91685184 case-study-age

HOLY ANGEL UNIVERSITY
COLLEGE OF NURSING
ANGELES CITY
A Case Study of a patient with
ACUTE GASTROENTERITIS (AGE)
In partial fulfillment of the course requirements in NCM RLE
Prepared by:
Group 2-A
CON II-202
Asuncion, Mark Jason C.
Aquino, Romulo C.
Fernandez, Krista Manelle P.
Icban, Trixia Jennica Q.
Manalang, Ma.Filipinas M.
Pangilinan, Jacquelyn L.
Submitted to:
Ms. Doreen M. Dimalanta, RN
Clinical Instructor

I. INTRODUCTION
Gastroenteritis (also known as gastro, gastric flu, tummy bug in some countries, and
stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract,
involving both the stomach and the small intestine (see also gastritis and enteritis) and
resulting in acute diarrhea. The inflammation is caused most often by an infection from
certain viruses or less often by bacteria, their toxins, parasites, or an adverse reaction to
something in the diet or medication. Worldwide, inadequate treatment of gastroenteritis
kills 5 to 8 million people per year,[1]
and is a leading cause of death among infants and
children under 5.
At least 50% of cases of gastroenteritis due to foodborne illness are caused by
norovirus..Another 20% of cases, and the majority of severe cases in children, are due to
rotavirus. Other significant viral agents include adenovirus and astrovirus.
According to the website Science Daily (May 11, 2009) — Zinc supplementation can
be ineffective in the treatment of diarrhea. A randomized controlled trial published in the
open access journal BMC Medicine has shown that supplementation with either zinc or
zinc and copper is no more effective than placebo.
Archana Patel, from the Lata Medical Research Foundation, India, led a team of
researchers who studied the effects of the different supplements on a group of 808
children in Nagpur, also in India. She said, "The expected beneficial effects of zinc
supplementation for acute diarrhea were not observed. Therapeutic zinc or zinc and
copper supplementation may not have a universal beneficial impact on the duration of
acute diarrhea in children".
The authors found that neither duration of diarrhea, total stool weight, use of oral
rehydration salts nor use of intravenous fluids were affected by supplementation. The
authors said, "There could be many reasons for the lack of effect observed in our study.
Although our study controlled for baseline serum zinc concentrations, these are not
always a reliable measure of body zinc status. As such, baseline zinc deficiency in our
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subjects may have affected our results. Different diarrhea etiologies and the impact of
interactions of zinc with multi-vitamins shown in previous studies may also explain the
difference between our study and others that have shown a positive effect."
The authors have called for a re-examination of all available trial data, including this
one, to dissect out the potential contributors to heterogeneity of results before zinc can be
universally recommended for treatment of acute childhood diarrhea. Caring for a patient
is our primary goal as health care providers and as far as nursing management is concern.
The case was chosen because we all know that acute gastroenteritis is a very common
disease but we still forget to put in mind that if this will not be treated promptly it will
eventually lead to complications like hypovolemic shock and death. Though it is simple,
we still forget some things regarding this disease and thru this, we are able to freshen our
minds regarding the disease condition. Another reason is that AGE is a very common
disease nowadays and one way of preventing it, is to know what are the causative factors
responsible in acquiring such. In opting such case, this can help us to be skillful in
providing health teachings about what should be done and avoided as to prevent
acquiring such diseases. And also for those people who by now are at risk, it is better to
be informed early in order to alleviate the risk of acquiring such. This case can also be
helpful for hospital nurses to do the proper intervention if they have encountered patient
with the same ailment and to provide the necessary health teachings.
OBJECTIVE:
After 2 days of nurse-patient interaction, student nurses shall have:
• Render services of nursing interventions for the client’s care.
• Provide and disseminate important information as teachings to the client and the
significant others to boost the knowing and understanding of the nature of the said health
condition.
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II. NURSING HISTORY
A. Demographic/ Personal Data
Gastroboy, son of Mommy Gastro and Daddy Gastro, is a 27-month old male,
Roman Catholic and currently living in a certain barangay in San Fernando, Pampanga.
He was born on August 3, 2007 in Bulaon via caesarian section and is a full-blooded
Filipino. He is the youngest among 3 siblings.
Their housing structure is made up of light wood and concrete and is in fair
condition as verbalized by Mommy Gastro. The house has two rooms and their source of
water (including drinking water) is through nawasa. They get their food from the market
or nearby store and their method of excreta disposal is through pour flush or pail system.
In terms of health seeking behaviors, they would rather prefer going first to herbolarios
then to public doctors, or in hospitals due to their socio-economic status.
He was admitted in a secondary hospital in San Fernando on November 19, 2009
at 9:25 p.m. with the chief complaint of LBM and vomiting. He was confined for 2 days
and was discharged on November 21, 2009. The information that was provided regarding
Gastroboy’s personal history was provided by Mommy Gastro.
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B. SOCIO-ECONOMIC AND CULTURAL FACTORS
Daddy Gastro is a construction worker for 3 years already; he works 5 days a week and
earns 250php/ day. On the other hand, Mommy Gastro is a housewife and takes care of her
children and husband. The head of the family earns enough for their food allowances and some
other important expenses
Both parents are high school graduates. The eldest son is currently a fourth year
high school student while the second child is on his second year. Gastroboy is not yet attending
school.
Gastroboy is a Roman Catholic but Mommy Gastro verbalized that they are not a devout
Catholic. They seldom go to the mass every Sunday but they still never forget to pray.
Her mother verbalized that Gastroboy is fond of eating junk foods/chips and
softdrinks.
Their housing structure is made up of light wood and concrete and is in fair
condition as verbalized by Mommy Gastro. The house has two rooms and their source of water
(including drinking water) is through nawasa. They get their food from the market or nearby
store and their method of excreta disposal is through pour flush or pail system.
Mommy Gastro, as the decision maker in the family in terms of health, believes in
herbolarios and in superstitious beliefs like the concept of usog, nuno and the like. She
verbalized that in seeking health advice, she first consults in herbolarios and hilots then second to
it is the public hospital when someone in their family is sick.
The genogram on the last page shows the pertinent family history up to 3rd
degree
of relationship. Pictures were used to represent each member of the family .We can see that
Gastroboy’s relatives have no history of disease. Only his grandfathers on Mommy Gastro’s side
have a history of illness or disease. Mommy Gastro’s father has asthma; her siblings are free
from any disease condition. On the other hand, Daddy Gastro’s family members don’t have past
history of disease or illness
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3. HISTORY OF PAST ILLNESS
According to Mommy Gastro, Gastroboy also had chickenpox, measles and mumps
during his childhood years but she doesn’t remember anymore the age when her son had it and
the treatment done to resolve it. Other than that, he also experienced mild illnesses like cough &
colds, and fever. Mommy Gastro uses over the counter drugs to treat these illness like Tuseran or
Neozep for cough and colds, Paracetamol/ Bioflu for fever. Also, Mommy Gastro also uses non-
pharmacologic treatment in treating these illnesses like for cough and colds, she encourages
Gastroboy to increase his fluid intake and eat foods rich in Vitamin C like calamansi. She also
makes use Lagundi and boils it to make a concoction. He also has no known allergy to any food
or drug and there is no history of hospitalization.
4. HISTORY OF PRESENT ILLNESS
Two (2) days prior to admission, he experienced decrease in appetite, vomiting and
passage of loose watery stool. These continued until one (1) day prior to admission. Because of
this, Mommy Gastro decided to bring Gastroboy in the hospital for appropriate treatment. Hence,
admitted in a secondary hospital in on November 19, 2009 at 9:25p.m. with the chief complaint
of LBM and vomiting. He was confined for 2 days and was discharged on November 21, 2009.
III. PHYSICAL EXAMINATION
NOVEMBER 20, 2009 (INITIAL)
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GENERAL APPEARANCE
Gastroboy was seen wearing a white shirt, with diaper and received lying on bed. He
appears restless but he is cooperative when he was assessed by the student nurse.
Vital Signs: taken on NOVEMBER 20, 2009 (Friday)
Temperature: 36.5 ˚C / axilla
Respiratory Rate: 23 bpm
Heart Rate: 107 bpm
MENTAL STATUS:
• Appears weak and restless, conscious with slouchy posture and slow but coordinated
movement. He is lying on bed and is slightly irritable.
SKIN
INSPECTION
• Dark complexion
• Skin is dry
• Absence of lesions
PALPATION
• With poor skin turgor
• Absence of edema and nodules upon palpation
HEAD
INSPECTION
• Round
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PALPATION
