLAGIARISM-FREE PAPERSPurpose StatementThere are several types of hepatitis,
including Hepatitis A, B, C, D, and E. Hepatitis can also be caused by chemical exposure at
the workplace, such as carbon tetrachloride, toluence, or ethanol or from drug toxicity,

3. including large amounts of acetaminophen, halothane, phenothiazines, and tetracycline.
Exposure to these chemicals and drugs can cause inflammation and necrosis of the liver
(Hubert and VanMeter, 2018). The purpose of this case study is to discuss the
pathophysiology, signs and symptoms, and treatment recommendations for hepatitis
B.Pathophysiology of acute hepatitis B infectionHepatitis B is a double-stranded DNA virus,
and the whole virion is referred to as Sane particle, consisting of two core antigens, HBcAg
and HBeAG, and one surface antigen, HBsAg. The antigens cause a stimulation of the
antibody production in the body which is useful for diagnosing and managing the virus. The
incubation period of hepatitis B is about two months, but individuals can be asymptomatic
and still remain contagious, which is referred to as a carrier state. There is a lag time of
development of symptoms or serum markers which prevents detection of the virus, but it
can still be transmitted to others. Hepatitis can be transferred by contact with infected
blood such as during a blood transfusion, body secretions, and intravenous drug use, sexual
contact, and hemodialysis, passage to the fetus during pregnancy, tattooing, and body
piercing. Health care providers are at an increased risk of contracting hepatitis B from
treating infected patients (Hubert and VanMeter, 2018). Gastroenteritis
DiscussionTreatment measuresAt the time of exposure, there are no recommendations for
treatment for the virus. Individuals are treated for their symptoms, but usually medications
are not initiated for the infection. There is no cure for hepatitis B, but there are treatment
options for the symptoms to assist with protecting the liver. Individuals are encouraged to
refrain from alcohol and tobacco and certain hepatotoxic medications, and to see their
health care provider regularly or liver specialist. Medications that are used to treat hepatitis
B are immune modulators to boost the immune system and antivirals to stop the replication
of the virus in order to reduce inflammation and damage to the liver (Hepatitis B
Foundation, 2020). Treatment with medications is not generally implemented until there
are signs of acute liver disease. Regular monitoring and evaluation of the individual is
pertinent in the form of physical exams, blood tests, and imaging studies to manage the
virus.Signs of the preicteric and icteric stages of acute hepatitis B infectionDuring the
preicteric or prodromal stage, the liver becomes inflamed, liver enzymes become elevated,
and the individual may report right upper quadrant abdominal pain. The stage is
characterized by a gradual onset of anorexia, malaise, and fatigue. During the icteric stage,
the individual may experience liver tenderness and jaundice, dark-colored urine and
lighter-colored stools, nausea and vomiting, and pruritus (Samji, 2017).Please respond to
the above 2 responses with atleast 2 APA references