• No lesions and nodules palpated
HAIR
INSPECTION
• Evenly distributed hair strands
• No sign of hair loss
• No dandruff or flakes seen
NAILS
INSPECTION
• With pale nail beds on the upper and lower extremities, smooth texture, convex curvature
• With long and dirty nails
• With capillary refill less than 2 seconds
SKULL AND FACE
INSPECTION
• No lesions noted upon inspection
PALPATION
• Scalp is smooth
EYES
INSPECTION
• Eyelashes and eyebrows are evenly distributed
• With sunken eyeballs
• Eyelashes slightly curled outward
• Pink palpebral conjunctiva
• Cornea is shiny and transparent
• Pupils are black in color, equal in size and converges when seeing near objects
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• Pupils are equally round and reactive to light and accommodation
• Sclerae are white in color
PALPATION
• No edema and no tenderness of the lacrimal sacs and nasolacrimal duct
EARS
INSPECTION
• Auricles are symmetrical in size and are in line with the outer canthus
• Pinna recoils after being folded
• With minimal presence of cerumen on both ears
NOSE
INSPECTION
• Both nostrils are patent
• No noted nasal discharges
• Nasal septum is in midline
MOUTH
INSPECTION
• Gums are pink in color and no noted sores or lesions upon inspection
• Presence of dental caries on lower and upper incisor
• Uvula is positioned in the midline of the soft palate
• Inner and outer lips are pale in color and dry
NECK
INSPECTION
• No distended jugular veins
• No masses noted
PALPATION
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• Carotid pulse palpated
• No pain upon swallowing
LUNGS/CHEST
INSPECTION
• Chest wall symmetrically expands and relaxes
• No deformities in chest noted
AUSCULTATION
• Absence of rales or crackles upon auscultation
• Normal respiratory rate and rhythm
HEART
AUSCULTATION
• Absence of murmurs and heaves
• Normal heart rate and heart beat
ABDOMEN
INSPECTION
• Uniform in color, not distended, symmetric contour
PERCUSSION
• Normal abdominal bowel sounds
PALPATION
• Soft and tender
EXTREMITIES
INSPECTION
• Extremities are symmetrical
PALPATION
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• Peripheral pulses are equal and non-palpable
DEVELOPMENTAL STAGE
• Cognitive development : pre operational stage
Gastroboy likes to talk to others even though he cannot speak straight. He tends to
repeat every syllable he said before finally saying the word. He can now speak having at least 3-
4 words per sentence. According to his mother, whenever Gastroboy plays, he did it with an
imaginary friend.
• Development Task: Autonomy vs. Shame & Doubt
During the assessment, we observed that whenever Gastroboy’s mother would attend
to his needs, he refuses. Instead he will do it on his own. Like for example, when his mother
is feeding him, he refuses to eat the food given by his mother. Instead he’ll get the spoon and
feed on his own. Whenever his mother tries to assist him, he refuses and get mad.
Another is, when someone tries to ask him, he always responds negatively. Let’s say
for instance, you asked him if he wants to eat, he’ll say “No”.
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IV. DIAGNOSTIC AND LABORATORY PROCEDURES
Diagnostic/
Laboratory
Procedure
Indication/Purposes Date
ordered/Date
released
Result Normal
Values
Analysis &
Interpretatio
n
Hemoglobin 
Measures
Gastroboy’s
amount of
hemoglobin
molecule in
volume of
blood
 This test is
important to
know
Gastroboy’s
oxygen
carrying
capacity of
the blood
DO:
November 19,
2009
DR:
November 20,
2009
121g/l
Normal
M – (140-
180g/L)
F – ( 120-
140g/L)
C – (110-
130g/L)
Gastroboy’s
hemoglobin
level is
within the
normal
range for
children.
This means
that the
Gatroboy
has no
anemia.
Thereby,
has good
oxygen
carrying
capacity in
the blood.
Hematocrit  Signifies
percentage of
Gastroboy’s
white blood
occupied by
red blood
cells
 Aids in
diagnosing if
Gastroboy
has an
abnormal
state of
hydration
DO:
November 19,
2009
DR:
November 20,
2009
0.39g/l
Normal
M – 0.42-0.52
F – 0.37-0.47
C - .34-.40
Gastroboy’s
hematocrit
level is
within the
normal
range for
children. It
indicates
that
Gastroboy
has no
anemia as
well as
abnormal
hydration.
Leukocytes
(WBC)
 Indicates
whether
Gastroboy
has a
presence of
bacterial
infection
DO:
November 19,
2009
DR:
November 20,
2009
4.2
thousand/
mm33
Decreased
5-10
thousand/mm33
Gastroboy’s
leukocytes
are
decreased. It
indicates
that
Gastroboy
has an
increased
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risk of
infection.
Lymphocyte
s
 To check
if Gastroboy
has a viral
infection
DO:
November 19,
2009
DR:
November 20,
2009
0.45
Increased
0.20-0.40 Gastroboy’s
lymphocytes
are
increased.
Thus, it
indicates
viral
infection.
Neutrophils  Indicates
whether
Gastroboy
has a
bacterial
infection
DO:
November 19,
2009
DR:
November 20,
2009
0.55
Normal
0.40-0.60 Gastroboy’s
neutrophil
level is
within
normal
range. This
indicates
that
Gastroboy
has no
bacterial
infection.
NURSING RESPONSIBILITIES
Hematology (CBC)
Before:
 Check the doctor’s order for CBC.
 Explain the test by using direct, simple language and avoid jargon.
 Tell the patient that fasting is not required.
 Explain that some brief discomfort may accompany the needle puncture or the
application of a tourniquet.
 Always observe standard precautions.
During:
 Do not take the blood sample from a hand or arm receiving IV fluid. The tourniquet
should be less than a minute.
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 Collect 5-7ml of venous blood in purple/violet cap.
 List on the laboratory slip any drugs that may affect test results.
After:
 After taking blood sample apply a pressure or a pressure dressing to the venipuncture site
for 2 minutes.
 If any hematoma develops at the venipuncture site, apply warm soaks.
 Label the sample.
 Document properly.
 Send the sample in the laboratory immediately.
V. PATIENT AND HIS ILLNESS
1. ANATOMY AND PHYSIOLOGY
The digestive system is made up of the digestive tract—a series of hollow organs joined
in a long, twisting tube from the mouth to the anus—and other organs that help the body break
down and absorb food.
Organs that make up the digestive tract are the mouth, esophagus, stomach, small
intestine, large intestine—also called the colon—rectum, and anus. Inside these hollow organs 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. The digestive tract also contains a layer of smooth
muscle that helps break down food and move it along the tract.
Two “solid” digestive organs, the liver and the pancreas, produce digestive juices that
reach the intestine through small tubes called ducts. The gallbladder stores the liver’s digestive
juices until they are needed in the intestine. Parts of the nervous and circulatory systems also
play major roles in the digestive system.
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WHY IS DIGESTION IMPORTANT?
When you eat foods—such as bread, meat, and vegetables—they are not in a form that
the body can use as nourishment. 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 the
body can use them to build and nourish cells and to provide energy.
HOW IS FOOD DIGESTED?
Digestion involves mixing food with digestive juices, moving it through the digestive
tract, and breaking down large molecules of food into smaller molecules. Digestion begins in the
mouth, when you chew and swallow, and is completed in the small intestine.
MOVEMENT OF FOOD THROUGH THE SYSTEM
The large, hollow organs of the digestive tract contain a layer of muscle that enables their
walls to move. The movement of organ walls can propel food and liquid through the system and
also can mix the contents within each organ. Food moves from one organ to the next through
muscle action called peristalsis. Peristalsis looks like an ocean wave traveling through the
muscle. The muscle of the organ contracts to create a narrowing and then propels the narrowed
portion slowly down the length of the organ. These waves of narrowing push the food and fluid
in front of them through each hollow organ.
The first major muscle movement occurs when food or liquid is swallowed. Although
you are able to start swallowing by choice, once the swallow begins, it becomes involuntary and
proceeds under the control of the nerves.
Swallowed food is pushed into the esophagus, which connects the throat above with the
stomach below. At the junction of the esophagus and stomach, there is a ringlike muscle, called
the lower esophageal sphincter, closing the passage between the two organs. As food approaches
the closed sphincter, the sphincter relaxes and allows the food to pass through to the stomach.
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The stomach has three mechanical tasks. First, it stores the swallowed food and liquid. To
do this, the muscle of the upper part of the stomach relaxes to accept large volumes of swallowed
material. The second job is to mix up the food, liquid, and digestive juice produced by the
stomach. The lower part of the stomach mixes these materials by its muscle action. The third task
of the stomach is to empty its contents slowly into the small intestine.
Several factors affect emptying of the stomach, including the kind of food and the degree
of muscle action of the emptying stomach and the small intestine. Carbohydrates, for example,
spend the least amount of time in the stomach, while protein stays in the stomach longer,
and fats the longest. As the food dissolves into the juices from the pancreas, liver, and intestine,
the contents of the intestine are mixed and pushed forward to allow further digestion.
Finally, the digested nutrients are absorbed through the intestinal walls and transported
throughout the body. The waste products of this process include undigested parts of the food,
known as fiber, and older cells that have been shed from the mucosa. These materials are pushed
into the colon, where they remain until the feces are expelled by a bowel movement.
PRODUCTION OF DIGESTIVE JUICES
The digestive glands that act first are in the mouth—the salivary glands. Saliva produced
by these glands contains an enzyme that begins to digest the starch from food into smaller
molecules. An enzyme is a substance that speeds up chemical reactions in the body.
The next set of digestive glands is in the stomach lining. They produce stomach acid and
an enzyme that digests protein. A thick mucus layer coats the mucosa and helps keep the acidic
digestive juice from dissolving the tissue of the stomach itself. In most people, the stomach
mucosa is able to resist the juice, although food and other tissues of the body cannot.
After the stomach empties the food and juice mixture into the small intestine, the juices
of two other digestive organs mix with the food. One of these organs, the pancreas, produces a
juice that contains a wide array of enzymes to break down the carbohydrate, fat, and protein in
food. Other enzymes that are active in the process come from glands in the wall of the intestine.
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The second organ, the liver, produces yet another digestive juice—bile. Bile is stored
between meals in the gallbladder. At mealtime, it is squeezed out of the gallbladder, through the
bile ducts, and into the intestine to mix with the fat in food. The bile acids dissolve fat into the
watery contents of the intestine, much like detergents that dissolve grease from a frying pan.
After fat is dissolved, it is digested by enzymes from the pancreas and the lining of the intestine.
ABSORPTION AND TRANSPORT OF NUTRIENTS
Most digested molecules of food, as well as water and minerals, are absorbed through the
small intestine. The mucosa of the small intestine contains many folds that are covered with tiny
fingerlike projections called villi. In turn, the villi are covered with microscopic projections
called microvilli.These structures create a vast surface area through which nutrients can be
absorbed. Specialized cells allow absorbed materials to cross the mucosa into the blood, where
they are carried off in the bloodstream to other parts of the body for storage or further chemical
change. This part of the process varies with different types of nutrients.
Carbohydrates. The Dietary Guidelines for Americans 2005 recommend that 45 to 65 percent
of total daily calories be from carbohydrates. Foods rich in carbohydrates include bread,
potatoes, dried peas and beans, rice, pasta, fruits, and vegetables. Many of these foods contain
both starch and fiber.
The digestible carbohydrates—starch and sugar—are broken into simpler molecules by
enzymes in the saliva, in juice produced by the pancreas, and in the lining of the small intestine.
Starch is digested in two steps. First, an enzyme in the saliva and pancreatic juice breaks the
starch into molecules called maltose. Then an enzyme in the lining of the small intestine splits
the maltose into glucose molecules that can be absorbed into the blood. Glucose is carried
through the bloodstream to the liver, where it is stored or used to provide energy for the work of
the body.
Sugars are digested in one step. An enzyme in the lining of the small intestine digests
sucrose, also known as table sugar, into glucose and fructose, which are absorbed through the
intestine into the blood. Milk contains another type of sugar, lactose, which is changed into
absorbable molecules by another enzyme in the intestinal lining.
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Fiber is indigestible and moves through the digestive tract without being broken down by
enzymes. Many foods contain both soluble and insoluble fiber. Soluble fiber dissolves easily in
water and takes on a soft, gel-like texture in the intestines. Insoluble fiber, on the other hand,
passes essentially unchanged through the intestines.
Protein. Foods such as meat, eggs, and beans consist of giant molecules of protein that must be
digested by enzymes before they can be used to build and repair body tissues. An enzyme in the
juice of the stomach starts the digestion of swallowed protein. Then in the small intestine, several
enzymes from the pancreatic juice and the lining of the intestine complete the breakdown of
huge protein molecules into small molecules called amino acids. These small molecules can be
absorbed through the small intestine into the blood and then be carried to all parts of the body to
build the walls and other parts of cells.
Fats. Fat molecules are a rich source of energy for the body. The first step in digestion of a fat
such as butter is to dissolve it into the watery content of the intestine. The bile acids produced by
the liver dissolve fat into tiny droplets and allow pancreatic and intestinal enzymes to break the
large fat molecules into smaller ones. Some of these small molecules are fatty acids and
cholesterol. The bile acids combine with the fatty acids and cholesterol and help these molecules
move into the cells of the mucosa. In these cells the small molecules are formed back into large
ones, most of which pass into vessels called lymphatic near the intestine. These small vessels
carry the reformed fat to the veins of the chest, and the blood carries the fat to storage depots in
different parts of the body.
Vitamins. Another vital part of food that is absorbed through the small intestine are vitamins.
The two types of vitamins are classified by the fluid in which they can be dissolved: water-
soluble vitamins (all the B vitamins and vitamin C) and fat-soluble vitamins (vitamins A, D, E,
and K). Fat-soluble vitamins are stored in the liver and fatty tissue of the body, whereas water-
soluble vitamins are not easily stored and excess amounts are flushed out in the urine.
Water and salt. Most of the material absorbed through the small intestine is water in which salt
is dissolved. The salt and water come from the food and liquid you swallow and the juices
secreted by the many digestive glands.
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HOW IS THE DIGESTIVE PROCESS CONTROLLED?
Hormone Regulators
The major hormones that control the functions of the digestive system are produced and
released by cells in the mucosa of the stomach and small intestine. These hormones are released
into the blood of the digestive tract, travel back to the heart and through the arteries, and return to
the digestive system where they stimulate digestive juices and cause organ movement.
The main hormones that control digestion are gastrin, secretin, and cholecystokinin (CCK):
• Gastrin causes the stomach to produce an acid for dissolving and digesting some foods.
Gastrin is also necessary for normal cell growth in the lining of the stomach, small
intestine, and colon.
• Secretin causes the pancreas to send out a digestive juice that is rich in bicarbonate. The
bicarbonate helps neutralize the acidic stomach contents as they enter the small intestine.
Secretin also stimulates the stomach to produce pepsin, an enzyme that digests protein,
and stimulates the liver to produce bile.
• CCK causes the pancreas to produce the enzymes of pancreatic juice, and causes the
gallbladder to empty. It also promotes normal cell growth of the pancreas.
Additional hormones in the digestive system regulate appetite:
• Ghrelin is produced in the stomach and upper intestine in the absence of food in the
digestive system and stimulates appetite.
• Peptide YY is produced in the digestive tract in response to a meal in the system and
inhibits appetite.
Both of these hormones work on the brain to help regulate the intake of food for energy.
Researchers are studying other hormones that may play a part in inhibiting appetite, including
glucagon-like peptide-1 (GPL-1), oxyntomodulin (+ ), and pancreatic polypeptide.
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Nerve Regulators
Two types of nerves help control the action of the digestive system.
Extrinsic, or outside, nerves come to the digestive organs from the brain or the spinal
cord. They release two chemicals, acetylcholine and adrenaline. Acetylcholine causes the muscle
layer of the digestive organs to squeeze with more force and increase the “push” of food and
juice through the digestive tract. It also causes the stomach and pancreas to produce more
digestive juice. Adrenaline has the opposite effect. It relaxes the muscle of the stomach and
intestine and decreases the flow of blood to these organs, slowing or stopping digestion.
The intrinsic, or inside, nerves make up a very dense network embedded in the walls of
the esophagus, stomach, small intestine, and colon. The intrinsic nerves are triggered to act when
the walls of the hollow organs are stretched by food. They release many different substances that
speed up or delay the movement of food and the production of juices by the digestive organs.
Together, nerves, hormones, the blood, and the organs of the digestive system conduct
the complex tasks of digesting and absorbing nutrients from the foods and liquids you consume
each day.
DEFINITION OF THE DISEASE
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.
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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 CAUSES
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 the
germs
Campylobacter - Undercooked meat, unpasteurized milk
Shigella - Dysentery
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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 was attributed to 9 out of the 21 outbreaks of acute gastroenteritis on cruise
ships reported to the CDC’s Vessel Sanitation Program from January 1, 2002, to
December 2, 2002.
Noroviruses cause about 23 million cases of acute gastroenteritis each year and are the
leading cause of outbreaks.
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.
23

Medications like:
>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
GASTROENTERITIS SYMPTOMS
Gastroenteritis may affect both the stomach and the intestines, resulting in one or more of the
following symptoms:
Common symptoms
Low grade fever (99°F)
Nausea with or without vomiting
Mild-to-moderate diarrhea: May range from 2-4 loose stools per day for adolescents and adults
to stools that run out of the diaper in infants.
24

Crampy painful bloating
Vomiting: May or may not accompany diarrhea. If you do vomit, your dehydration rate will
increase. Either together or alone, diarrhea and vomiting result not only in loss of significant
amounts of fluid, leading to dehydration and possibly shock, but also loss of potassium, sodium,
and bicarbonate.
More serious symptoms
Blood in vomit or stool
Vomiting more than 48 hours
Fever higher than 101°F
Swollen abdomen or abdominal pain coming from the right lower side
Dehydration - Little to no urination, extreme thirst, lack of tears, and dry mouth (dry diapers in
infants)
EXAMS AND TESTS
Symptoms of diarrhea and vomiting often indicate gastroenteritis. Finding the cause is
another matter. If others around you have similar symptoms, you may be able to trace the illness
to a food source or foreign travel.
A doctor first will determine if your symptoms are acute (lasting less than 2 weeks) or
chronic (longer lasting).
A long-lasting illness suggests an inflammation or immune disorder, which should be
checked after infection, has been ruled out.
Sudden onset of illness may indicate changes in diet or medication. Rapidly developing
fever, abdominal pain, bloody stool and presence of white blood cells (leukocytes) may mean an
inflammation or diarrhea caused by bacteria. Watery stools without blood or leukocytes are more
typical of viral- or toxin-induced diarrhea.
You will be asked if other family or friends have similar exposure or symptoms. The
doctor will want to know about the duration, frequency, and description of your bowel
movements and whether you are vomiting. You will be asked how often and the amount you are
25

urinating to help the doctor determine if your fluid loss is causing dehydration. Have you lost
any weight?
You will be given a physical exam to find any specific or localized tenderness in your
abdomen. The doctor will want to determine if you have appendicitis, inflammation of the
gallbladder or pancreas, or other noninfectious gastrointestinal disease. The doctor also will feel
your abdomen for masses and possibly your rectum.
The doctor may perform other lab tests, checking your electrolytes, blood, and stool. The
doctor may examine a stool sample for blood, mucus, or abnormal odor. The sample may be
inspected under a microscopic to look for parasites and their eggs.
The doctor also will take your medical history including the following:
Travel history: Travel (especially to Mexico) may suggest E coli bacteria or other
Salmonella in 12-72 hours
Medications: If you have used broad-spectrum or multiple antibiotics recently, you may
have antibiotic-associated irritation.
GASTROENTERITIS TREATMENT
From the history of your gastroenteritis and the physical exam, the doctor will assess how
dehydrated you are. Self-care at home by drinking fluids may help relieve your symptoms and
avoid dehydration.
Self-Care at Home
The mainstay of home treatment of gastroenteritis is to drink fluids. Fluid intake helps
correct electrolyte imbalance, which may stop vomiting.
Dehydration in children: Children should be given oral rehydration solutions such as
Pedialyte, Rehydrate, Resol, and Rice-Lyte.
26

Cola, tea, fruit juice, and sports drinks will not correctly replace fluid or electrolytes lost
from diarrhea or vomiting. Nor will plain water. The intestines irritated by gastroenteritis do not
absorb plain water as well. In addition, plain water will not replace electrolytes and may dilute
electrolytes to the point of seizures.
After each loose stool, children younger than 2 years should be given 1-3 ounces of any
of the rehydration solutions. Older children should be asked to drink 3-8 ounces. Adults should
drink as much as possible.
This guideline serves only to replace fluid loss due to diarrhea. Drink additional fluid
equal to the amount you normally drink.
In underdeveloped nations or regions without available commercial pediatric drinks, the
World Health Organization has established a field recipe for fluid rehydration: Mix 2
tablespoons of sugar (or honey) with ¼ teaspoon of table salt and ¼ teaspoon of baking soda.
(Baking soda may be substituted with ¼ teaspoon of table salt.) Mix in 1 liter (1 qt) of clean or
previously boiled water.
You will need solid foods eventually to help end the diarrhea. After 24 hours, begin to
offer bland foods with the BRAT diet—bananas, rice, applesauce without sugar, toast, pasta, or
potatoes.
Next Steps
Diarrhea is one of the leading causes of infant sickness. Worldwide, diarrhea accounts for
3-5 million deaths for all age groups. In general, most adults and children recover after they are
appropriately rehydrated.
FOLLOW-UP
After an infection or irritation of the digestive tract, you may not be able to eat a regular
diet. Some people may be unable to tolerate dairy products for several weeks after the disease
has gone.
27

You should continue to advance slowly from bland nondairy soups and grain products to
a solid diet.
If your symptoms continue or worsen, call your doctor.
PREVENTION
With most infectious germs, the key is to block the spread of the organism.
Always wash your hands.
Eat properly prepared and stored food.
Bleach soiled laundry.
Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been developed.
But doctors base their use on your medical and foreign travel history.
For lactose intolerance, supplementary enzymes are available over-the-counter for
adolescents and adults to aid digestion of milk sugars. Soy formulas and other lactose-free
products are available from most grocery stores for formula-feeding infant.
28

A. Book Based Pathophysiology
Alters the apical membrane permeability of
mucosal cells
Unsanitary
Environment
Improper Hygiene Contact with other
people
Improper Food
Preparation
Contaminated food
and water
Age <5yrs. old
Developmental
Stage
Oral
Phase
Male
More Active
Lifestyle
Ingestion of Pathogens
Settles in the gastric and intestinal
mucosa
Enterotoxins are
released Digestive and
absorptive
malfunction
Forms pores in the cell membrane
Death of epithelial cells
Ulceration
Excessive gas
formation
Increase
peristaltic
movement
29

Fluid Deficit
Dry Oral Mucosa Dry Skin
Sunken Eyes
Diarrhea
PainBleeding
HematocheziaMelena
Hematemesis
Nausea and
Vomiting
Increase
peristaltic
movement
Secretion of fluid
and electrolyte
Increase secretion of Cl and
HCO3 ions in the bowel
30

B. Client Based Pathophysiology
Unsanitary
Environment
Improper Hygiene Contact with other
people
Improper Food
Preparation
Contaminated food
and water
Age <5yrs. old
Developmental
Stage
Oral
Phase
Male
More Active
Lifestyle
Ingestion of Pathogens
Settles in the gastric and intestinal
mucosa
Enterotoxins are
released
Alters the apical membrane permeability of
mucosal cells
Digestive and
absorptive
malfunction
Forms pores in the cell
Death of epithelial
Ulceration
Excessive gas
formation
Increase
peristaltic
movement
Nausea and Vomiting
(November 19, 2009)
31

Fluid Deficit
Dry Oral Mucosa
(November 20, 2009)
Dry Skin
(November 20, 2009)
Sunken Eyes
(November 20, 2009)
Diarrhea
(November 19, 2009)
Pain
(November 19 & 20, 2009)
Increase
peristaltic
movement
Secretion of fluid
and electrolyte
Increase secretion of Cl and
HCO3 ions in the bowel
32

I.) Synthesis of the disease
Rotavirus is a genus of double-stranded RNA virus in the family Reoviridae. It is the
leading single cause of severe diarrhea among infants and young children, and is one of several
viruses that cause infections commonly known as stomach flu, despite having no relation to
influenza. By the age of five, nearly every child in the world has been infected with rotavirus at
least once.
A. Definition of the disease
Acute Gastroenteritis (also known as gastro, gastric flu, tummy bug in some
countries, and stomach flu, although unrelated to influenza) is inflammation of the
gastrointestinal tract, involving both the stomach and the small intestine (see also gastritis
and enteritis) and resulting in acute diarrhea. The inflammation is caused most often by
an infection from certain viruses or less often by bacteria, their toxins, parasites, or an
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.
Risk factors include consumption of improperly prepared foods or contaminated
water and travel or residence in areas of poor sanitation. It is also common for river
swimmers to become infected during times of rain as a result of contaminated runoff
water.
B. Precipitating factors and Predisposing factors
Rotavirus that causes Acute GastroEnteritis can be transmitted through direct or
indirect contact. Factors that may cause Acute GastroEnteritis are:
a. Predisposing Factors/Modifiable Factors:
a. Contaminated food/water- the patient is 2 years old who is currently in
the Oral phase of growth and development. The virus may be
transmitted through fecal-oral route
b. Improper Hygiene- the patient cannot wash his hands by himself
c. Unsanitary Environment
b. Precipitating Factors/ Non-Modifiable Factors:
a. Age (2 years old)- children of 2 years are immunocompromised due to
underdeveloped immune system
C, Signs and Symtpoms with Rationale
a. Vomiting- penetration of the enterotoxin from the pathogen stimulates
the vomit receptors in the gastric mucosa
b. Diarrhea- the action of enterotoxins leads to increased chloride ion
permeability of the apical membrane of intestinal mucosal cells. Increased
chloride permeability leads to leakage into the lumen followed by sodium and
water movement..
33

c. Abdominal Cramps- enterotoxins are mostly pore forming toxins
(mostly chloride pores), secreted by bacteria, that assemble to form pores in
cell membranes. This causes the cells to die. The ulceration causes by the
death of epithelial cells in the gastric mucosa is minimized by the contraction
of the abdominal muscles. It is also to minimize bleeding if there is.
d. Dehydration- This is caused by the profuse leakage of fluids and
electrolytes in the body through vomiting and diarrhea
e. Sunken eyes, Poor skin turgor, Dry oral mucosa- caused by dehydration.
Decreased body fluid will mean insufficient supply of water that will
moisturize the mucus membrane and skin.
34

V. THE PATIENT AND HIS CARE
A. MEDICAL MANAGEMENT
a. INTRAVENOUS FLUIDS
MEDICAL
MANAGEMENT
TREATMENT
GENERAL
DESCRIPTION
INDICATION/S OR
PURPOSE/S
DATE ORDERED
DATE/S
PERFORMED,
DATE CHANGED
D/C
CLIENT’S RESPONSE
TO THE TREATMENT
Dextrose in 5
% 0.3 Sodium
Chloride
(30-
33µgtts/min)
(30-33
µgtts/min)
Hypertonic solution
w/c increases the
extra cellular fluid,
drawing water from
the cells that will
lead to swelling.
-To provide
Gastroboy
hydration and
electrolyte.
-To increase
Gastroboy’s ECF
volume and
decrease cellular
swelling.
DO: 11/19/09
DP: 11/19/09 -
11/20/09
DC: 11/20/09
- Gastroboy did not
experience
dehydration and pain
on the venipuncture
site.
- Medications are
efficiently
administered on this
route because of
rapid and effective
absorption of
medications.
A.1 NURSING RESPONSIBILITIES FOR IVF
Before:
a. Verify the doctor’s order.
b. Identify the client.
c. Explain the procedure to the SO to relieve anxiety and worry for the patient.
35

d. Obtain the necessary materials. Acquaint the SO and patient the requirements needed
for IVF infusion
e. Inform that she will be experiencing a discomfort on the venipuncture site for a few
seconds, but there should be no discomfort while the solution is flowing
f. Inform the client that the procedure takes only few minutes
g. Provide for client privacy, if appropriate
h. Open and prepare the infusion set
i. Prime the tubing
During:
a. Practice aseptic technique.
b. Select the venipuncture site; use the non-dominant arm, unless contraindicated.
c. Select a suitable vein for venipuncture. It should be relatively straight, not sclerotic or
tortuous, and avoid venous valves. The vein should be palpable, but may not be visible,
especially in clients with dark skin. Consider the catheter length; look for a site
sufficiently distal to the wrist or elbow tatter tip of the catheter will not be at a point of
flexion.
d. Dilate the vein. Apply the tourniquet firmly 15 t0 20 cm above the venipuncture site.
Note that use the tourniquet on only one client to avoid cross-contamination.
e. Tape the catheter once inserted
f. Check for the patency of the tubing.
g. Check if the IVF is infusing well.
After:
a. Adjust rate of flow of fluids appropriate to the needs of patient as prescribed.
b. Monitor IVF flow and patient’s response.
c. Monitor patient for evidence of local IV r/t complications such as pain, swelling and
tenderness.
d. Check for the presence of air in tubing. If there is, remove immediately.
e. Isotonic solution expands the intravascular compartment, monitor patients fluid overload.
f. Record all procedures done.
36

C. DIET
NURSING RESPONSIBILITIES:
Prior to:
 Check the doctor’s order.
 Check the right client.
 Be sure that the diet is properly instructed.
During:
 Monitor if the client complies with the given diet.
 Be sure patient is taking or eating food he can tolerate
After:
 Assess for patient’s condition; how he responds to the diet
 Document accordingly.
Type of
Diet
Date
Ordered
Date
Started
Date
Changed
General
Description
Indications/Purpose Specific
food taken
Client
Respone To
Therapy
DAT DO, DS,
DC:
11/21/09
Gastroboy can
eat anything
as long as he
can tolerate.
To restore needed
energy and nutrition
of the body.
Lugaw,
biscuits.
Gastroboy
was able to
eat and
tolerate the
food that he
wants.
37

D. ACTIVITY/EXERCISE
Type of Exercise General Description Indication/Purpose
Date ordered, date
started, date changed
or D/C
Clients’s response
and/or reaction to the
activity
Changing positions
(Flat on bed to side
lying position).
The position of the
client should be
changed every 2 hours
from flat on bed to side
lying position (lateral).
To promote venous
return and prevent
breakdown of skin over
a bony surface caused
by a prolonged lying on
the same position.
11/21/09 Gastroboy cooperated
with the exercise
advice.
NURSING RESPONSIBILITIES:
Before:
 Tell the patient or Significant others about the importance of the activity.
During:
 Assist the patient in turning side to side.
 Observe patient’s response to the activity.
After:
 Evaluate patient’s improvement after every change in position.
38

VI. NURSING CARE PLAN
IMPAIRED PHYSICAL MOBILITY
39

CUES
NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVE
NURSING
INTERVENTIONS
RATIONALE EVALUATION
S:’ayoko kong
gumalaw,masakit.’
O:
The patient
manifest:
· Limited ROM
· Slowed movement
· Weakness
· Difficulty in
performing
activities
Impaired
physical
mobility
related to pain
Limitation in
independent, purposeful
physical movement of the
body or of one or more
extremities Alteration in
mobility may be a
temporary or more
permanent problem. Most
disease and rehabilitative
states involve some
degree of immobility
(e.g., as seen in strokes,
leg fracture, trauma,
morbid obesity, and
multiple sclerosis). With
the longer life expectancy
for most Americans, the
incidence of disease and
disability continues to
grow. And with shorter
hospital stays, patients are
being transferred to
rehabilitation facilities or
sent home for physical
therapy in the home
environment. Mobility is
also related to body
changes from aging. Loss
of muscle mass, reduction
in muscle strength and
function, stiffer and less
mobile joints, and gait
changes affecting balance
can significantly
compromise the mobility
of elderly patients.
Mobility is paramount if
elderly patients are to
maintain any independent
living. Restricted
Short term:
After 5 hours of
nursing
interventions,
the client will
be able to
demonstrate
techniques or
behaviors that
enable
resumption of
activities.
Long term:
After 5 days of
nursing
interventions,
the client will
be able to
maintain or
increase
strength and
function of
affected and/or
compensatory
body part.
1. Assess for
impediments to
mobility.
2. Assess patient’s
ability to perform
ADLs effectively
and safely on a daily
basis.
3. Note emotional/
behavioral responses
to problems of
immobility.
4. Evaluate the
safety of the
immediate
environment.
5. Evaluate need for
assistive devices.
6. Turn and position
every 2 hours or as
needed.
Identifying the
specific cause
guides design of
optimal
treatment plan.
Restricted
movement
affects the
ability to
perform most
ADLs. Safety
with ambulation
is an important
concern.
Feelings of
frustration/
powerlessness
may impede
attainment of
goals.
Proper use of
wheelchairs,
canes, transfer
bars, and other
assistance can
promote activity
and reduce
danger of falls.
Obstacles can
further impede
one’s ability to
ambulate safely.
This optimizes
circulation to all
tissues and
relieves
Short term:
After 5 hours of
nursing
interventions, the
client shall have
demonstrated
techniques or
behaviors that
enable
resumption of
activities.
Long term:
After 2-3 days of
nursing
interventions, the
client shall have
maintained or
increased
strength and
function of
affected and/or
compensatory
body part.
40

FLUID VOLUME DEFICIT
CUES NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVES NURSING
INTERVENTIONS
S: “Nagsusuka at
nagtatae siya
kagabi.” As
verbalized by his
mother.
O:
Dry skin
Poor skin turgor
Patient’s eagerness
to drink
Capillary refill of
more than 2
seconds
Fluid volume
deficit R/T
vomiting and
diarrhea AEB
thirst
The electrolytes are out of
balance when there is a
fluid volume deficit. The
osmotic pressure is
reduced when there is a
decrease in the
extracellular fluid volume
because there is a decrease
in number of particles per
unit of water. As a
consequence fluid moves
from the extracellular
compartment into the cell.
After 4 hours
of NI, the pt‘s
SO will be able
to maintain pt’s
fluid volume at
a functional
level as
evidence by
good skin
turgor and
prompt
capillary refill
1. Instructed the
mother to provide
BRATT diet to her
son.
2. Instructed the
mother to increase
the fluid intake of
her son.
3. Reinforced
proper hand washing
of both the pt and
caretaker.
4. Emphasized the
importance of proper
food preparation and
handling.
5. Advised mother to
boil water
thoroughly for 10-15
minutes before
drinking.
To provide
proper nutrition.
To replace loss
fluid.
To reduce the
spread of germs
and viruses.
To reduce the
spread of germs
and viruses.
To kill the
microorganisms
that may be
present on the
water.
After 4 hours of
NI, the pt’s SO
was able to
maintain pt’s
fluid volume at a
functional level
as evidence by
good skin turgor
and prompt
capillary refill
41

CUES
NURSING
DIAGNOSIS
SCIENTIFIC
EXPLANATION
OBJECTIVE
NURSING
INTERVENTIONS
S: Ø
O:
The patient
may
manifest:
· Loss of
weight
· Pale
mucous
membrane
The patient
manifested:
· Afebrile
· Pale
conjunctiva
· Lack of
interest to
food
· Capillary
refill (< 3
seconds)
Risk for
Imbalanced
Nutrition:
Less than
body
requirements
r/t lack of
interest to
food
Adequate nutrition is
necessary to meet the
body’s demand.
Nutritional status can
be affected by the
presence of disease.
During times of illness,
adequate nutrition plays
an important role in
healing and recovery.
Usually sick patients
would have an altered
sense of taste and smell
which cause lack of
interest in eating thus
the patient could not
meet the metabolic
needs of the body
which makes her at risk
for imbalanced
nutrition.
Short term:
After 1-2 hours
of nursing
interventions,
the client’s SO
will be able to
verbalize
understanding
of the
importance of
individual
nutritional
needs and
necessary
interventions to
improve
nutrition.
Long term:
After 2-3 days
of nursing
interventions
the patient will
be able to
demonstrate
change in
behavior
towards eating.
1. Monitor and
record VS.
2. Assess patient’s
condition.
3. Advise SO to give
patient food s that are
appealing.
4. Encourage SO to
give nutritious foods
that reflect patient’s
like.
5. Encourage SO to
give foods in variety
and in moderation.
patients with
vitamins.
7. Advise SO to
encourage patient to
increase
carbohydrates,
protein and caloric
intake.
foods rich in Vitamin
C.
To obtain
baseline data.
To ascertain
status and note
progress of the
disease.
To stimulate
appetite.
This will
motivate the
patient to eat.
To decrease
boredom and
will also allow
patient to
choose foods
she likes.
It stimulates
appetite and
can also
provide
adequate
nutrients.
To sustain the
metabolic
needs of the
body and can
also help on
faster recovery
of the patient.
Short term:
After 1-2 hours of
nursing
interventions, the
client’s SO shall
have verbalized
understanding of
the importance of
individual
nutritional needs
and necessary
interventions to
improve nutrition
Long term:
After 2-3 days of
nursing
interventions the
patient shall have
demonstrated
change in
behavior towards
eating.
RISK FOR IMBALANCED NUTRITION
43

VII. DISCHARGE PLANNING
Topic: Teachings on the Prevention of Recurrence of the Disease
Time Allotment: 3 hours
Venue: Hospital (Pediatric Ward)
Objective Content Time
Allotment
Teaching
Strategies
After 3 hours of health
teachings, SO will verbalize
understanding and interests on
the interventions on how to
prevent the recurrence of the
disease.
• Instruct the SO to
prepare food properly such
as:
 Handwashing
before and after
 Thorough
cooking of handling of
food
 Washing of
fruits and vegetables
before cooking and eating
 Washing of
kitchen utensils before
and after cooking.
• Advice the SO to boil
water thoroughly, for 10-
15minutes before drinking.
• Demonstrate proper
hand washing before and
after meals and reinforce it to
the patient and care taker.
• Emphasized
importance of environmental
sanitation
• Emphasize proper
sewage disposal
1 hour
30
minutes
30
minutes
30
minutes
30
minutes
One on one
interaction
Poster
One on one
interaction
Return
Demonstration
One on one
interaction
Brochure
One on one
interaction
Visual Aids
Poster
45

VII. LEARNING DERIVED
Emphasizing a healthy lifestyle with appropriate health maintenance is also important in
achieving a fruitful life especially nowadays, we all live in a world where there are a lot of things
surround us and are in an instant. With these, we resort to them and end up having a lifestyle that
is sedentary and is different from what we should practice resulting to different diseases.
For us student nurses, we gained knowledge about its occurrence, how to deal with such
condition and, as future nurses, we will handle patients with this kind of diseases, we would
know the nursing responsibilities that should be implemented. As student nurses, it is important
for us to be equipped with knowledge, skills, and attitude. With these, we would be a competent
nurse and this would serve as a preparation for us in handling all kinds of patients. Since it is not
only the patient who we are going to deal with but also the patient’s significant others as well. In
dealing with them, it is very important to use therapeutic communication to have a harmonious
working relationship with both the patient and the SO.
With the proper knowledge about the disease, we could explain to them about the possible
factors or reason why or how the patient got the disease. We may also tell them about how it can
be treated but of course, only a professional knows accurately on how the patient would be
treated. But being the patient’s advocate, our job would then be to advice them what’s best for
the patient and to protect whatever right they have.
As nursing students, this study somehow made us realize the importance of imposing a
good hygiene and food handling because AGE may lead to a more serious condition if it is not
properly managed or treated. Prompt recognition, which allows for early treatment of AGE, is
recommended to avoid complications
X. REFERENCES
46

Bloodbook.com/ranges
Medicinenet.com/hemoglobin
Medfriendly.com/hematocrit.html
Labtestonline.org/understanding/analytes/hematocrit/test.html
Answers.yahoo.com/questions/index?qid=20080921120840AAa61B
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